Trump Says He’ll Stop Health Care Fraudsters. Last Time, He Let Them Walk.

5 years in the past, the CEO of one of many largest ache clinic firms within the Southeast was sentenced to greater than three years in jail after being convicted in a $4 million unlawful kickback scheme.

However after simply 4 months behind bars, John Estin Davis walked free. President Donald Trump commuted Davis’ sentence within the final days of his first time period. In an announcement explaining the choice, the White Home mentioned that “nobody suffered financially” from Davis’ crime.

In court docket, nevertheless, the Trump administration was saying one thing very totally different. Because the president let him go, the Division of Justice alleged in a civil lawsuit that Davis and his firm defrauded taxpayers out of tens of thousands and thousands of {dollars} with extreme urine drug testing. The DOJ alleged that Complete Ache Specialists made such a “staggering” sum from cups of pee that workers had given the testing a profit-minded nickname: “liquid gold.”

Davis and the corporate denied all allegations in court docket filings and settled the DOJ’s fraud lawsuit with none dedication of legal responsibility. Davis declined to remark for this text.

Since returning to the White Home, Trump has mentioned he’ll goal fraud in Medicare, Medicaid, and Social Safety, and his Republican allies in Congress have made combating fraud a key argument of their plans to slash spending on Medicaid, which gives well being look after thousands and thousands of low-income and disabled People. Throughout an tackle to Congress final month, Trump mentioned his administration had discovered “a whole bunch of billions of {dollars} of fraud” with out citing any particular examples of fraud.

“Taken again numerous that cash,” Trump mentioned. “We obtained it simply in time.”

However Trump’s historical past of exhibiting leniency to convicted fraudsters contrasts together with his present-day crackdown. In his first and second phrases, Trump has granted pardons or commutations to a minimum of 68 folks convicted of fraud crimes or of interfering with fraud investigations, in response to a KFF Well being Information evaluation of court docket and clemency data, DOJ press releases, and information reviews. A minimum of 13 of these fraudsters have been convicted in instances involving greater than $1.6 billion of fraudulent claims filed with Medicare and Medicaid, in response to the Division of Justice.

And as one of many first actions of his second time period, Trump fired 17 impartial inspectors basic answerable for rooting out fraud and waste in authorities.

“It sends a extremely unhealthy message and actually hurts DOJ efforts at creating deterrence,” mentioned Jacob Elberg, a former assistant U.S. lawyer and regulation professor at Seton Corridor College in New Jersey. “To be able to scale back well being care fraud, you want folks each to be afraid of getting in hassle, but in addition for folks to consider within the legitimacy of the system.”

Elberg mentioned appreciable fraud in Medicare and Medicaid exists largely as a result of the packages’ “pay-and-chase fashions” prioritize paying for affected person care first and monitoring down stolen {dollars} second. To forestall extra fraud, the packages would possible should be redesigned in ways in which can be slower and extra cumbersome for all sufferers, Elberg mentioned.

Regardless, Elberg mentioned the president’s claimed concentrate on fraud seems to be a pretext for slashing spending that has been legally appropriated by Congress. Trump has empowered the Elon Musk-led Division of Authorities Effectivity, which he established and named by govt order, to make deep cuts in federal budgets, halting some medical analysis and support packages along with reducing spending on local weather change, transgender well being, and variety, fairness, and inclusion packages.

“What’s been the point of interest so far of the administration is just not what anyone has ever known as well being care fraud,” Elberg mentioned. “There’s a actual blurring — a seemingly intentional blurring — between what is definitely fraud and what’s simply spending that they don’t seem to be in favor of.”

Jerry Martin, who served as a U.S. lawyer for the Center District of Tennessee below President Barack Obama and now represents well being care fraud whistleblowers, additionally mentioned Trump’s concentrate on fraud seemed to be “only a platform to assault issues that they don’t agree with” reasonably than “a real need to root out and fight fraud.”

Even so, Martin mentioned a few of his whistleblower shoppers have been emboldened.

“I’ve had shoppers repeat again to me ‘President Trump says fraud is a precedence,’” Martin mentioned. “Persons are listening to it. However I don’t know that what he’s saying interprets into what they consider.”

