Digital Health at a Crossroads: The Fallout from a $100M Adderall Fraud Scheme

A federal jury has convicted the founders of Done, one of the fastest-growing telehealth companies in the stimulant-prescribing space, for orchestrating one of the largest Adderall distribution and fraud schemes in U.S. history. More than 40 million stimulant pills, over $100 million in revenue, and a business model engineered around speed, volume, and automated prescribing — all built with no real clinical guardrails.

In this episode, host Alex Yarijanian breaks down not only what happened, but what this case means for the entire digital health ecosystem, especially behavioral health and companies prescribing controlled substances. When a company like Done collapses — and its founders now face up to 20 years in federal prison — it doesn’t just take itself down. It drags trust, access, and payer willingness down with it.

Alex outlines how this case will reshape:

• Payer contracting and credentialing
• Prescribing oversight and compliance expectations
• Trust in telehealth platforms
• The future of value-based behavioral health
• Why incentives — good or bad — always scale

And most importantly, he explains why value-based care is the antidote to the shortcuts and misaligned incentives that fueled this scandal.

If you’re building, funding, regulating, or partnering with telehealth organizations, this is a must-listen.

Takeaways:

• The case of the telehealth startup highlights the critical importance of clinical oversight in health services.
• Payers are likely to impose stricter regulations on telehealth providers following recent fraudulent activities.
• Building a sustainable healthcare model requires prioritizing patient interests over profit maximization strategies.
• The future of digital health will hinge on trust, necessitating alignment between clinical and business models.

Episode Transcript

(00:00):
Hey everyone. Welcome to theValue Based Care Advisory Podcast.
I'm your host, AlexYarijanian. Today I want to talk
about a case that's going toreally echo through digital health,
payer contracting, andparticularly behavioral health for
some time to come. This week afederal jury convicted the founders
of a telehealth startup fororchestrating one of the largest

(00:23):
Adderall distribution andfraud schemes in United States history.
More than 40 million stimulantpills, over 100 million in revenue,
and a business model built onspeed, volume and zero clinical guardrails.
The headline isn't a crimehere, you guys. The headline is what

(00:43):
this means for the future ofdigital health, especially for those
of us building responsiblevalue based models. So here's what
happened. A telehealth companybuilt a hyper aggressive direct to
consumer pipeline. I'm talkingsocial ads, social media ads, instant
online visits, easyprescriptions, automated refills.

(01:04):
The internal incentives weresimple. Grow patient volume, grow
stimulant prescriptions, growrevenue. And in that environment,
quality collapsed. Clinicaloversight collapsed. Compliance disappeared.
Federal prosecutors describedit as a pill mill dressed up as a
telemedicine platform. And nowtwo telehealth founders are facing

(01:27):
up to 20 years in federalprison. So let this be a cautionary
tale and let founders holdother founders accountable. Right,
because once an organizationlike this goes down, it becomes harder
for all others to do business.Because now you have to defend another

(01:49):
organization's behavior andexplain how it is not what we are
doing at this organization.Value based care is the exact opposite
of that. It's based onalignment, clinical integrity, patient
safety, and financialaccountability. So when a company
breaks out alignmentsspectacularly, in this case, it affects
the entire industry. Payerstighten contracting, regulators impose

(02:14):
restrictions. Good telehealthcompanies get pulled into the same
spotlight as bad actors. Ifyou're building anything in digital
health, especially behavioralhealth, opioid use disorder, or anything
with controlled substances,understand this. Speed is not scale,
volume is not value,Convenience is not care. At VBCA

(02:39):
here, I talk a lot about themoral architecture of a healthcare
business. You cannot build asustainable clinical model on shortcuts.
Let me tell you something,this case is going to have cascading
effects throughout theindustry. Okay? This happened when
Straight Bro went down acouple years ago. And more and more

