CEO of Health Care Software Company Sentenced for $1B Fraud Conspiracy

118 pointsposted 13 hours ago
by healsdata

86 Comments

exabrial

11 hours ago

> An Arizona man was sentenced Friday to 15 years in prison and ordered to pay more than $452 million in restitution for conspiring to defraud Medicare and other federal health care benefit programs of more than $1 billion by operating a platform that generated false doctors’ orders used to support fraudulent claims for various medical items.

I wish all headlines read like this instead of "here's why you should be scared"

lixtra

11 hours ago

As you would expect from a state press release, not a tabloid publication.

burkesquires

10 hours ago

I think fraudsters should have to work off the money they stole at prison wages…punishments are supposed to be deterent and prevent people from commingting crime…don’t seal a billion dollars becasue IF you get caught you will have to pay back half is not a deterent…BUT if they have to pay off a billion dollars at 13-52 cents/hour…that is a deterent!

UqWBcuFx6NV4r

9 hours ago

That sounds like something you’d read in a Facebook comment. This is government-sanctioned slavery, and I strongly doubt that it would serve as a deterrent. People routinely put much more on the line for much less.

mr_toad

7 hours ago

There’s a lot of research of people for whom punishment obviously didn’t act as a deterrent, and unsurprisingly this research concludes that the prospect of punishment doesn’t act as a deterrent.

There is no research I’m aware of on people for whom the prospect of punishment did act as a deterrent (i.e. people who decided not to commit the crime).

So I argue that there is a very big selection bias in literature surrounding the effectiveness of punishment as a deterrent .

f1shy

7 hours ago

AFAIK, this is a (dangerous and misleading) simplification.

Punishment absolutely works as deterrent. Boy I know people that would absolutely forge the tax declaration, if it wasn't a terrible fine if they do!

The key point is the probability of the punishment being enforced. There is a trade off calculation going on, like "I could get 5 years prison and 10 grand fine... IF they catch me!". Studies suggest, that if you have 100% probability of being caught, then the punishment is extremely good deterrent.

Closi

2 hours ago

> There is no research I’m aware of on people for whom the prospect of punishment did act as a deterrent (i.e. people who decided not to commit the crime).

Surely this can’t be true - as a trivial example I would be surprised if removing parking fines wouldn’t increase parking violations, or if Singapore stopped punishing littering that it wouldn’t affect the amount of littering etc

Maybe the difference between a 10 year or 20 year sentence for murder doesn’t make much difference, but if murder had no punishment at all I would be very surprised if that wouldn’t raise the murder rate!

Throaway198712

an hour ago

What he's trying to say is that most people crimes under the assumption that they won't get caught, not that, if they get caught, they can withstand the punishment.

btreecat

2 hours ago

Unfortunately government sanctioned slavery does still exist in the US prison system.

yunohn

3 hours ago

Ah then I trust you are completely aware that federal prisons already make prisoners work for their keep, and the privatization of prisons and their lobbying has led to a vicious cycle of imprisonment for cheap prison slave labor?

Of course, those prisoners aren’t billionaire healthcare CEOs, so maybe not…

beAbU

7 hours ago

The US constitution explicitly allows for this (prisoner slavery) so there's that

stavros

5 hours ago

Imagine "someone two hundred years ago said it was OK" being valid ethical justification.

philwelch

11 minutes ago

Criminals need to be isolated from peaceful society anyway, and if we’re going to the expense of warehousing them, the least we can expect is for them to contribute something back. The ethical justification for prison labor is obvious and the analogy to heritable chattel slavery is ludicrous.

bdangubic

an hour ago

ethical - no. legal - yes.

janalsncm

9 hours ago

At that rate you can pay back maybe $1000 per year, so if you’re only going to live 30 more years there’s no difference in punishment between 30k in fraud and a billion dollars in fraud. Punishment is the same, so might as well scam more.

matwood

7 hours ago

The movie Heat addresses this scenario in the opening scene. A guard is shot 'accidentally' during a robbery even though they didn't intend to kill anyone. At that point they killed all the guards because 1 guard or 3 guards, it had become a capital murder crime so might as well not leave any witnesses.

f1shy

7 hours ago

That is the problem with draconian law. Because it saturates to death penalty pretty fast, any crime escalates pretty quick.

f1shy

7 hours ago

They should absolutely pay the money back. But why prison wages? Let they produce what they can, and pay back, with interest and all you want. I think it is more important that they are able to "undo" the damage, as to make they suffer.

ndsipa_pomu

an hour ago

The problem is that fraudsters won't be "producing", but instead will be stealing from others. They need to be in prison not because it's a punishment but because they cannot be trusted to participate in society honestly.

