> Authorities allege Gehrke and King, who got married this year, knew charges were coming and had been preparing to flee. At their home, authorities found a book titled “How To Disappear: Erase Your Digital Footprint, Leave False Trails, and Vanish Without a Trace,” according to court papers. In one of their bags packed for their flight, there was a book titled “Criminal Law Handbook: Know Your Rights, Survive The System,”
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 In any case it would be a bit out of date by now.
Everyone here making AI 'social profile' systems take note of this and add it as something to track. Will come in great for the marketing feature list.
Yes, there's got to be people farmers who grow various fictional people over time for use by ___. Create and shut down employers who pay the fictional people, rent apartments left empty in their name, maybe ding up a credit report to look real, arrange for someone who matches a look to appear in a paper under the name being farmed, kind of like Sim City but in the "real world" like Pokemon Go.
I thought shelf companies were so you could quickly get a new company going (as it's all pre-registered), so you have an established history, which some organisations - such as banks - value, or so you can access a type of company no longer available[0]. They're not fake companies; to the extent companies are "real", they are real. They're just dormant.
You're probably thinking of letterbox companies. Shelf companies are kept by lawyers, accountants and the like so they can provide them to clients without them having to go through an incorporation process. In some jurisdictions it's a way to not have to wait a year or so until you can pay out cheap dividends.
> It specifically recommends against breaking the law.
It's so kind of them.
Otherwise yes, any trick that ends up in a popular book would probably not be that useful for people actually trying to flee from law enforcement. Or it would be some super vague advice in the tune of "don't leave traces of you being there".
There's a rather rich literature about 'OPSEC', i.e. how to hide from powerful enemies. Breaking the law is commonly the right thing to do, could be to expose corruption for example.
If they had other books about civil rights, sure, but having only the books related to their predicament and a packed bag is a little more than "authorities scared of you knowing your rights"
How do you know they didn't have other books about civil rights? Maybe they had an entire library filled with such books, but that wasn't brought up in the article.
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.
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.
No, but it will make a difference in determining whether they're a flight risk by the judge. Given the evidence these two will probably await trail in jail rather than at home. Or at the very least they just bought themselves a nice new ankle bracelet.
The books evidence a desire to flee but equally evidence an ineptitude, the lack of an ability to flee. Buying a ticket for an international flight is akin to making an appointment with the FBI for you to be arrested. The FBI only dreams that every fugitive first pass through inspection/x-ray before being arrested in an airport terminal ringed with security. No need to worry about a fight, weapons or a dangerous police chase. The perps have already been frisked by the FAA. If these people ever run, they won't get far.
The FAA administers aviation, an actual necessary and valuable endeavor. The theatrical display you are subjected to in airports is overseen by DHS as justification for their continued existence as a jobs program. It has nothing to do with aviation.
But yes, the FBI would be happy to have fugitives be caught at an airport checkpoint, although I doubt they’d risk relying on DHS to do it.
I don't know that the system is all that great. I've known people with multiple warrants fly around and in/out of the country multiple times before finally getting stopped.
I can see it making a difference when presented to jury, if it's admitted as evidence. It may not be main evidence but combined altogether with other things they did, it might tilt the balance into the "sentence them closer the maximum term limit" vs the "lower end".
> 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.
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.
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
That's a lot of effort. No point getting into crime if you're going to have to work so much. The other way to think about it is these people were caught because they were being so blatant about it. There are probably lots more cases like this where the criminals are a tiny bit smarter about covering their tracks.
They got DPR that way. Distracted him at a coffee shop while he was logged into his computer and snatched it. If he had just been at home on a VPN, he probably wouldn't have gotten snagged. They knew who he was already but needed that laptop to prove it.
He was at the library not a coffee shop. I bet they still could have got him at home: Swat kicks he door in, shit! Lock the laptop! Slams the lid. Notorious Linux suspend bug kicks in and it fails to suspend. (You can tell because the fans keep going) Shit. Open, slam, open, slam. Hang on guys, I need to like modprobe or something…
Shit those bracelets hurt.
