21 century corruption

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RickyScott

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21 century at it again- wall street journal article - please post it.

Wall Street Journal (subscription)-Sep 26, 2017
... through a sweetheart deal with one of the largest public health-care systems in the U.S., North Broward Hospital District, or Broward Health.

Anyway here are the salient points: Broward Health - public health system - in Florida signed a no bid "contract" with 21 century oncology for 30 year term for 21 century to place docs at Broward Health's hospital radiation center. (built by the hospital/tax payers)

The contract turns over all professional and technical fees to 21 century. In addition, for inpatient or nonpaying patients, Broward Health actually pays 21 C .7x medicare technical l!! And Broward Health pays for the staff, facility, operation and 500,000 for doctors. In return, Broward Health gets.... nothing. 21 century earned 20 million/year from this contract according to company's prospectus when they were filing for an IPO (which didnt take place) Last year the CEO of Broward Health shot himself in the head.

Hmm. how do you get a contract like that?

This would be analagous to new york city turning over the subway system to me. Of course the city built it and still pays to operate it, but I would still get to collect all the money. And if someone couldnt afford to ride the subway, of course, the city would pay me so that person could ride for free.
 
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business guy shot himself over money? that's the real shame
 
seper said:
business guy shot himself over money? that's the real shame
Click to expand...

Broward Health Medical Center is being actively investigated by the FBI. The previous CEO was shot twice in the heart....not suicide. I can't believe such hospitals exist.
 
Radiation therapy company settles U.S. kickback probe for $11.5 mln

ION Settles 5+ Year Investigation

Integrated Oncology Network Holdings, LLC (“ION”), the parent company of SightLine Health, LLC along with other SightLine subsidiaries (”SightLine”), announced today that they have reached final agreement to end a more than 5 year investigation by the Office of Inspector General and to settle a civil litigation matter brought by a Qui Tam Whistleblower in November 2016.

The government investigation and the subsequent Whistleblower lawsuit alleged that SightLine engaged in conduct that caused the submission of false claims to the United States based on the manner in which SightLine allegedly offered and provided kickbacks in the form of investment opportunities and ownership dividends in independent, turnkey radiation oncology clinics.

Although ION disputes the DOJ’s allegations, ION elected to settle in order to avoid the cost and uncertainty of continued litigation, as well as the distraction that this investigation and litigation were having on the company. This settlement reflects ION’s disagreement with the claims and does not include any admission or determination of any wrongdoing.

“This settlement allows ION to eliminate the cost and distraction of this matter, which has been the subject of an on-going five year old investigation into SightLine, and the SightLine management team that predates ION’s acquisition of SightLine,” stated Jeffrey Goffman, CEO of ION. “Most important, ION’s core values are cemented around conducting ourselves with integrity and in compliance with all healthcare laws and regulations as evidenced by the dedication to our existing corporate compliance program and our longstanding policies and procedures”.

Under the terms of this civil settlement, ION and SightLine will pay the United States up to $11.5 million over a period of five years, payable as $500,000 annually plus interest. In addition, there is an additional one-time payment of $9 million at the time of a recapitalization of ION. In addition, ION and Sightline have agreed to enter into a Corporate Integrity Agreement with the OIG, which is customary at the conclusion of these types of government healthcare investigations. The CIA provides that the company will maintain, over a five-year term, a corporate compliance program that includes oversight, reporting, policy, screening and monitoring obligations. 5Many of the requirements in the CIA have already been implemented as part of ION’s existing compliance program.
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Had heard of these guys before... sounded like 21C to me on the surface, but it looks like instead of employing specialists like urologists and med oncs, they just gave them straight up kickbacks (with the usual caveats....Not really admitting guilt in the settlement yada yada)
 
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Sounds like 21C was in bed with FCS to divvy up MO and RO business between themselves in SW Florida.... FCS settled a large antitrust judgement with the doj, unclear how much 21C had to pay....

www.medscape.com

Cancer Patients Illegally 'Traded as Commodities,' Says Suit

Two large cancer treatment center companies agreed to exclusively refer patients to one another for the purpose of driving out competition in southwest Florida, according to a whistle-blower lawsuit.
www.medscape.com www.medscape.com

www.wsj.com

Florida Cancer Center to Pay $100 Million in Antitrust Probe of Oncology Industry

