text: WASHINGTON (AP) — Republican presidential contender Ben Carson has maintained a business relationship with a close friend convicted of defrauding insurance companies and testified on his behalf, even as the candidate has called for such crimes to be punished harshly. 
   
   This Tuesday, Nov. 10, 2015 photo shows the office building, owned by BenCan LLC, and INBS LLC, in Mount Lebanon, Pa. Republican presidential contender Ben Carson has maintained a business relationship... (Associated Press) 
   
   In this photo taken Dec. 1, 2005, Dr. Ben Carson, center, flanked by Dr. Al Costa, right, and then Pittsburgh Steelers running back, Jerome Bettis pose at the The Pittsburgh Carson Scholars Fund 2nd Annual... (Associated Press) 
   
   Pittsburgh dentist Alfonso A. Costa pleaded guilty to a felony count of health care fraud after an FBI probe into his oral surgery practice found he had charged for procedures he never performed, according to court records. 
   
   Though the crime carries a potential sentence of up to 10 years in federal prison, Costa was able to avoid prison time after Carson helped petition a federal judge for leniency. 
   
   That's different from the position Carson took in 2013 as he prepared to launch his presidential campaign, saying those convicted of health care fraud should go to prison for at least a decade and be forced to forfeit "all of one's personal possessions." 
   
   At Costa's 2008 sentencing hearing, Carson described the dentist as "one my closest, if not my very closest friend." 
   
   "We became friends about a decade ago because we discovered that we were so much alike and shared the same values and principles that govern our lives," Carson told the judge, adding that their families vacationed together and that they were involved in "joint projects." 
   
   "Next to my wife of 32 years, there is no one on this planet that I trust more than Al Costa," Carson said. 
   
   Costa has served on the board of Carson's charity, the Carson Scholars Fund, and continues to lead the charity's fundraising efforts in the Pittsburgh area to provide $1,000 college scholarships to children in need. 
   
   Before his criminal conviction and the revocation of his license to practice dentistry, Costa built a multimillion-dollar fortune through commercial real estate. Investments Carson and his wife made through Costa earn the couple between $200,000 and $2 million a year, according to financial records that Carson was required to file when he declared his candidacy. 
   
   Costa also continues to promote his involvement with Carson's charity as part of his real estate business, prominently featuring the logo of the Carson Scholars Fund on the company's website. His son has worked with Carson's presidential campaign and a political committee founded by the retired neurosurgeon. 
   
   Doug Watts, the campaign's spokesman, said Wednesday he was unable to immediately respond to specific questions about land deals involving Carson and Costa. The AP contacted Watts on Tuesday and again Wednesday. 
   
   "I will confirm they are best friends and that they do hold business investments together," Watts said. 
   
   Costa did not respond to messages seeking comment. 
   
   The breadth of the two men's business ties has not been previously reported, partly because details can be obscured in property and incorporation records. Costa's company and its affiliates own properties in at least five states and overseas. 
   
   In 2007, a few months before Costa was charged, records show that a pair of corporations was established in Pennsylvania called BenCan LLC, and INBS LLC. Carson and his wife are listed as the sole members of the companies. Though the Carsons live outside Baltimore, the mailing address on the incorporation forms was Costa's home address in Pittsburgh. 
   
   BenCan and INBS then paid more than $3 million to purchase an office building in suburban Pittsburgh. The mailing address for the corporations listed on the deed matches the office of Costa's real estate firm, Costa Land Co. 
   
   That September, federal prosecutors charged Costa, accusing him of fraud committed over a nearly five-year period, according to court records. Investigators determined that Costa's dental practice charged more than 50 patients for procedures that had not been performed, resulting in a loss of more than $40,000 to insurance companies. 
   
   After Costa pleaded guilty, 40 of his family members, friends and dental patients wrote letters to the judge as character witnesses. Carson was one of three people who also testified at Costa's 2008 sentencing hearing, stressing his friend's charitable works and vouching for his personal integrity. Also testifying on Costa's behalf was Jerome Bettis, a beloved former Pittsburgh Stealers running back who had helped bring home a Super Bowl trophy to the city two years earlier. 
   
