Last year, as part of the largest health care fraud takedown in history, prosecutors charged Haitian national Jean Jethro Alexandre with a scheme that ran two clinics as fraudulent prescription mills. On paper, the clinics treated patients for HIV and other sexually transmitted diseases. In reality, according to the Department of Justice prosecutors, the clinics existed to harvest the deep discounts that the 340B Drug Discount Program confers on HIV medications. This spring, Alexandre was sentenced with prison time and ordered to pay $14.3 million in restitution. If you’re wondering how Alexandre, a citizen of Haiti, can come to the United States and easily rake in tens of millions of dollars of taxpayer money through criminal fraud, your answer is the 340B Drug Discount Program. 340B has exploded from roughly $5 billion in discounted purchases in 2010 to more than $66 billion in 2023, across thousands of covered entities and contract pharmacies.  The 340B Program was built so that theoretically clinics could buy medicines cheaply and stretch those savings to make treatment affordable for lower-income patients. This may have been a noble goal, but unfortunately the program is rife with abuse. And as the Alexandre case shows, this goes well beyond wasteful practices, clerical errors, or improper billings. In the Alexandre case, federal prosecutors in Florida described in granular detail how criminal fraudsters can loot the 340B Program of millions of dollars.