(03:02):
dominoes falling. The greater,greater difficulty for other telehealth
companies to do business inthis space. So being prepared is
going to be important movingforward. Being prepared in terms
of what to do with yourinternal business operations, what
to do when you're speakingwith health plans and they ask you

(03:24):
a question that's related hereto either this case or how you would
prevent something like thishappening. Like I said this, this
case is going to shape severalaspects of the business moving forward.
First and foremost,perceptions. It's going to essentially
play a role in how healthplans credential and contract with

(03:47):
telehealth companies. Some ofthe things I would say you should
anticipate is moredocumentation, audits. I would expect
more prescribing oversight,especially if you're using mid level
practitioners, have a processin place that you can articulate.
Because 20 years in prisonsimply not worth it, right? Simply
not worth it. And if you playyour cards right, you have nothing

(04:12):
to be concerned about. Sure,your issues might scale along with
your organization, but if youbuild the right safeguards into the
DNA of the organization versusthose that have been convicted in
this case, which they buildthe wrong incentives with the DNA

(04:32):
of the organization, what youseed now will scale in accordance
with your intention and yourincentives. If your main incentive
is to become amultimillionaire, then consider finance
or another industry becausenow really it's going to become more

(04:54):
and more restrictive, tell allit's going to get more and more scrutiny.
So that's really not thespotlight you want to be under. And
of course all of this causesan issue, meaning less and less access
for telehealth companiesseeking to do business with health
plans and less and less accessfor patients to actually benefit

(05:16):
from these telehealthcompanies. There are plenty of good
telehealth companies and onlya handful of bad actors. But payers
are tired. Payers are tired ofbeing burned. They're tired. I speak
with many plan executives,they embrace telehealth now they're
going to be looking forplatforms with real clinical governance,

(05:39):
real outcomes data and realvalue based infrastructure. This
actually benefits the goodactors because the company's investing
in longitudinal care,measurement based outcomes, behavioral
integration and compliance aregoing to be growing. Okay, now what
is the future? The future ofdigital health will be built on trust.

(06:03):
And trust is only possiblewhen your clinical model and your
business model are aligned.They're not in opposition, they're
not fighting one another. Thisis why value based care matters,
because you have that compass.You have the North Star of asking
a single question is what I'mdoing at this moment in the best

(06:23):
interest of the patients andthe answer should be a yes or no.
There's really no in between.And you would immediately and instinctively
know, right? By posing thatquestion is this in the best interest
of patients. You would knowwhether you're on the right track.

(06:44):
You would know whether you'redrifting away from value. When you're
accountable for total cost ofcare, patient safety, and outcomes,
you really can't affordshortcuts. Your incentives pull you
towards ethics, not away fromthem. Here's my message today. If
you're a founder, build yourcompany like you're already under

(07:05):
an audit. If you're a payer,demand clinical governance before
you demand scale. If you're aprovider, never let a business model
erode your judgment as anorganization. And if you're a patient,
understand that real care hasstructure, boundaries, and integrity.
This particular case will bestudied in business schools, medical

(07:26):
schools, and compliancetrainings for years. But if we're
smart, it will also become aturning point where digital health
finally shifts from. Fromspeed to substance, from value to
volume. And I would reallywant to echo that. There is an important
distinction between businessreality and clinical reality. And

(07:49):
as long as these two aremisaligned, the organization's on
a bad track. So as long asthere are efforts to align these
two, then the organizationwill continue to not only survive,
but thrive as otherorganizations are found to either
be no longer good partners todo business with, or found in some

(08:11):
federal indictment andsubsequent conviction and so forth,
like this particular case. Solet this be a cautionary tale and
let founders hold otherfounders accountable. Right, because
once an organization like thisgoes down, it becomes harder for
all others to do businessbecause now you have to defend another

(08:35):
organization's behavior andexplain how it is not what we are
doing at this organization.Thank you for listening. This is
Alex from the Value Based CareAdvisory podcast. Thank you.