200 people charged in $2.7B health care fraud crackdown

I have read 'How to disappear', i don't think it would be very useful here. It's written by two private detectives to help people evade stalkers or family violence. It specifically recommends against breaking the law. In any case it would be a bit out of date by now.

I don't get it. Why do these criminal masterminds always get arrested at the airport? The authorities know who they are, yet for some reason decide to wait for them to go to the airport instead of just arresting them at home or wherever? I guess this shows that if you are a fugitive from justice, or expect to be indicted, stay the fuck away from the airport. take the bus, uber, or train or something.

Would you expect that kind of book to make any difference for final sentencing?

People shouldn’t be profiled based on what they watch or read. Are we going so say that couldn’t video games are evidence that somebody is going to go commit violence next? What if you’re into spy movies? Crime documentaries? Weird reality tv shows?

I read all kinds of non fiction things I won’t even list here but I seem to be a perfectly boring member of society. It’s just interesting subject matter

This is bleak, but it reminds me how police found, in the home of convicted murderer and former Linux FS contributor Hans Reiser, a book about how to get away with murder.

Spousal privilege may not apply when both members of the couple are accused of committing the crime.

You’d think these folks would takeout cash, go to Walmart and buy a laptop which they only use at public hotspot locations. To later dispose of. Still traceable but a lot harder

Was it Hans Reiser who decided to randomly clean his car interior with bleach while there was a manhunt going on for his wife? Same vibes.

That the authorities think it is wrong for someone to know their rights is more of a condemnation of the "authorities".

“They can’t arrest a husband and wife for the same crime!”

I need to stock my library with books like... "Wrongly accused" and "what it's like to get setup"

It's fun to satire the stupid and criminal ... as it happens I just watched the gang that can't shoot straight. Not as good as I hoped, but the repeated "hey" at film beginning and using a lion as motivation to pay mobsters for "protection money" was a good laugh.

I've owned that book. I think that's the NOLO one? It's definitely not a bad intro to criminal defense, but it is no way likely to get you out from under this weight of charges.

These days if you can get someone on the phone with access to an AI you can definitely get some pretty decent motions written, just watch for hallucinated citations.

Almost comical

> The owners of the wound care companies, Alexandra Gehrke and Jeffrey King, were arrested this month at the Phoenix airport as they were boarding a flight to London

The whole sequence of events reads like something straight out of a Vince Gilligan show, like Breaking Bad or Better Call Saul.[a]

The only significant difference is that Gilligan's shows take place in New Mexico instead of Arizona.

--

[a] https://en.wikipedia.org/wiki/Vince_Gilligan

In one of their bags packed for their flight, there was a book titled “Criminal Law Handbook: Know Your Rights, Survive The System,”

Don't know your rights, people, it's proof you're bad!

I guess "step 15" from the book was "marry your criminal associates, so you're not forced to testify against each other"

That may constitute bigamy in some states.

https://www.law.cornell.edu/wex/bigamy

Not so fast, these are only the crimes we know about.

Louis Vuitton Medallion Blanket $1510.00 - Purchased

Really can’t make this stuff up

the schedule not being chronological is baffling to me, is that a common thing?

lol when you click "our story" [1] it says:

Our Story coming soon!

also under "Travel":

Travel coming soon!

haha no kidding!

[1]: https://www.theknot.com/us/jeff-king-and-lexie-gehrke-feb-20...

Checks out that they were in Phoenix/Scottsdale... When I visited last year it felt very much like LA 2.0. Lots of plastic surgery, people flaunting wealth, and generally materialistic and shallow culture. Not representative of the entire area of course, but I was surprised by how much of that there was.

All that money and they went with a free wedding website?

Dolce&Gabbana Casa Leopard Silk & Wool Throw - $3245.00 - Purchased

Goddamn.

Now I know who buys leopard print dessert plates for $1155:

https://www.theknot.com/us/jeff-king-and-lexie-gehrke-feb-20...

Dolce&Gabbana Casa Leopard Silk & Wool Throw $3,245.00 - Purchased

Baccarat Lucky Butterfly $250.00 Purchased

Maybe not as lucky as advertised?

The ‘our story’ section says ‘coming soon’. Can’t wait.

Wedding Party coming soon!

I bet $15 on 'nope'

"Our Story" > Coming Soon!

No - but $2.7B in fraud over $4.5T total healthcare spending per year is peanuts.

This appears to happen over ~5 years or more - so that's $2.7B vs $22.5T or about 0.012% of total spending.