The treatment center admitted to engaging in a yearslong conspiracy to limit competition for oncology treatments and will pay $100 million in criminal penalties as part of a continuing Justice Department probe of the industry.
www.wsj.com www.wsj.com

www.justice.gov

Leading Cancer Treatment Center Admits to Antitrust Crime and Agrees to Pay $100 Million Criminal Penalty

Florida Cancer Specialists & Research Institute LLC (FCS), an oncology group headquartered in Fort Myers, Florida, was charged with conspiring to allocate medical and radiation oncology treatments for cancer patients in Southwest Florida, the Department of Justice announced. This charge is the...
www.justice.gov www.justice.gov
 
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Gross.
giphy.gif
 
medgator said:
Sounds like 21C was in bed with FCS to divvy up MO and RO business between themselves in SW Florida.... FCS settled a large antitrust judgement with the doj, unclear how much 21C had to pay....

www.medscape.com

Cancer Patients Illegally 'Traded as Commodities,' Says Suit

Two large cancer treatment center companies agreed to exclusively refer patients to one another for the purpose of driving out competition in southwest Florida, according to a whistle-blower lawsuit.
www.medscape.com www.medscape.com

www.wsj.com

Florida Cancer Center to Pay $100 Million in Antitrust Probe of Oncology Industry

The treatment center admitted to engaging in a yearslong conspiracy to limit competition for oncology treatments and will pay $100 million in criminal penalties as part of a continuing Justice Department probe of the industry.
www.wsj.com www.wsj.com

www.justice.gov

Leading Cancer Treatment Center Admits to Antitrust Crime and Agrees to Pay $100 Million Criminal Penalty

Florida Cancer Specialists & Research Institute LLC (FCS), an oncology group headquartered in Fort Myers, Florida, was charged with conspiring to allocate medical and radiation oncology treatments for cancer patients in Southwest Florida, the Department of Justice announced. This charge is the...
www.justice.gov www.justice.gov
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Wow. Thanks for posting. Had been following this for a while but had not seen the settlement.
 
There's a lot to unpack in that complaint.
1) FL CA Specialists made ~$1 billion from the collusion or antitrust activity or whatever it might be called over a ~20 year period.
2) They're paying the $100 million over a few year period, will pay $40 million this summer. That's pretty impressive a PP group can come up with $100 million and not be...
3) Put out of business, which they won't be. Deferred prosecution agreement (DPA) is a totally new thing against a medical practice as far as I can tell. Usually all the cases are either civil, or the govt goes after folks individually when it's criminal. I've read that DPAs have become more desirable by the govt after Arthur Andersen (in the Enron case) got found criminally guilty and it caused such an upheaval to innocent folks working at AA who had done nothing wrong. AA had all charges unanimously overturned by the Supreme Court years later; I guess this caused some introspection going forward on the part of the DoJ.
4) FL CA Specialists colluded with a large "Company A"; FCS did the chemo, and Company A did all the rad onc in the region. And there's a company B and C who also maybe does rad onc that are smaller than Company A? And Fl Ca Spec colluded with Company D, "a large hospital system in the region." All those companies unnamed of course. Hammer to fall on them later?
5) Not a single doctor or executive named in the DPA. A DPA approach was already actually kind of "kind" to Fl CA Spec, and not naming a single name in the DPA is extra kind.

One thing among many I thought when reading this is that a bunch of people (doctors mostly I guess), decided and agreed to send each other patients. And that is the basis of this whole DPA. Nowadays, when a young rad onc signs a contract to go to work at a large hospital system, I think many must sign an agreement that they will endeavor to send all their patients to one place (the employing organization) at the behest of the organization. And if there's no written agreement, it sure is unwritten. It's been unwritten in my face many times. And that kind of activity is perfectly legal I suppose.
 