His dad testified in court that it was a Reiser family tradition to hose out the interior of your car to clean it (when Hans was arrested in the car there was an inch or two of water in it )
Hans also claimed to have misplaced the passenger seat (it was missing from the car)
After trial he admitted he threw the passenger seat in a dumpster.
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.
An investigation can keep gathering evidence more easily if the suspects are still generating evidence. About to board an international flight is logical as the spot where the investigators need to decide: arrest now or it's gonna be much much harder later. As long as the investigator knows they are at home, there is no rush. A bus to Mexico would be an arrest also.
They were in Phoenix why not drive yourself to Mexico? I’ve never been stopped by American border agents on the way into Mexico. Rocky point is a short ~3.5 hour drive, you can show up and get a nice condo for ~150 a night at one of the many resorts. Then you can start working on your next steps.
If they were smart they’d realize that the same amount of effort can be put into legal activities and you get to keep the proceeds at the end.
For the most part smart people have already self-selected out of a life of crime.
Airports post-911 have a robust security setup with only a few clearly defined entrances and exits, with a person stationed at each one, in addition to whatever team you have brought with you. If you’re arrested at the terminal, they have likely already swept you for weapons without raising your suspicions already.
Yeah, but they were identified and enough evidence to make the arrest, yet decided to wait. that is the puzzling part. how long would they have waited.
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
When the authorities catch up to you, you are definitely going to be treated differently if you have bags packed, tickets booked, and a bunch of books on how to evade the police versus being on your volunteer shift at the local soup kitchen. Getting caught fleeing speaks poorly to your character if you don't have a good reason or have already been told to not leave town by the cops.
If they had contacted a defense attorney, does that also speak poorly to their character and should be held against them? Certainly that's something a criminal who knew they were guilty would do.
It’s not profiling as the book was collected as evidence after being charged with a crime and with a search warrant (or at least probably cause must be established with other evidence). Profiling would be using information about such a book before crimes were committed or charged.
In addition, such evidence is important in establishing bail, as risk of fleeing is of primary concern.
Apply that to other situations though. Those sorts of books are ordinary. If you used that sort of profiling after the fact on everyone, you could make anyone look suspicious or untrustworthy
Witch hunters during the inquisition literally used to do this sort of thing to help condemn people
You are absolutely correct! Law enforcement should not in any circumstance be allowed to go through someone's library of books that are publicly available and then try to tie in one of those books with the fact that they've committed a crime. That is the problem, like many people in this feed they are totally oblivious of how much illegal control and power they are giving the authorities. Interestingly though, my gut tells me that they didn't even find that book that that book may have been planted as evidence against them. We live in a world where police are always getting busted on social media for lying in deception. We can no longer sit back and assume that they are doing the right thing behind closed doors. I don't believe for one minute that they found the book I think that was their way of adding a layer so that they could later charge the people.
If we don't fight this type of stuff now, our lives As Americans in the future lives of the next generations literally will not even be worth living!!!
> In one of their bags packed for their flight, there was a book titled “Criminal Law Handbook: Know Your Rights, Survive The System,” the papers say.
You sensibly mention that this was not brought up until after the warranted search. But why is this title being mentioned now? Is the suggestion that someone who’s been charged with a crime should not attempt to read up on his rights—that doing so is a black mark suggesting flight risk? If the other book, on disappearing, is derogatory in itself, then why bring up this book too?
I'd guess that it speaks to the "knew charges were coming" bit to support that they were specifically fleeing the law and not disappearing to escape a bookie or an annoying family member or something
This is the sort of action we need more of to help combat corruption and restore some basic faith in the medical industry, but it's only a start. 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. If the people involved get away with a slap on the wrist or fines that are only a fraction of what they made in profit it will only encourage others to do the same thing. Any doctors accepting kickbacks should, at the very least, lose their license and be prevented from practicing medicine again.