   The government urged the judge to make an example of Costa. 
   
   "Reduction of a sentence based on good works by a wealthy person can create the appearance that a defendant's financial resources and prominent connections can skew the justice system in ways not available to persons of lesser means," a prosecutor told the judge. 
   
   In the end, Costa got no prison time. He was sentenced to one year of house arrest and 100 hours of community service, and ordered to pay more than $294,000 in fines and restitution. Costa later got 12 months shaved off his three-year probation. 
   
   Though Costa was assigned to serve his sentence in his 8,300-square-foot mansion in nearby Fox Chapel, his lawyers repeatedly returned to court to seek permission for him to travel. A few months after starting his sentence, Costa asked to travel to the White House as one of 10 invited guests at a June 2008 ceremony where President George W. Bush presented Carson with the Presidential Medal of Freedom. 
   
   The judge denied that request, though Costa was later allowed to take a month-long trip to the Italian coast while on probation to handle what his lawyer described as urgent business at a resort he owns. 
   
   Carson's appeal for leniency toward Costa contradicts the draconian criminal penalties he called for in his 2013 political treatise, "America the Beautiful." In his book, Carson wrote that anyone found guilty of health care fraud should face what he called the "Saudi Arabian Solution." 
   
   "Why don't people steal very often in Saudi Arabia?" Carson asked. "Obviously because the punishment is the amputation of one or more fingers. I would not advocate chopping off people's limbs, but there would be some very stiff penalties for this kind of fraud, such as loss of one's medical license for life, no less than 10 years in prison, and loss of all of one's personal possessions." 
   
   Despite the tough-on-crime message, Carson and his wife kept their investment with Costa in the years since his conviction. Tax bills for the Pittsburgh office building owned by the couple are mailed to Costa Land Co. A recent lease for a portion of the property was signed on the Carsons' behalf by the president of Costa's company. 
   
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   Associated Press researcher Monika Mathur in Washington contributed to this report. 
   
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   Follow Biesecker at http://Twitter.com/mbieseck ||||| Dr. Ben Carson made quite a splash at the National Prayer Breakfast the other day. Elsewhere I discuss the moral vision he provides in his book, America the Beautiful: Rediscovering What Made This Nation Great. But here I want to look at his recommendations for health reform. 
   
   Most people who saw the speech were thrilled (or appalled) that he called for universal Health Savings Accounts beginning at birth. This is a fascinating idea that would merit some deeper analysis. Unfortunately, he doesn’t mention it in his book, even though he devotes a chapter to health care. 
   
   Instead, his writing offers up some off-the-cuff emotional reactions to problems he has experienced. They are not well thought through and I expect he would write something very different if he had an opportunity to dig a little deeper. Let me start that rethinking here. 
   
   He begins by writing about what drew him to medicine as a boy, and then to neurosurgery as a medical student. (If you aren’t familiar with Carson’s upbringing I urge you to buy the video version of his autobiography, Gifted Hands). 
   
   He then describes one of the problems of providing free health care — poor attitudes on the part of patients. He says their sense of entitlement turns them hostile, and even abusive, toward providers: 
   
   Contrary to popular belief, one of the reasons many physicians refuse to see indigent patients is not that they cannot pay, but because of the poor treatment they receive from such patients. 
   
   He goes on to complain about the complexity of dealing with many insurers: 
   
   Unfortunately, our healthcare insurance system has become so complex that virtually all medical offices and larger practices need billing specialists just to navigate its intricacies. All of this variation and complexity produces mountains of paperwork and requires armies of people to push it around. 
   
   He thinks this is all done to prevent fraud. But he says a better remedy would be to impose very stiff penalties on those few providers who engage in fraud, “such as loss of one’s medical license for life, no less than ten years in prison, and loss of all of one’s personal possessions.” 
   