scarbrtj said:
There's a lot to unpack in that complaint.
1) FL CA Specialists made ~$1 billion from the collusion or antitrust activity or whatever it might be called over a ~20 year period.
2) They're paying the $100 million over a few year period, will pay $40 million this summer. That's pretty impressive a PP group can come up with $100 million and not be...
3) Put out of business, which they won't be. Deferred prosecution agreement (DPA) is a totally new thing against a medical practice as far as I can tell. Usually all the cases are either civil, or the govt goes after folks individually when it's criminal. I've read that DPAs have become more desirable by the govt after Arthur Andersen (in the Enron case) got found criminally guilty and it caused such an upheaval to innocent folks working at AA who had done nothing wrong. AA had all charges unanimously overturned by the Supreme Court years later; I guess this caused some introspection going forward on the part of the DoJ.
4) FL CA Specialists colluded with a large "Company A"; FCS did the chemo, and Company A did all the rad onc in the region. And there's a company B and C who also maybe does rad onc that are smaller than Company A? And Fl Ca Spec colluded with Company D, "a large hospital system in the region." All those companies unnamed of course. Hammer to fall on them later?
5) Not a single doctor or executive named in the DPA. A DPA approach was already actually kind of "kind" to Fl CA Spec, and not naming a single name in the DPA is extra kind.

One thing among many I thought when reading this is that a bunch of people (doctors mostly I guess), decided and agreed to send each other patients. And that is the basis of this whole DPA. Nowadays, when a young rad onc signs a contract to go to work at a large hospital system, I think many must sign an agreement that they will endeavor to send all their patients to one place (the employing organization) at the behest of the organization. And if there's no written agreement, it sure is unwritten. It's been unwritten in my face many times. And that kind of activity is perfectly legal I suppose.
Click to expand...

It was 21C. I'd be shocked if they aren't paying heavily as well, has to be like their 10th CMS settlement??

Cancer Patients Illegally 'Traded as Commodities,' Says Suit

Didn't realize FCS had to pay it over a few years, where did you read that?
 
medgator said:
It was 21C. I'd be shocked if they aren't paying heavily as well, has to be like their 10th CMS settlement??

Cancer Patients Illegally 'Traded as Commodities,' Says Suit

Didn't realize FCS had to pay it over a few years, where did you read that?
Click to expand...
"The United States and FCS agree that FCS will pay a monetary penalty in the amount of $100,000,000, plus interest beginning June 1, 2020 and computed daily at a rate equal to the weekly average I-year constant maturity Treasury yield, as published by the Board of Governors of the Federal Reserve System, for the calendar week preceding June 1, 2020, to the United States Treasury. FCS agrees to pay the penalty in the following installments: $40,000,000 by June 1, 2020; an additional $10,000,000 plus interest by June 1, 2021; an additional $16,627,384 plus interest by December 31, 2021; an additional $16,627,384 plus interest by December 31, 2022; and an additional $16,745,232 plus interest by December 31, 2023."

EDIT: Also, if FCS ever even hints to anyone, anywhere, that they did nothing wrong, they're in breach and prosecution in theory can proceed.
"FCS expressly agrees that it shall not, through present or future attorneys, partners, members, officers, directors, employees, agents or any other person authorized to speak for FCS or its subsidiaries or corporate affiliates, make any public statement, in litigation or otherwise, contradicting the acceptance of responsibility by FCS set forth above or any of the facts set forth in the Statement of Facts. Any such contradictory statement shall, subject to cure rights ofFCS described below, constitute a breach of this Agreement and FCS thereafter shall be subject to prosecution as set forth in this Agreement."

EDIT2: This is all a bit diff than a "settlement," which usu goes "parties admit no wrongdoing" yada yada. This is DPA. Ultimately the endpoints are about the same. The settlements have been so ubiquitous because the govt can achieve treble damages and $thousands per incident if goes to (civil) trial because false claims act is uniquely draconianally scary that way.
 
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scarbrtj said:
One thing among many I thought when reading this is that a bunch of people (doctors mostly I guess), decided and agreed to send each other patients. And that is the basis of this whole DPA. Nowadays, when a young rad onc signs a contract to go to work at a large hospital system, I think many must sign an agreement that they will endeavor to send all their patients to one place (the employing organization) at the behest of the organization. And if there's no written agreement, it sure is unwritten. It's been unwritten in my face many times. And that kind of activity is perfectly legal I suppose.
Click to expand...