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.
I worked in this space as a statistician. You are completely correct. The environment is so incredibly target rich and resources are so limited that only the biggest and most obviously winnable cases are pursued.
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
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…,
Most of the article is about Gehrke and King, but the last fraud case mentioned is absolutely vile:
> Another case alleges a scheme in Florida to distribute misbranded HIV drugs. Prosecutors say drugs were bought on the black market and resold to unsuspecting pharmacies, which then provided the medications to patients.
> Some patients were given bottles that contained different drugs than the label showed. One patient ended up unconscious for 24 hours after taking what he was led to believe was his HIV medication but was actually an anti-psychotic drug, prosecutors say.
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.
Agree on all accounts, but I'd also like to add: Surprisingly good Italian food. Not the standard "high class" American stuff slathered in cheese either. Just really good wholesome delicious high quality dishes I as not expecting that from Scottsdale.
That's interesting. I suppose that if I won the lotto I would want to try expensive things to see if they were worth the extra money. I've never dried off with $700 towels before, would I feel $695 fancier for using them?
I'm of the same opinion when I see the dime a dozen Mercedes or BMW in the middle/middle upper class ends of town. I can understand getting an AMG Merc or M series BMW if you have the money, but the average luxury brand 60 to 80k car that is parked every other parking spot with the owner maxxed out on leverage just seems foolhardy to me.
They're billionaires because they don't waste their money? I don't think so. They're billionaires because they invest in companies that provide shed loads of value to their customers, so their stock is worth more.
Here's an idea: the government (HHS) makes available all public expenditure data (suitably anonymized) and if you can reliably identify fraud, you get 20% cut of the money recovered.
Go forth and go crazy with the data, my ML homies!
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.
It wouldn't be randoms on the internet submitting data. Submitting false data could be fraud itself and the people doing it could trivially be identified.
"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.
> Total fraud in that case was $900 million, for a only 500 patients, or almost $2M per patient.
That seems so outside the bounds of reality that I'm questioning if it's what happened here. I can't imagine how that would pass any kind of sniff test by Medicare.
Quote from the article: "In less than two years, more than $900 million in bogus claims were submitted to Medicare for grafts that were used on fewer than 500 patients, prosecutors said."
The alternative interpretation of this is that the grafts were _applied_ to 500 patients, but potentially many many more were billed for grafts that they didn't need (and didn't receive). Maybe more feasible?
Wound care is bullshit when it’s not fraud. My dad was getting billed $12,000 weekly for treatment of bedsores due to neglect when he was inpatient. The procedure took under 15 minutes.
Compromised patient, injured due to basic incompetence, A Medicare probably paid a million dollars or more to treat it.
> Did his insurance cover this? What happens if you refuse to pay such outlandish fees?
The billed numbers are almost completely made up. The insurance company (Medicare in this case) will only reimburse up to a set amount.
The reimbursement is calculated as min(billed_amount, allowed_amount). If the facility accidentally bills less than the allowed_amount, they get less than they could have. So to make sure they get 100% of the possible payout, they bill extremely high numbers to insurance.
It's a dumb system, but it's something you have to keep in mind whenever someone talks about how much things cost in the US system. With expensive procedures, products, or drugs, virtually nobody ever pays the big number. It's just a placeholder to make sure insurance payouts are not left on the table.
That's not quite it. Hospitals would make every code cost $1M or some other ridiculous number if that were the only thing going on.
The provider has a list of prices called the chargemaster. The insurance (and Medicare) have lists of prices they'll pay. For private insurance, there will often be negotiations to set prices for patients with the insurer getting treatment at the provider, called the network agreement. These fall between the two lists, generally.
If you're out of network, the provider bills their chargemaster, the insurer tries to pay their price depending on the terms of the insurance. In network, the provider bills the negotiated rate and the insurer (probably) pays it.
