AI Meets Healthcare Fraud
You know you are old when you are nostalgic for earlier forms of web content. Not too long ago, if you wanted to take a trip down memory lane, you could type the domain name of your favorite Geocities page and read someone’s ungrammatical, but all too human, fanfiction in lavender text on a yellow background. You could watch the obviously amateur home videos uploaded to YouTube in its early days, the “Charlie bit me” era. You could giggle at the nonsensical cat memes on “I Can Has Cheezburger.” Eventually, you would get to the subreddits where everyone is a troll, or at least, the indefatigable optimist tells you that this is how you should interpret their posts. There would be the Elsagate videos, where adults dressed in Halloween costumes of popular characters from children’s movies engage in pointless or downright disturbing antics. Eventually, you would get to the AI slop which alarmists would say is robbing us of our humanity. The few people left who have a modicum of sense know that AI generated content is only as good as the edits it receives from living, breathing human beings with human judgment, and some of them have figured out how to leverage AI to enable them to do their human jobs quickly, to great financial benefit. Here, our Miami white collar crime lawyer explains how a healthcare entrepreneur allegedly used automatically generated doctors’ orders to defraud Medicare and other insurers out of hundreds of millions of dollars.
Watch Out, Grandpa! Here Comes AI!
The old days of the Internet may be the focus of nostalgia, but if you are old enough to be nostalgic, you are old enough to have gotten used to the obviously false promises of financial security in the form of postal mail, email, phone calls from people who are not in your contact list, and more recently, text messages. You know not to fall for them. The target audience of these scams is not you; it is lonely, elderly people who have lost the ability to tell the difference between a genuine communication from a legitimate creditor and a somewhat convincing fake, or else seniors who are so lonely that they are willing to engage even if they know that they are being lied to, just so they can hear a human voice.
Baby Boomer Defendant Outwits Large Language Models
The healthcare professions are a line of work where people continue to stay at their jobs long past the usual retirement age, but they usually only stay as long as it does not require them to use new technology. The CEO of a company called Power Mobility Doctor Rx LLC oversaw a platform where patients and businesses such as pharmacies and durable medical equipment providers would sign up, and the platform promised to connect them to each other. Over several years, the platform created thousands of computer-generated doctors’ orders, using information that patients had provided, to bill Medicare for unnecessary and often unprovided services, and the patients consented to receive these, not knowing that they did not need them. The defendant and his accomplices allegedly reviewed the computer-generated invoices for red flags that would lead Medicare to audit them and then modified them to fly under Medicare’s radar. Prosecutors allege that the platform generated $1 billion in fraudulent invoices and that the company was responsible for $360 million paid on these claims. The defendant, who is facing federal charges for healthcare fraud and related offenses, is 79 years old as of June 2025. If convicted, he could receive a sentence of decades in prison.
The Role of Adversarial Stylometry in Criminal Cases
The defendant in this case may try to argue that he did not know that the claims were fraudulent. He might say that he did not alter the computer-generated text or that, when he did, he reasonably believed that he was correcting it so that it would be accurate. In some cases, word choice and writing style can be key pieces of evidence. Stylometry is the analysis of a person’s writing style; it is how bots figure out whether a text is the work of another bot or a human. Humans can get good at stylometric analysis. Adversarial stylometry is when someone makes a conscious effort not to write like himself or herself.
Contact Our Criminal Defense Attorneys
A South Florida criminal defense lawyer can help you defend yourself against charges of healthcare fraud or other financial crimes. Contact Ratzan & Faccidomo in Miami, Florida for a confidential consultation about your case.
Source:
justice.gov/usao-sdfl/pr/ceo-health-care-software-company-convicted-1b-fraud-conspiracy