The reason healthcare is broken in the US is not because of fraud.

It's due to the design.

By the way, fraud is inevitable.

We might be able to save about ~1% per year on healthcare if fraud was reduced to more reasonable levels. That's not going to move the needle at all.

"In the Arizona case, prosecutors have accused two owners of wound care companies of accepting more than $330 million in kickbacks as part of a scheme to fraudulently bill Medicare for amniotic wound grafts, which are dressings to help heal wounds."

Total fraud in that case was $900 million, for a only 500 patients, or almost $2M per patient.

if they were smart they paid taxes on the fraudulent gains. So they netted US $5 million or more each

Medicare fraud is really profitable (until you're caught)! There's a reason it keeps cropping up.

I wonder: would this level of fraud occur if the US had universal healthcare, or its effective equivalent?

The fraud was perpetuated against Medicare, which is the US-run insurance plan for people 65 and older and people with disabilities. Nearly 20% of the population is on Medicare.

Universally letting everyone on to the plan would have actually allowed them to run the fraud on everyone, not just people on Medicare.

This was Medicare fraud, which I imagine you’d see more of if universal healthcare was implemented as single payer “Medicare for all.”

This level of fraud is almost non-existent when there is NO insurance and NO universal healthcare.

Anytime the person paying is not the one receiving service, the appeal of fraud goes up. When the person paying is not paying with their own money the appeal goes up and a TON of incentives argue against finding fraud. At least in govt, there is sometimes a willful blind eye because finding fraud causes a huge headache and you don't benefit or get paid more. In fact, if you are taking an administrative fee to manage the program, reducing expenditures can hurt your own budget.

I have traveled internationally where folks paid cash for services. It was a bit crazy - they would basically hold you hostage until you paid a bill / impound your car etc. BUT you could buy many drugs OTC (no DR visit even required) and the layers of things like approvals, pre-approvals, billing and billing codes etc simply didn't exist.

The biggest scam in US health care is the insurance industry.

Most of the 'fraud' that doctors complained about where I lived in Italy was old people coming in with mostly imagined complaints because they're lonely and don't have anyone and a doctor visit is free. Which is kind of sad, but... not the same level of problematic.

from Dec 2016, https://www.thestar.com/politics/provincial/ontario-s-top-bi...

====

The province’s 12 top-billing doctors — who received payments of between $2 million and $7 million in one year — are overcharging the Ontario Health Insurance Plan, documents obtained by the Star suggest.

[stuff deleted]

Among additional “concerns” alleged in the report:

- Three specialists “inappropriately delegated” duties — for which they billed OHIP and which were supposed to perform themselves — to unqualified individuals to undertake.

- Six claimed to have worked between 356 and 364 days of the year.

- Eight recorded notably high volumes of claims and/or patients. One radiologist, who worked 332 days, billed for 100,000 patients, indicating that more than 300 scans were interpreted per day, the report stated.

- Eleven billed OHIP incorrectly.

- An obstetrician/gynecologist billed for seeing male patients.

====

There would still be some fraud, but since the prices of basic medical care would be considerably lower (as demonstrated everywhere else in the world) the amount of money made from fraud would be considerably smaller thus creating less incentives.

I suspect this is just a the tip of the iceberg. These clowns are just the dumb ones who got caught. I mean they bought books on "how to disappear" and "how to avoid criminal prosecution". I guess the smart ones get away with it regularly. It's sad really.

The convictions that follow have to come with severe enough consequences to more than offset the the millions they got while hurting patients and stealing from taxpayers.

I wish they land in prison for many years and then have to pay back what they stole and for all the court fees as well.

The other good news of the day was that the Sackler family lost much of their future prosecution immunity

https://news.ycombinator.com/item?id=40813369

The legal thing to do is to over-treat and do sessions in 8 minute increments so you can round up.

Cornwell health does it!

When people talk about price distortion, this is it. Reimbursements always open up the possibility for abuse.

Related: https://hospitalogy.com/articles/2024-06-18/done-adhd-telehe...

But this fraud is huge, so you can be all but certain this will go on for years, and then a fine of 5% or less of what they took, and no admission of wrongdoing…,

Yes totally, and then we need stricter regulations to keep this from happening again. Unfortunately every regulation makes healthcare even more expensive and adds more middlemen and makes healthcare companies hire more paper pushers to make sure they're meeting regulations.