Now what happens if the patient doesn't have insurance? The provider bills their chargemaster and the patient (rarely) pays it. If they do, confetti. If they don't, the provider graciously takes a percentage off and offers a repayment plan. They collect on a meaningful percentage of these.
The patient pays more if the chargemaster is higher.
I don't understand how it isn't fraud. I looked at an ambulance bill for my mom the other day:
$1798 total
-$388 Medicare paid
-$1324 Service adjustment
$86 Amount you owe.
I don't think dumb is sufficient to explain this. It's pretty easy for me to see how someone leaps from this de facto legal system to outright fraud, because the line between them is pretty thin.
The way medical billing works is plainly fraud, but the people who are successfully defrauded don't end up knowing any better. For everyone else it's merely attempted fraud, and if you (forcefully) call out the fraudsters they'll bargain their bill down to something more defensible and/or find someone else to pay it.
I'm nearly done dealing with an instance of this myself (for someone else). Had a $1k copay that was legit per their "insurance" plan. The hospital also sent a fraudulent bill for another ~$2k rather than doing the work of figuring out how to bill "insurance" for it. Told them we'd pay in full once they presented a complete set of non-fraudulent bills. Half a year later, with me holding the hands of both bureaucracies, they finally were able to get "insurance" to pay that second bill. I told them we were ready to pay the $1k legit copay, and they told me they had taken care of it months ago using some internal charity fund. The system is an utter joke.
Medical billing is dumb but I'm not sure why that would be or appear fraudulent. The normal cost of the ambulance service would be $1798, medicare pays a max of ~$500 for ambulances and your mom pays 20% of that. The reason the rest of us would pay $1798 is because we essentially subsidize the medicare rates. Many insurance companies negotiate rates that are some % of the medicare rate, so they might pay 2x or whatever, and pay $1000. Medicare often has agreements that they can't bill the rest of the charge to the patient so it's 'adjusted' essentially written off.
why do people have to be so damn greeedy. $900m on 500 patients is just asking to get caught. Even if all 500 patients had cancer and tripple bypass surgery, and required lengthy ICU stays, their costs will still barely be that.
Why can't scammer just exercise some moderation and they get to keep scamming for a long time. No, they have to just get greedy. Greed always get you caught
The design of the system makes normal billing practice indistinguishable from fraud. I will go as far as to say that charging $200 for a Tylenol, bundled with a million other different line items in a treatment is fraud.
Honestly I'd assume medicare fraud might not be representative. It's kinda big risk/ big reward because the govt has the power to imprison you, but other insurance companies would just stop dealing with you if you rip them off enough and still sue you to get their money back.
> The FBI estimates fraud accounts for upwards of 10% of healthcare expenditures.
One of my clients had their business roped into a multi-million dollar medicaid fraud scheme. The FBI eventually handled it but it months and a lot of work to get the feds interested.
I would argue the whole system is fraudulent and highly corrupt but profitable so it's ok. Insurances reject legitimate claims, hospitals charge exorbitant rates for procedures that never happened and much more. Look at what PBMs do.
This was one case, and it's not the first time someone went and just checked for the most blatantly suspicious case and discovered fraud. It is safe to say there is a lot more going on that is being perpetrated by people with better opsec.
Yeah but that tiny % of healthcare spending is enough to fund a lot of other stuff. Don't get thrown off by the orders of magnitude: a small fraction of a big number is still a big number.
Imagine what $2.7B could do for transit or housing or relocating migrants or student loan debt relief or wildland firefighter pay raises or invasive species remediation. Hell, imagine what even 1% of $2.7B could do for independent journalism or the arts.
>Medicare fraud is really profitable (until you're caught)! There's a reason it keeps cropping up.
Seriously, if they'd just been content with a few million and jetted off to the Caribbean it would have never been noticed. All of these medicare fraud things are always in the multi-millions before they get noticed.