The White Home didn’t reply to requests for remark for this text.

A Billion-Greenback Fraud Case and Pointless Eye Injections

Presidents benefit from the distinctive authority to erase federal convictions and jail sentences with pardons and commutations. In principle, the ability is meant to be a ultimate bulwark towards injustice or overly harsh punishment. However many presidents have been accused of utilizing the pardon energy to reward highly effective allies and shut associates as they go away the White Home.

Trump issued about 190 pardons and commutations within the ultimate two months of his first time period, together with for some well being care fraudsters convicted of schemes with astonishing prices.

For instance, Trump granted a commutation to Philip Esformes, a Florida well being care govt convicted in 2019 of a $1.3 billion Medicare and Medicaid fraud scheme. After he was sentenced, DOJ introduced in a press launch that “the person behind one of many largest well being care frauds in historical past might be spending 20 years in jail.” Trump freed him 14 months later.

Trump additionally granted a commutation to Salomon Melgen, a Florida eye physician who was serving a 17-year jail sentence for defrauding Medicare of $42 million. Melgen falsely recognized sufferers with eye ailments, then gave them pointless care, together with laser therapies and painful eye injections, in response to DOJ and court docket paperwork.

“Salomon Melgen callously took benefit of sufferers who got here to him fearing blindness,” mentioned a DOJ information launch after Melgen was sentenced in 2018. “They obtained medically unreasonable and pointless exams and procedures that victimized his sufferers and the American taxpayer.”

DOJ: $70 Million Spent on ‘Extreme’ Urine Testing

Regardless of the flurry of pardons and commutations on the finish of Trump’s first time period, the leniency he confirmed Davis was distinctive. Davis was the one convicted well being care fraudster to obtain clemency whereas the Trump administration was concurrently accusing him of extra fraud.

As CEO of Complete Ache Specialists from 2011 to 2017, Davis oversaw a fast growth to greater than 60 places throughout 12 states, in response to federal court docket paperwork.

He was indicted in 2018 for utilizing his CEO place to refer Medicare sufferers in want of medical gear to a conspirator in return for kickbacks paid via a shell firm, in response to court docket paperwork. He was convicted at trial in April 2019 of defrauding Medicare.

Three months later, the DOJ filed a fraud lawsuit towards Davis and CPS that piggybacked on the claims of seven whistleblowers. The lawsuit alleged that CPS collected greater than $70 million from federal insurance coverage packages for urine drug testing, most of which was “extreme,” and that an audit of a sampling of the exams had discovered a minimum of 93% “lacked medical necessity.”

Usually, authorities insurance coverage packages pay for urine testing so ache clinics can confirm that sufferers are taking their prescriptions correctly and never abusing another medication, which may contribute to an overdose. Sufferers might be examined as little as annually or as typically as month-to-month relying on their degree of danger, in response to the DOJ lawsuit.

However Complete Ache Specialists carried out “myriad urine drug testing on just about each CPS affected person on just about each go to” then performed “a minimum of 16 several types of exams” on every pattern, and generally as many as 51, in response to the lawsuit.

Trump commuted Davis’ sentence for his legal conviction in January 2021 because the DOJ was finalizing a settlement within the civil lawsuit. The commutation was supported by nation music star Luke Bryan, in response to a White Home assertion.

Months later, with President Joe Biden in workplace, CPS and its homeowners agreed to repay $4.1 million — lower than 10% of the damages sought within the swimsuit — and the case was closed.

Within the settlement, Davis agreed to not take any job the place he would ever once more invoice Medicare or different federal well being care packages. He was not required to personally repay something.

Martin, who represented one of many whistleblowers who first raised allegations towards Davis and CPS, mentioned the leniency that Trump confirmed to him and different well being care fraudsters might discourage DOJ workers from pursuing related investigations throughout his second time period.

“There are numerous rank-and-file people who find themselves working on the lowest level of their skilled careers, the place they’ve seen numerous their work primarily be water below the bridge,” Martin mentioned. “That’s obtained to be actually demoralizing.”