However, I don't think it's practical to get fraudsters to pay back all the money in most cases as they won't be able to. What we need is a faster way to detect and imprison fraudsters to limit the damage they do. Also, most people don't respond to the "size" of punishments, but more to the likelihood that they will be caught.

inamberclad

10 hours ago

I'd like to see a prison sentence for corporations.

x3n0ph3n3

10 hours ago

I'd like to see the death penalty (dissolution) for them.

llmslave2

9 hours ago

How would that work. Would the employees be banned from working together again or something?

saghm

9 hours ago

The corporation would be terminated, all of its copyrights and trademarks would be nullified, and the assets seized. If investors want to try to spend their money on building the exact same thing again under a different name after those losses, that's their perogatice. I suspect that after a few of these occurrences they might start to get cagey about whether they want to give money to someone who's had this happen before though.

KellyCriterion

8 hours ago

...regarding their trademarks & IP, I suggest that all of these are moved over to either Public Domain or the government should try to make much money as possible from selling the IP to someone else?

SpicyLemonZest

8 hours ago

The process you're describing is hardly unheard of. The problem is that a large corporation's assets include things like employees, office buildings, supplier contracts, etc, which generally aren't valuable except in the context of the business unit they operate within. So if you want to maximize recovery, you have to keep critical business units intact, which often means that large parts of the business survive in all but name.

Purdue Pharma is a recent instructive case. The marketing folks did some terrible stuff, but it would be pretty rough on victims, employees, and patients who need pain meds to respond by tearing down Purdue's factories and auctioning off the contents. So the bankruptcy plan calls for keeping the factories running, transferring them to a new company called Knoa, which will be owned by a trust that's dedicated to managing the opioid crisis. Isn't Knoa just Purdue wearing a new hat? Kinda, sure, but there's no better alternative.

kelseyfrog

8 hours ago

What if you don't want to maximize recovery?

bryan_w

8 hours ago

Do you genuinely just not like businesses?

nrb

6 hours ago

Surely there’s some wiggle room in between “I just do not like businesses” and “businesses that are convicted of causing some amount of damage to society should not exist”

At some point, recovery needs to take a back seat to deterrence.

ssl-3

8 hours ago

Well that would be terrible! People all over would be furious!

(As, perhaps, they should be.)

SpicyLemonZest

8 hours ago

Again, it's pretty rough on the victims to tell them we won't bother trying to get the money they're owed. Sometimes you have no choice; I would be shocked if the healthcare company mentioned in the source link were still operating, since it doesn't sound like it was actually doing much beyond the Medicare fraud. But when you do have a choice, what does anyone have to gain from blowing it up?

kelseyfrog

8 hours ago

Punitive punishment serves as a deterrent to other businesses.

I really dislike the black or white thinking of, "if we're not maximizing recovery then victims will get nothing."

llmslave2

6 hours ago

> Punitive punishment serves as a deterrent to other businesses.

You mean the owners and management and employees? Because a "business" in the way it's being suggested isn't a human with emotions or feelings, you can't "deter" a legal construct...

mschuster91

7 hours ago

> So if you want to maximize recovery, you have to keep critical business units intact, which often means that large parts of the business survive in all but name.

Easy solution: fire (and imprison) the executives, sell off the entire company, leave the owners/investors with nothing.

That sets a proper incentive for shareholders to not send yes-men or people with a dozen or more other well-paid low-effort board memberships into corporate boards but people actually willing and capable of controlling the executive.

bsder

8 hours ago

All investors are wiped. Anyone on board of directors is gone. Anyone in main executive management (CEO, CFO, CTO, etc.) is fired and replaced. All assets placed into immediate Chapter 11 (restructuring) bankruptcy.

llmslave2

7 hours ago

Keep in mind all investors would include the average joe's who are investing their retirement savings as well. You think they should just have those wiped out, despite there being no fault of their own?

nubg

7 hours ago

Yes as for the average Joe it's 0.001% of his ETF getting nuked.

cyberpunk

7 hours ago

Make those who are convicted personally liable to repay investors?

bsder

6 hours ago

Absolutely.

It used to be that "company reputation" was part of the value of a stock certificate. That disappeared and the primary value of CEO became being a sufficiently raging asshole to pump the value of the lottery ticket at all costs.

Bringing back a bit of risk to investors would help put some pushback into the system.

tobr

8 hours ago

Ok, so they have to. Or else what? Back of the envelope, it would take somewhere between 200k and 1 million years of 24/7 work to pay it back at that rate.

free_bip

10 hours ago

I wouldn't want to see that. That's called slavery!

And no, the severity of the crime does not (IMHO) justify it.

hasperdi

9 hours ago

Slavery as punishment is actually allowed by the constitution...

AMENDMENT XIII

Section 1. Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.

https://www.archives.gov/milestone-documents/13th-amendment

stavros

5 hours ago

That doesn't mean it's right, it means the constitution is wrong!