If you're interested in how often people get away with this kind of scam, and how they get away with it, I strongly recommend the two episodes on the subject from the popular podcast "Behind The Bastards" titled "Part One: The Fake Doctors Who Gave Everyone Alzheimer's" and "Behind the Bastards (2018)
Part Two: The Real Bastard Was Health Insurance Companies All Along"
These episodes detail several people who pulled off these same scams, including how others tried to turn them in for it and were ignored.
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.
> 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.
The difference is that private insurers have an actual incentive against this happening but when the scheme is state-funded you have to rely on the people's sense of duty which we know is not particularly strong in many cases.
Investigations are a cost-center. Government can staff investigators; private insurers just factor the fraud into next year's premium hike.
> To put that record in context, take a look at the state’s Medicaid program, which covers about 13 million low-income people. During fiscal 2017 and 2018, the program’s fraud unit filed criminal charges against 321 fraudulent medical providers. It garnered 65 civil settlements and judgments and recovered more than $93 million, according to the state attorney general’s office.
> A rigorous search for civil lawsuits filed by private health insurers over fraud in California turned up just one case in 2017 and 2018. Experts said insurers rarely sue over fraud because of the high cost of litigation.
> I tracked down a dozen or so investigators who once worked for insurers, and they all said the same thing: Insurers don’t police fraud as much as they could because it hurts the bottom line.
This is one of those moments where you realize how frustrating the discourse is that Everyone Just Knows the US doesn't have government-run health insurance. The US invented government-run health insurance. And Medicare has its warts, but works extremely well on the whole.
The US has multiple government run single-payers. I remember being told six, but I remember Medicare, Medicaid, and the VA. What the US does not have is universal healthcare, though I think we spend something like as much of a percentage of GDP on our non-universal government systems as other countries do on their universal healthcare, and then again we spend more GDP on private. All for worse outcomes than those other countries (though we can do some really impressive stuff if you're rich). It's quite a racket for sure.
> Maybe 6 is Medicaid through a managed care plan.
House of Representatives and Senate offices will provide health coverage to Members of Congress and designated staff through the Small Business Health Options Program (SHOP).
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.
> 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.
I don't think that's a relevant analogy at all. In this case, the doctors were the ones perpetuating the fraud. Not the patients, not the insurance company.
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.
Yeah I've wondered about a system where health insurance is for major events like injury accidents and cancer, and typical office visits are handled as a consumer product. Insurance companies may want to pay for basic checkups and the like to reduce their risk of high ticket items -- or not, however the math works out. Seems like this has at least some of the benefits of a market system, for those who insist that nationalized health care is not something we can stomach in the US.
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.
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.
Insurance is the Major healthcare fraud,and is widely accepted. I pay a monthly fee to a company for a "service" which actually is on the company's interest to avoid providing. Insurance companies would spend $500,000 in lawyers to prevent paying me $500,001 .
Worse yet, in some cases I am required by law to contract this fraud.
My personal opinion is that the extremely high levels of activity in healthcare fraud prosecutions really aren't good for our country. They sound perfectly bipartisan and like no brainers (I haven't read into the details of this one but assume there are plenty of compelling details) - but it's just another 50lbs on the pile of "healthcare is highly complex and hard to do business in." These rules are BRUTALLY hard to comprehend for businesses.
The anti kickback statute and false claims act and cures act are all riddled with ambiguity and cases where normal intuitive business practices become criminal. It just stinks to do business with Medicare.
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?
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.
Horrible, disgusting, yet not at all surprising. I don't know what medical billing accountability looks like in this dizzyingly complex system, but as a US citizen and patient of the US healthcare system, it looks barely existent. My family has fought our fair share of bogus healthcare charges. One instance: after my daughter was born at a birthing center (independent of a hospital), my wife experienced postpartum complications and was transferred to a nearby hospital for care. As if that experience wasn't stressful and traumatic enough, many months later we were hit with a surprise charge from the hospital for treatment and care of our newborn baby - the baby that was delivered hours earlier, in a separate location, that never left my arms in the hospital!