   Yikes! The family members of such a doctor would not be very happy about this. But, more importantly, what is called “fraud” is often nothing more than a billing dispute. Indeed, just a few pages later, Dr. Carson relates the story of a physician friend who wanted to get into real estate development, so he sold his oral surgery practice to a colleague. Medicare decided the colleague was engaged in fraud, but he didn’t have many resources, so they went after Carson’s friend as well: 
   
   They meticulously examined fifteen years of his practice records for evidence of fraud and were only able to uncover two questionable bills, amounting to a total of $180…He was told that they would take him to trial as a co-defendant with the buyer of the practice and would convince jurors that he had knowledge or turned a “blind eye” to the other doctor’s activity. And that eventually he would end up in federal prison if he did not plead guilty to a federal offense in connection with the $180 discrepancy…He accepted their deal and was sentenced to a one-year house arrest and a $300,000 fine. 
   
   This is how Medicare often operates. It chooses not to do simple claims adjudication before paying bills, so every five years or so, it makes a big public relations splash of criminally prosecuting providers who never should have been paid in the first place. 
   
   Also, to reduce paperwork Carson would have all payers pay all providers the exact same rate, regardless of their skills or underlying expenses. And he would require all insurers to “become non-profit service organizations with standardized, regulated profit margins.” 
   
   He would also “remove from the insurance companies the responsibility for catastrophic healthcare coverage, making it a government responsibility.” He thinks this would make coverage more affordable, because “if we did not regulate utilities, few people would be able to afford their water or electricity.” He would confine insurers to “a 15 percent annual profit, 5 percent of which would go to the government’s national catastrophic healthcare fund.” 
   
   Readers of this blog know that I am no great fan of health insurance companies and would like to see their role in health care greatly reduced. They are far too intrusive into the patient/physician relationship and have indeed piled on vast amounts of administrative costs to the entire system. The idea of universal HSAs Dr. Carson presented during his speech might help remedy all this but the ideas presented in the book are poorly informed: 
   
   Insurers don’t currently make anywhere near 15 percent profits, more like 4 percent. 
   
   Five percent of claims wouldn’t come anywhere close to funding catastrophic expenses. 
   
   Not-for-profit insurance companies are no more efficient, accountable or affordable than for-profit ones. 
   
   Utilities make a whole lot more money by selling services to the masses than they could by raising prices so that only a few could afford it. 
   
   The reason utilities are regulated is because they are state-sanctioned monopolies not subject to the discipline of competition. 
   
   Using criminal fraud to deter false claims is already being done in Medicare, with poor results. 
   
   After his prayer breakfast talk, some people thought Dr. Carson should run for president. That is a terrible idea. We don’t need more politicians, but we could use a great moral leader like Billy Graham or Martin Luther King, Jr. Dr. Carson’s gifts would be wasted by descending into the weeds of public policy and practical politics.
target: – "Next to my wife of 32 years, there is no one on this planet that I trust more than [Alfonso] Costa," Ben Carson said at a 2008 sentencing hearing for the man he calls his best friend. "We discovered that we were so much alike and shared the same values and principles that govern our lives." Carson may have to elaborate on those shared values and his loyalty to Costa, a former dentist convicted of charging for never-performed procedures, the AP reports. Records examined by the AP show the men have been entwined for some time, including Costa's ongoing involvement with Carson's children's charity and his son's role in Carson's election campaign. Most notable, though, is the money Carson has made with commercial real-estate investments via Costa, earning Carson and his wife between $200,000 and $2 million a year, per candidacy financial records. The AP notes Costa's ongoing links to Carson—who's always sworn the case against Costa was bogus, notes Mother Jones—are in the spotlight because Carson came out in 2013 with harsh words for those convicted of health care fraud, saying such convicts should go to prison for at least a decade and have to give up "all of one's personal possessions"—what the AP notes he called the "Saudi Arabian solution" in his 2011 book America the Beautiful. Carson's campaign spokesman told the AP Wednesday that he couldn't give any details on specific questions, but he did confirm that Carson and Costa "are best friends and ... do hold business investments together." And where Carson spent his most recent vacation to Italy in September? At Costa's luxury villa on the Amalfi coast, per Mother Jones. Read the full AP report.