This right here... No good way out of this one I suppose.

Excuse my ignorance, what makes 21C different from say a Univ hospital in regards to referral between RO and MO?
 
RadOncMegatron said:
This right here... No good way out of this one I suppose.

Excuse my ignorance, what makes 21C different from say a Univ hospital in regards to referral between RO and MO?
Click to expand...
They don't have capable enough lobbyists on Capitol Hill like the AHA does?
 
21C declared bankruptcy so presumably won't have to deal with the ramifications of this. We shall see.
 
From my understanding, if you bill from one organization, internal referrals aren't illegal.

I wonder if they were telling patients that they could only go to this other RO/MO or they wouldn't treat them.
 
udrag14 said:
From my understanding, if you bill from one organization, internal referrals aren't illegal.

I wonder if they were telling patients that they could only go to this other RO/MO or they wouldn't treat them.
Click to expand...

I'm thinking, isn't 21C smart enough to be aware of this? As posters above note, this is all shady stuff...

Please, do not make me even more cynical of our system folks! @scarbrtj @medgator in reply to your posts say it ain't so...
 
udrag14 said:
From my understanding, if you bill from one organization, internal referrals aren't illegal.

I wonder if they were telling patients that they could only go to this other RO/MO or they wouldn't treat them.
Click to expand...

I doubt you would even need to be that explicit with most patients. The machine of cancer care in the United States is annoyingly difficult to navigate even for those of us who are cogs. I'm in a relatively affluent area of the country with several competing "big name" academic medical systems, and MAYBE 10-20% of our wealthy/highly educated patients are savvy enough to get second opinions from an outside source (which is easily accomplished here).

I imagine in a large state like Florida it was (is?) easy to keep people in the system you want them in.
 
RadOncMegatron said:
I'm thinking, isn't 21C smart enough to be aware of this? As posters above note, this is all shady stuff...

Please, do not make me even more cynical of our system folks! @scarbrtj @medgator in reply to your posts say it ain't so...
Click to expand...
Why not.... We have different payment systems for freestanding vs hospitals when it comes to nearly everything, including RO. And even that's not good enough for the anointed....
 
elementaryschooleconomics said:
I doubt you would even need to be that explicit with most patients. The machine of cancer care in the United States is annoyingly difficult to navigate even for those of us who are cogs. I'm in a relatively affluent area of the country with several competing "big name" academic medical systems, and MAYBE 10-20% of our wealthy/highly educated patients are savvy enough to get second opinions from an outside source (which is easily accomplished here).

I imagine in a large state like Florida it was (is?) easy to keep people in the system you want them in.
Click to expand...

Practicing in FL was the best and worst thing at the same time with a bunch of craziness. Hell its where Carole Baskins resides!
 
udrag14 said:
From my understanding, if you bill from one organization, internal referrals aren't illegal.

I wonder if they were telling patients that they could only go to this other RO/MO or they wouldn't treat them.
Click to expand...
“Internal referrals” aren’t, you’re right. But that’s all that’s needed to make FL Ca Specialists activity legal: stamp “internal referral” on the process. Nowadays the internal referral is within the large sprawling medicoacademic complex (can be hundred miles or more in size!). Have seen many in that complex heavily infer that patients should stay within or risk not getting treated. With a wink and nod sometimes, with a scowl at others. I have many doctors that I will only refer to and many who only refer to me. I have “colluded” with them ‘cause we are comfortable w each other and we want what’s best for patient. Only in academic or internal referral settings can this collusion also occur with obvious financial benefits. My buddies and me must collude for free lol.

I don’t know what’s necessarily right or wrong. One day an NCAA player and its school gets completely destroyed for letting a player get paid for endorsement. Now everyone agrees it’s ok and they’re changing the rules. One day everything is the most illegal thing ever and the next everybody is like hey it’s all good!
 