Every single fraudster costs future Americans a ton more money than they just stole

When our first child was born (a long, traumatic story in itself), after the ordeal was over and we were resting in the hospital, a nice fellow came by and asked whether we wanted to test our baby's hearing. Sure? No mention was made of a price. He put a device in the baby's ears. Hearing was fine. Then we got the bill. Hundreds of dollars, maybe $500, for a moment's effort and no expenditure of resources. We had almost no money at the time and certainly no insurance. This was in Nashville. He was an independent contractor they let wander the halls of the laying in ward accosting unsuspecting new parents. He bought the machine. Now he's got a steady income from this grift.

Another event in Nashville, my wife cut her hand making dinner. We walked to the emergency room. Eventually someone saw us. He asked whether we wanted to try some experimental tree sap glue to close the wound. Sure? It actually wasn't much of a cut and it had stopped bleeding. No mention of a price. While he was squeezing a droplet of liquid out of a tube the attending physician looked over his shoulder. Yep, checks out. It was basically a glance, less than a minute's interaction and no interaction with out. The whole experience, again, when we had essentially no means to pay, cost hundreds of dollars. They guy who glanced over glue man's shoulder tacked on a couple hundred for himself. Coming through the door and signing some papers then waiting hours to be attended to cost us maybe $400.

I've got similar stories from Washington, DC. My son (not the baby with the hearing test) had to deal with the medical system in Vermont. He's dead now but we're still paying the bills. And now we have insurance.

Regular healthcare in the US looks a hell of a lot like a scam. If you have insurance, the scam is less visible, but it's the same system.

My son got his first official letter when we was about two weeks old. It was a bill from the hospital for his birth: $8,000. He was directly charged on that bill, not us parents.

And that was on top of the $24,000 bill that we had received from hospital. So $32,000 for a no-frills (from a medical viewpoint) birth and that was many years ago.

The health insurance paid 100% of both bills, so we ended up not following up.

I use Kaiser. I have never seen a bill.

Meh, most of these people are parasites. I agree the government going after things like patient assistance programs for helping Medicare or TRICARE patients due to the AKS is probably bad.

But the typical prosecution is much more straightforward. A DME retailer whose “clients” are really just identify theft victims. A doctor who signed off on a bunch of things without ever meeting the patients. And some of it is going to get people killed. Especially when they do the scam where they buy HIV medicine from people who get it free and they use lighter fluid (!) to remove labels from the bottle and store the medicine in storage lockers and car trunks before some corrupt pharmacy buys it. Then the thief is back on the plane to whatever ex communist country they came from. There needs to be a deterrent because it is immensely profitable.

Healthcare business are fine, the Healthcare industry in America is larger than the retail industry and accounts for 17% of the GDP. Americans spend more per capita on Healthcare than any country, and get worse outcomes. No one is scared about doing business in the industry because the profits are enormous.

The idea of just letting fraud go without prosecution in this industry is really hard for me to understand... Did you read the part where someone thought they were taking HIV medications, but because someone was profiting off fraud, they instead took anti-psychotic meds and were unconscious for 24 hours? We don't want to investigate that happening, because it might be bad for business? The business which is wildly thriving?

These aren’t people failing to jump through hoops.

I see medicare fraud nearly every shift…

Until someone spams them with garbage, or uses it to deliberately screw with certain people, and the system starts requiring more people to sift through the garbage than it needed without it.

IIRC, there's a law practice that solely goes after pharmacy prescription management something something. They make good money.

I've since been wondering if bounties for third parties is a way to mitigate regulatory capture.

Apex Mobile Medical LLC, Apex Medical LLC, Viking Medical Consultants LLC, and APX Mobile Medical LLC.

That is so messed up :(

Not to be pedantic, but you suggested general statistics up front (how often people get away with it) then delivered anecdotes later: examples from several people.

If people died that would not have died, is this murder?

Like rats looking for holes, they always will find some

Too many people willing to cheat the system, and the government doesn't sweat the small stuff.

The government is far more likely to sweat the small stuff. They'll happily pay $20k in staffing to prosecute a $1k theft, because it doesn't hit their profits/bonuses at all to do so.

https://www.propublica.org/article/we-asked-prosecutors-if-h...

Michael Crowley investigated fraud for more than a decade for three companies, including Humana and United. The flood of fraud was so great, he said, that investigators ignored suspect claims worth less than $300. Investigating those, the companies determined, would cost more than what they could recover, he said.

But those small claims add up. Williams, the personal trainer from Texas, billed insurers in increments of $300 and under for more than four years, and it added up to about $25 million. “If you’re a provider, you’re going to figure out that threshold real quick and stay under it,” Crowley said.