200 people charged in $2.7B health care fraud crackdown

> 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 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".

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.

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.

Here's the scammer's wedding registry from earlier this year. They look happy https://www.theknot.com/us/jeff-king-and-lexie-gehrke-feb-20...

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!

$2.7B in made-up claims, divided by 200 accused individuals, gives us an average of $13.5M per alleged criminal.

That's not peanuts!

They are ready to move on to become governor and senator: https://en.wikipedia.org/wiki/Rick_Scott

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.

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

Asking out of genuine intellectual curiosity, not with political or other overtones (even with the highly political character of the news today).

Jail for the execs.

Loss of license for the nurses and doctors.

People died but the money matters more?

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.

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.

And here’s their wedding invite [0]. Money made off dying old people had to sustain their vacuous lifestyle

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

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?

How can I help!

The healthcare system is rotten from top to bottom.

https://www.usatoday.com/story/news/health/2024/06/25/baylor...

Medicare expansion > provider-pigs at the trough. The scale of fraud is heartbreaking.

Source: I'm fin. director for a large "non profit" community health clinic.

> a wound care company

What is the name of the "wound care company" that Alexandra Gehrke and Jeffrey King owned?

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.

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.

[0]: https://www.justice.gov/opa/speech/attorney-general-merrick-...

If only we can be faster to detect health care fraud.