The constitution isn't a holy book, it's some opinions someone wrote down on paper. Some of them might be wrong.

user_7832

8 hours ago

Just because it's legal doesn't mean it's ethical or moral, and there are enough examples of things in such categories.

cyberpunk

7 hours ago

Not just permitted, but actually widespread. If you’re imprisoned in Texas, Georgia, Arkansas, Alabama, and Mississippi, you are going to be doing unpaid forced labor which is slavery, and many of the prisons are privately owned.

Federal prisons pay roughly $0.12 to $0.40 per hour for regular jobs, which isn’t much better.

The hypocrisy of the US is breathtaking sometimes, and the current administration has the gall to criticise europe.

empiko

9 hours ago

Just to play devil's advocate, you're okay with forcing a criminal to sit in a room for the rest of their life, but you're not okay if they also have to work for society during that timeframe. What is the main argument why the first case is okay and the second is not.

devsda

9 hours ago

Because it creates perverse incentive for government to put more people in prison.

Right now the punishment is confinement. When you add effectively unpaid labour in prison as part of acceptable punishment, you're also paving the way for a future where unpaid labor as a standalone punishment is also acceptable. That's just slavery by law.

blobbers

8 hours ago

Outside in society, I have to work to pay my rent, to pay for my food.

Inside a prison, should they not have a similar responsibility? They commit a crime and as such are held in stasis? Should they not at least carry the burden of themselves

devsda

7 hours ago

Its a fair point but its probably not practical.

I don't think there's enough jobs in prisons that need physical labour where they can cover the costs. You would then have to train them in useful skills but incompetence is not a crime so you cannot penalize those who "cannot learn/do" skilled work.

Other alternative is to make them work the same job they did outside but that is a slippery slope with lot of potential for abuse.

navigate8310

7 hours ago

Apologies for my ignorance, exactly what kind of jobs do prisoners work inside that benefit the society outside?

serf

an hour ago

the US has had lots of programs where labor can effectively be bought or contracted from prisoner sites by private companies.

I know of prison ran machine shops that were doing die-casting and tool production. I also heard of one (didn't see) that was doing basket weaving for a floral/arrangement company.

these are shallow 'social benefits'; but the companies were privately owned.

I guess the classic example is license plate pressing.. I guess that's a social good? I don't know if it goes on at all anymore.

ndriscoll

an hour ago

Why do they have to stay inside? Have a chain gang trim overgrown weeds along roads, fill in potholes, clean leaves, clean and repair sidewalks, plant shrubs, etc.

hvb2

9 hours ago

> Because it creates perverse incentive for government to put more people in prison.

Except for some rare cases, I think you'll find that the cost of keeping an inmate in prison for a day makes it that you never break even

thelock85

8 hours ago

Or the taxpayers foot the bill for keeping the inmate in prison while private interests (including but not limited to private prisons and select contractors) take additional profit off the unpaid labor instead of passing savings to the consumer

reed1234

8 hours ago

Breaking even is more attractive than debt for a cash-strapped city

empiko

8 hours ago

So if we could set it up in a way where there is no slippery slope, you would be okay with it?

tyre

8 hours ago

Not really a perverse incentive. The government isn’t making any money here. They’re paying someone from their own pocket only to take it away again?

At that point it really is just slavery, which they can already do as protected in the US Constitution.

(I’m not arguing for this. I agree with restitution and believe that sentences longer than a certain point are also pointless and a net negative to society.)

devsda

7 hours ago

> The government isn’t making any money here.

Hypothetically let's say govt is allowed to use unpaid labour outside menial tasks and the prison system is setup in a way to efficiently utilize the skills of their labour pool and is allowed to outsource their skills to private entities at attractive rate for covering prison costs (i.e. more money left for govt spending)

E.g. tradesmen employed on their related jobs. A programmer employed in software jobs or a technician "loaned" to a nearby lab etc.

Don't you think the local/state governments will then have incentive to fill their pool with "missing" talent according to the job requirements.

vincnetas

9 hours ago

thats why for some prison systems main goal is not punishment but rehabilitation. i think this is scandinavian approach.

"The stated goal of the Swedish prison system is to create a safer society by reducing recidivism and rehabilitating offenders rather than focusing solely on punishment. This is achieved through humane treatment, education, and reintegration programs designed to prepare prisoners for life after release."

llmslave2

9 hours ago

Probably for the same reason that it's generally seen as less intrusive to prevent someone from doing something, compared to forcing them to do something.

thayne

8 hours ago

That might, maybe, make it more effective as a deterrent, and possibly as retribution, but it would be less effective for restitution (since it would take much longer for those defrauded to get paid back).

donmcronald

8 hours ago

Seize the generational wealth they accumulated. Make their parents, siblings, kids, grandkids, cousins, etc. demonstrate how they earned their money and take every penny they can’t link to honest means.