All that to say - it's alarmingly easy for a charge to get processed in a batch of other charges, and either insurance pays it without question, or the patient pays it unknowingly. During our experience, we learned that this kind of thing is exceedingly common. The power dynamic between patients and healthcare administration severely misaligned, the information imbalance is huge, and the patient is always in a compromised position.
The article doesn't include details on how they tracked down these criminals (I'm curious to know!), but it wouldn't surprise me in the least if this is just the tip of the iceberg.
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.
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.
> 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.
Newborn hearing screening is standard, or even mandated, in most states. This wasn't just a grifter they allowed to roam the halls. They were contracted with the person to administer the tests. It's likely it was even required by your state lawmakers:
Well, it wasn't presented to us like that. He asked, "Do you want it?" Implying we could say no. We looked at each other, shrugged, and said, "Okay." It was very sweet until we got the bill.
We had two kids more after the first one. No one offered to test their hearing or required that it be done. The second one is the one who died, but not from hearing-related complications.
>and some medical practitioners are solely in for the money
So is everyone else that works any kind of job. 'Solely in it for the money' is such a weird complaint, as if you'd do your job for free if you were independently wealthy.
Actually, most people have multiple motivations for working in their field. Nursery school teachers like kids. They also like getting paid. Most doctors like the status their job confers and helping people in need. They also like getting paid. People who have jobs that suck -- septic tank pumper, say -- may well be in it solely for the money.
From what I see on the news, rich white-collar criminals get fined a small amount of what they stole and are sentenced to much less jail time than their poorer fellows.
To remedy this, I suggest everyone adopt a system where anyone who stole money or did other financial damage through criminal means spends one day in jail for every $300 of damage they caused.
This has several advantages:
1. The rich would no longer be above the law.
2. It would deter financial crimes and vandalism.
3. It would prevent "victim restitution extortion" where middle-class people are extorted to either give up their life savings or go to prison; They are going to jail regardless, so there is less incentive to set them up to get victim restitution.
> 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...
Man, I would love the job of catching these crooks.
From a comment on HN recently I located and began watching the French spy series, "The Bureau". The series has in no way convinced me that I want to head to dangerous countries and spy on them. But catching white-collar criminals ripping off the system?
I'm pretty convinced that this is the tip of the iceberg. I think most end of life care is a scam designed to separate the dying and elderly from their wealth and benefits, before they actually die.
.... and this is why we will never have universal healthcare. Too many people willing to cheat the system, and the government doesn't sweat the small stuff.
> 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.
> 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.
Why is Garland quoted talking about "profit from the unlawful distribution of controlled substances" when the vast majority of the fraud here had nothing to do with controlled substances? The quote is definitely missing context but it seems inappropriate inserted here.
Edit: Ok, found the actual statement[0]. Indeed AP just pulled this quote completely out of context:
> The fourth pillar of our strategy is ensuring that we keep pace with constantly evolving health care fraud schemes. That includes addressing the rise of schemes that exploit telemedicine technology — specifically as it relates to Adderall and other stimulants.
> Utilizing proactive data analytics, we identified misuse of telemedicine as a possible source of an increase in prescriptions for stimulants. Thereafter, we worked with law enforcement officers to identify potential schemes. Our investigation led us to a digital health care company called Done.
> Earlier this month, we charged and arrested the former CEO and the clinical president of Done for their respective roles in a $100 million scheme to defraud taxpayers and provide easy access to Adderall and other stimulants for no legitimate medical purpose.
> Today, we are also announcing that we have charged an additional five defendants for their alleged involvement in that scheme to distribute more than [40 million] medically unnecessary pills.
> One of the defendants, who was among the company's largest prescribers, was indicted for rubber stamping prescriptions without any medical review. As alleged, the defendant also signed prescriptions for patients who were deceased.