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scarbrtj said:
“Internal referrals” aren’t, you’re right. But that’s all that’s needed to make FL Ca Specialists activity legal: stamp “internal referral” on the process. Nowadays the internal referral is within the large sprawling medicoacademic complex (can be hundred miles or more in size!). Have seen many in that complex heavily infer that patients should stay within or risk not getting treated. With a wink and nod sometimes, with a scowl at others. I have many doctors that I will only refer to and many who only refer to me. I have “colluded” with them ‘cause we are comfortable w each other and we want what’s best for patient. Only in academic or internal referral settings can this collusion also occur with obvious financial benefits. My buddies and me must collude for free lol.

I don’t know what’s necessarily right or wrong. One day an NCAA player and its school gets completely destroyed for letting a player get paid for endorsement. Now everyone agrees it’s ok and they’re changing the rules. One day everything is the most illegal thing ever and the next everybody is like hey it’s all good!
Click to expand...

Preferences are not illegal. If a patient ask you to go to a specific provider, you have to comply with the patients wishes.

From these judgements, it seems like a shady actvity was done with large financial benefit. If you are in the top percentile of Medicare billing, you will have people looking into your practices. I doubt they care about middle of the road rad onc.
 
udrag14 said:
Preferences are not illegal. If a patient ask you to go to a specific provider, you have to comply with the patients wishes.

From these judgements, it seems like a shady actvity was done with large financial benefit. If you are in the top percentile of Medicare billing, you will have people looking into your practices. I doubt they care about middle of the road rad onc.
Click to expand...
“Shady activity” is such a waste basket subjective term though. “Shady activity done with financial benefit” could describe half of all medicine and 90% of pharma. But definitely true is that risk of problems like these are correlated to your Medicare percentile. I mean FCS made bank yeesh. And they’ve got the cheddar to pay $100 million over next three years so they’re still making bank.
 
scarbrtj said:
“Shady activity” is such a waste basket subjective term though. “Shady activity done with financial benefit” could describe half of all medicine and 90% of pharma. But definitely true is that risk of problems like these are correlated to your Medicare percentile. I mean FCS made bank yeesh. And they’ve got the cheddar to pay $100 million over next three years so they’re still making bank.
Click to expand...

Do we know they have the $ to pay? That's a lot of $ for a practice doing just under $1B per year in revenue
 
At my training institution there was an issue with some of the urologists having their hands in a freestanding radiation center and benefiting from referring patients out outside of our academic center. The admins could not do anything about it. My understanding is that you cannot force a doctor to refer within a system. Not even sure if it can even be encouraged. Referring inside your own system obviously has a lot of benefits, like same EMR, more streamlined process, probably better feel for the patient to get comprehensive care under one roof. But if you are apart of another rad onc center, these benefits do not trump money I guess.
 
scarbrtj said:
“Shady activity” is such a waste basket subjective term though. “Shady activity done with financial benefit” could describe half of all medicine and 90% of pharma. But definitely true is that risk of problems like these are correlated to your Medicare percentile. I mean FCS made bank yeesh. And they’ve got the cheddar to pay $100 million over next three years so they’re still making bank.
Click to expand...

Shady activity is the price gouging going on at MSKCC and MDACC and large monopolistic university systems as well as thought leaders in bed with pharma

Amazon product ASIN 1421437635
 
RickyScott said:
Shady activity is the price gouging going on at MSKCC and MDACC and large monopolistic university systems as well as thought leaders in bed with pharma

Amazon product ASIN 1421437635
Click to expand...
The inequalities by which these situations and scenarios continue to exist:
Necessary = Shady
Shady ≠ Illegal

However, sometimes
Shady = Illegal

Many of the places held up as shining bastions of medicine in America have 1) mastered Shady ≠ Illegal, and 2) convinced many in power that Necessary = Shady. The places like 21st Century and Broward Health and Pacific Medical and Tuomey Health and Johnson & Johnson never fully mastered Shady ≠ Illegal. Many have. The 21st Century though is almost inexcusable because one of the worst things you can ever say about someone/anything is that they never learn from their mistakes.
 
Sorry I just followed the link and realized your post was likely in jest. Apologies, I don'tusually click links on this forum (and this post only reinforced that policy)
 
Tigerstang said:
This is incorrect, historically. Many companies have had judgments against them that pushed them into bankruptcy. What do you base this on?
Click to expand...
Please provide relevant references that are germane and contemporary to support your statement that this is incorrect.
In my experience with DOJ it was very clear that bankrupting corporations was not the objective.
 