The discussion around billionaires needs to move away from taxing their income and beyond taxing their wealth. We need to start talking about how much of their wealth we should be taking away. Light it on fire or delete it. The whole world will be better off.

frinxor

10 hours ago

Seeing a lot of these pop up more recently, but this has been happening for a decade now apparently. Isn't this the fault of Medicare itself, of not having routine checks and better processes for preventing these fraudulent claims at the source?

If only the big scams are being caught (and we don't know what % are being caught), there's likely a lot more going undetected.

xnx

9 hours ago

Is Trump going to pardon this guy like he did Salomon Melgen, who was convicted in 2017 of defrauding Medicare out of $73 million?

vdupras

2 hours ago

He could pardon Mangione as well and that would make his karma even. Even Steven, just about square.

stock_toaster

8 hours ago

Exactly what I was wondering. I guess it depends on how much he does or doesn’t “donate”.

e40

an hour ago

This is actually the answer.

1. Arrest and convict scammer

2. Scammer pays bribe from ill gotten gains

3. POTUS profits and scammer let out of jail

vdupras

an hour ago

Because it has landed on Netflix recently, I've rewatched Gangs of New York. The process where that corrupt cop is skimming off the top is eerily similar to what's happening now. Down to the part where the police officer claims that his watch is safe ("I could murder someone in the streets and nothing could happen to me!")

keernan

10 hours ago

Why does he only have to repay 45%?

wredcoll

10 hours ago

Article says medicaid only paid 300ish million on the claims.

burnt-resistor

3 hours ago

So token enforcement despite widespread corruption, collusion, racketeering, and rapacious bankrupting of ill, dying, and dead patients and their families in-lieu of a functional healthcare system that isn't obsessed with maximizing shareholder value over lives. It's literally the most expensive deathcare the market will bear.

AndrewKemendo

11 hours ago

I mean that’s pretty unabashed good news. I’m probably the most cynical person that comments regularly and I’ll take it!

It’s something at least.

Cipater

11 hours ago

You're nowhere near the most cynical peron here if your first thought wasn't "how long till he gets pardoned"?

atmavatar

10 hours ago

My first thought was that the guy was required to pay back less than half of what was stolen.

From there, of course, it's a short hop to "he has more than enough money left over to purchase himself a pardon."

Nevermark

10 hours ago

Well if he wasn't already contributing some percentage to the "right" people ahead of time, and saying the "right" things ("autism, something, something, vaccines, something something, persecution, ..."), he wasn't very good at what he did.

Despite the great post-sentencing opportunities for monetary re-justicing, insurance still works better when paid for up front.

dickersnoodle

5 hours ago

Good. Now do (Florida Senator) Rick Scott.

webdevver

7 hours ago

79 years of age!? umm... i dont understand - is this supposed to be a warning to others, or an invitation?

where was the FBI for the last 40 years? or did he really just go postal post-covid?

jmyeet

10 hours ago

Meanwhile, we have the former governor of Florida and now Seantor from Florida Rick Scott, who was CEO of the company successfully prosecuted for the largest Medicare fraud in history ($1.7 billion) [1].

Here's what to watch: how long it takes for a donation to show up to the Trump library and how soon after that the sentence is commutted. This has erased roughly $1 billion in penalties so far since January 20. Hell, it might only take $1 million.

[1]: https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386....

rdtsc

10 hours ago

> The fraudulent doctors’ orders generated by DMERx falsely represented that a doctor had examined and treated the Medicare beneficiaries when, in fact, purported telemedicine companies paid doctors to sign the orders without regard to medical necessity

They'll get doctors as well? Hopefully they are part of the co-conspirators group they mentioned they convicted at the start. Criminals are going to be criminal, but it's especially disheartening when doctors engage in this. All those years going to school should be canceled and thrown into the trash immediately if they get convicted of these kinds of crimes. The path of ever being a doctor should be closed for them.

OutOfHere

9 hours ago

The problem here is not the doctors. It is billing it to government insurance. Doctors should remain free to gratify patients who are willing to pay cash rather than bill to government insurance. In fact, most such gratifications never have a problem for precisely this reason.

kotaKat

5 hours ago

It's still partially a problem with crooked doctors.

This is just a step adjacent to the online pill mills for ED medication, GLP-1s, and ketamine, only the advertising and service delivery has been adapted to the elderly that don't use the Internet.

Instead of ads online it's ads on daytime television bragging for free orthopedic supports and braces at no charge to you if you "call today" while they link you up to someone that signs a prefilled script for fifty bucks a pop to bill out to Medicare.