> I want to be clear: it does not matter if you are a trafficker in a drug cartel or a corporate executive or medical professional employed by a health care company. If you profit from the unlawful distribution of controlled substances, you will be held accountable.
So, yeah, Garland is talking about adderall prescriptions. Whereas AP sandwiched the quote between discussion of the (unrelated) Arizona woundcare fraud. Frankly this AP article is a really poor summary of the original DOJ statement and if I were dang I'd update the link to go directly to the DOJ.
> I called up a former federal fraud prosecutor who’d worked with both Medicare and private insurers. He said my calls to the prosecutors exposed alarming differences in the way fraud is enforced in the private and government health plans. The Medicaid fraud units are “staffed and actively engaged,” said Michael Elliott, who ran about 100 fraud investigations when he worked for the Department of Justice in Texas from 2008 to 2015.
> Private insurers, he said, simply don’t make fraud enforcement a big enough part of their mission. “At the end of the day, it shows their priorities are elsewhere,” he said.
A couple of dumb nobodies bilked Medicare for almost a billion dollars before they got caught. Nothing in that Propublica article gets within an order of magnitude.
Also, just looking for fraud complaints is missing the way most insurers combat fraud: They have enough systemic protections to deny the claim in the first place.
ProPublica has done an extensive series on this; at least a skim is worth it. Even the industry doesn’t claim to be as effective at combating fraud as you do.
> While Pratte, Lankford and some of Williams’ clients repeatedly flagged bogus bills, the mammoth health insurers reacted with sloth-like urgency to the warnings. Their correspondence shows an almost palpable disinterest in taking decisive action — even while acknowledging Williams was fraudulently billing them.
> In September 2015, United wrote to Williams, noting his lack of a license and the resulting wrongful payments, totaling $636,637. But then the insurer added a baffling condition: If Williams didn’t respond, United would pay itself back out of his “future payments.” So while demanding repayment because Williams was not a doctor, the company warned it would dock future claims he would be making as a doctor.
> In November 2016, United investigators caught Williams again — twice. They sent two letters accusing him of filing 820 claims between May 2016 and August 2016 and demanded repayment. Again, almost inconceivably, the company threatened to cover his debt with “future payments.”
> Fraud in government programs, like Medicare and Medicaid, gets more publicity, he said, and has dedicated arms of agencies pursuing fraudsters. But the losses may be even greater in the commercial market because the dollar levels are higher, he said.
> He called fraud investigators from Aetna, Cigna and United, who testified that their companies auto-pay millions of claims a year. It’s not cost effective to check them, they said. “Aetna relies on the honesty of the person submitting the claim verifying that it’s true,” testified Kathy Richer, a supervisor in Aetna’s Special Investigations Unit.
Big catches make for splashy headlines, but for every $2B case that makes national headlines there are a whole bunch of these $25M cases they can’t be bothered to notice.
Why would you care about fraud if you can just raise premiums to cover it? My insurer just sent me a letter saying they’re applying for a 21% increase in my $3k/month health insurance policy for next year.
Still looking for that 9-figure scam run by (apparently) morons.
Are you or Propublica making the claim that private insurers pay out the majority of their claims on trust? Generally we hear the opposite, that they’re looking for any excuse to deny.
"Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion."
> Are you or Propublica making the claim that private insurers pay out the majority of their claims on trust?
That claim is made, under oath, by a "supervisor in Aetna’s Special Investigations Unit".
In a case where the insurers were repeatedly willing to be reimbursed from future payments to a provider they knew was unlicensed, no less. Where were the magical "systemic protections" that private insurers have nearly perfected while Medicare supposedly lacks them entirely?
I guess "step 15" from the book was "marry your criminal associates, so you're not forced to testify against each other": https://en.wikipedia.org/wiki/Spousal_privilege?
Step 1 should be "don't buy any incriminating books related to your planned disappearance" followed by the next chapter, "step 2: too late, already".