The banking industry figured this out a long time ago. Rules don’t matter if you make a lot of money. Say you do something clearly illegal and make billions of dollars then agree to pay a “fine” 200 million, slap on wrist, nobody went to jail or was named. It is simply the cost of doing business. Likewise, we have many crooked people in medicine.
 
Tigerstang said:
This is incorrect, historically. Many companies have had judgments against them that pushed them into bankruptcy. What do you base this on?
Click to expand...
I don't know about "many." One reason for my reasoning though is a DPA. They are usually used to allow the DPA defendant to maintain a going concern. I'm not a lawyer so don't take my word for it! Also, there are many ways to pay $100 million that aren't horribly onerous for a ~$1 billion a year company. E.g., take out a 30-year $100 million note and pay $6-7 million a year.
 
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thecarbonionangle said:
The banking industry figured this out a long time ago. Rules don’t matter if you make a lot of money. Say you do something clearly illegal and make billions of dollars then agree to pay a “fine” 200 million, slap on wrist, nobody went to jail or was named. It is simply the cost of doing business. Likewise, we have many crooked people in medicine.
Click to expand...
"A new car built by my company leaves somewhere traveling at 60 mph. The rear differential locks up. The car crashes and burns with everyone trapped inside. Now, should we initiate a recall? Take the number of vehicles in the field, A, multiply by the probable rate of failure, B, multiply by the average out-of-court settlement, C. A times B times C equals X. If X is less than the cost of a recall, we don't do one."
 
Chartreuse Wombat said:
Please provide relevant references that are germane and contemporary to support your statement that this is incorrect.
In my experience with DOJ it was very clear that bankrupting corporations was not the objective.
Click to expand...

OnCure
21C
 
scarbrtj said:
"A new car built by my company leaves somewhere traveling at 60 mph. The rear differential locks up. The car crashes and burns with everyone trapped inside. Now, should we initiate a recall? Take the number of vehicles in the field, A, multiply by the probable rate of failure, B, multiply by the average out-of-court settlement, C. A times B times C equals X. If X is less than the cost of a recall, we don't do one."
Click to expand...
There is almost always a Punjabi saying for most things. One that loosely translates to “The rich are restless while the poor sleep peacefully”, may come to mind .
Now, im not sure about that. I think the rich sleep quite well. A reporter once asked Rockerfeller, “how much money is enough?”. He replied “just a little bit more”

Systems are not “broken” or “rigged”, they operate exactly how they are meant to operate. In fact, they operate quite well.
 
thecarbonionangle said:
There is almost always a Punjabi saying for most things. One that loosely translates to “The rich are restless while the poor sleep peacefully”, may come to mind .
Now, im not sure about that. I think the rich sleep quite well. A reporter once asked Rockerfeller, “how much money is enough?”. He replied “just a little bit more”

Systems are not “broken” or “rigged”, they operate exactly how they are meant to operate. In fact, they operate quite well.
Click to expand...
And the results are a consequence of design
 
Chartreuse Wombat said:
It is not evident that these companies filed for bankruptcy BECAUSE of the DOJ...lots of other reasons
Click to expand...

If you read the SEC filing both listed DOJ settlements as a primary cause. I know folks in leadership at both organizations that indicated the same. But it seems as though you do not want this to be true, so I will leave it be.
 
I only write from my (fortunately limited) experience with DOJ and OIG in two kerfluffles as an "expert witness" for the prosecution. In both cases the intent was to injure but not interminably harm.
 
Tigerstang said:
Do we know they have the $ to pay? That's a lot of $ for a practice doing just under $1B per year in revenue
Click to expand...
Tigerstang said:
If you read the SEC filing both listed DOJ settlements as a primary cause. I know folks in leadership at both organizations that indicated the same. But it seems as though you do not want this to be true, so I will leave it be.
Click to expand...
You asked if they have "the $ to pay." You can have the money to pay, pay the money, and then go bust. Yeah sure occasionally the DoJ pushes you all in. But then you just do another buy-in and keep on goin'!

The DoJ approaches this with a surfeit of financial info on their adversary using the vast info-gathering power of the govt.
 
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