CEO of health care software company sentenced for $1B fraud conspiracy | Hacker News Reader

CEO of health care software company sentenced for $1B fraud conspiracy

justice.gov

132 pointshealsdata123 comments

> 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"

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

Here’s why you should be scared: CEO of health care company pardoned by Trump

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!

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

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

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

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.

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.

What if you don't want to maximize recovery?

Do you genuinely just not like businesses?

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.

I'm indifferent to the idea of businesses in general. I genuinely dislike businesses that make profits from breaking laws and then don't have to suffer the consequences that individuals would suffer from the same actions.

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?

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."

> 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...

If you can't deter a business, what function do fines and monetary legal judgements on businesses have?

What about the investors into businesses that make money through fraud and other illegal acts? My theory is that if the return on investment for a business making profits through fraud is literally zero, investors would figure out a way to start avoiding investing in fraudulent businesses pretty fast.

It’s not a question of black and white thinking. If a business took $20,000 from me, and prosecutors told me that they could get the full $20,000 back but instead they’re going to set some of it on fire and only get $10,000, I’d have some serious questions.

Maybe answerable ones, if the deterrence theory works out! But I don’t understand who it is that’s supposed to be getting punished or deterred. The owners are losing the business anyway, what do they care if you put the assets to productive use or not?

> I don’t understand who it is that’s supposed to be getting punished or deterred

The investors who will continue to make money from the business that committed fraud and lost virtually no profit from it under the current model. As long as fraud continues not to affect the bottom line, businesses aren't going to stop committing it.

I don't see this as exclusive with monetary fines. If you're saying that the remaining assets of the company are so much lower than the amount obtained fraudulently by the time the prosecution happens, I'd honestly consider it somewhat absurd to consider that a reason to let the company keep operating. By that logic, if I rob millions of dollars from bank and then spend it all by the time I'm caught, I shouldn't have to go to jail for decades so I can make enough money to pay them back.

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

(As, perhaps, they should be.)

> 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.

Again, you’re proposing this as a novel solution, but it’s well known and commonly deployed. The source link discusses one of the many times that it’s happened. People who think this doesn’t happen are simply mistaken, generally IME confused by large and complex cases where the story can't be so neat and clean.

> Again, you’re proposing this as a novel solution, but it’s well known and commonly deployed.

Imprisoning executives is rare enough (you gotta piss off the truly rich for that, e.g. Madoff or Benko), but seizing and selling off an entire company from its prior owners is something I haven't even heard of.

What can happen is that a company crashes down due to fines and/or public pressure, but that's not the same.

It happens all the time. It just happens through the bankruptcy process, so we generally understand it as "company crashes down" even if their core business remained healthy. Purdue, again, is a great recent example of this, although the state governments and other plaintiffs preferred to retain ownership in a trust rather than get cash by selling it to some marginally more responsible pharma company.

> It just happens through the bankruptcy process

And that is fundamentally different in messaging to owners and boards than a court order explicitly stating "the government has seized this company because too many laws were violated too egregiously, the entire board is banned for 5-10 years from holding any other board position, the owners/shareholders will not be compensated".

Bankruptcies and dissolutions happen all the time, they are a part of normal healthy capitalism. But explicit, no-nonsense, no-excuse seizures not.

...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?

The public domain certainly would be appealing, especially with regards to adding an additional deterrent to just forming the company again to do the same thing. Sadly all of this is probably a pipe dream though, so I'm mostly trying to make the point that there is a coherent implementation of this sort of policy, even if it's not something likely to happen.

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.

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?

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

Make those who are convicted personally liable to repay investors?

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.

The executives likely would, the SEC already does this.

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

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

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.

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.

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."

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.

> 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

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

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

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

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

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.

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.

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.

The problem is that there’s double dipping and profiteering. The prison company gets paid by the government for the same it costs the government to house prisoners and then contracts out the prison labor to private companies for basically pure profit. Private prisons’ ability to sell slave labor is a perverse system. The government doing so is at least marginally less but still exploitative in that it robs prisoners of their humanity and feeling like they’re part of the social fabric. Pay them a living wage for that effort and they start to learn that there’s respect and reward that come from being integrated in society.

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.)

> 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.

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

If you aren't already seeing it, it's because you're eyes are closed or you're intentionally looking away: https://www.epi.org/publication/rooted-racism-prison-labor/

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

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

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.

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.

The only way to get it to change might be to force it upon the middle and upper class.

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.

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 .

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.

> 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!

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.

In the 'purely rational' crimes, it's going to be some sort of function of both right? The expected benefit, the risk that you get caught, and the severity of the punishment.

While I agree that people conducting corporate fraud think they will get away with it - I don't agree that the long sentences won't act as a deterrence. If you set the sentence for these sorts of crimes to 1 year rather than 15+, that completely changes the risk profile for people who think there is a 90% chance they will get away with it.

It's simpler than that. You just don't think about getting caught, it's not part of the plan.

Sentence length has a small effect on crime rates, but what really matters is enforcement levels. If you have a 99% chance of getting caught & punished, you don't bother.

A lot of research on this topic tends to look at correlations between crime rates and harshness of punishments, which would tend to include this effect.

Think of it this way if the sentence for speeding was life in prison, do you really think that wouldn’t have any effect on people speeding.

I think this just highlights how stupid the idea is that punishment doesn’t act as a deterrent

I think if the punishment for speeding was life in prison, the entire system would be in such a shambles what would make sense is burning the entire country down.

Your assertion is not the slam dunk you think it is.

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

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

ethical - no. legal - yes.

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.

Society is not peaceful. It’s just that certain kinds of violence are legal.

You don’t really want perverse incentives, like that example where American judges were given kickbacks to imprison kids, so they found innocent kids guilty.

I think when money is involved that sort of stuff is much more likely.

That’s fine. Prison guards, like all public employees, shouldn’t be unionized and prison labor should be earmarked either for restitution or public use (picking up highway litter, manual construction labor for roads and government buildings, etc.)

A "peaceful society" that reserves the right to enslave a part of itself doesn't sound very peaceful to me.

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…

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

First there’s already government sanctioned slavery for the poor. At least it feels more like poetic justice for it to be applied to white collar crime and maybe that might spur changes to make prison labor more restorative rather than exploitative.

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.

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.

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

Agreed, and it's one of the reasons I'm anti-death penalty.

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.

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).

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.

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.

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.

I mean even at extremely high wages, cracking a billion is more than a lifetime

Fortunately we have a perfect justice system that never makes mistakes and never abuses their power, so let’s put all the convicts in prison for life for Mac deterrence!!

Nah. Just woodchipper them. More practical. Cheaper.

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.

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.

Why does he only have to repay 45%?

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

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

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

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

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!")

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

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....

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.

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

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."

Recent reports say the going price is a million

https://www.wsj.com/politics/policy/trump-presidential-pardo... ("Inside the New Fast Track to a Presidential Pardon" / "Lobbyists close to Trump say their going rate to advocate for a pardon is $1 million")

Thanks I knew I saw it somewhere reputable

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.

He should run for the Senate.

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?

see also: Odd Lots interviewed Jetson Leder-Luis about medicare and medicaid fraud (nov 2024): https://podcasts.apple.com/us/podcast/how-fraudsters-are-bil...

Good. Now do (Florida Senator) Rick Scott.

> 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.

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.

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.

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