My wife went to Aspen recently (we didn't know better). They told her that she had periodontal disease and needed an expensive procedure. She was shuffled into a "financing" room before even completing her checkup. While waiting, she Googled Aspen and figured out that this happens to oodles of people, declined, and went to another dentist. No problems detected.

In addition to being a scam organization, we got to see the group of people in the waiting rooms at Aspen vs our current dentist. As you can imagine, the folks waiting in the Aspen waiting room are observably less wealthy and are statistically going to be less able to defend themselves against medical scams.

Evil organization.

"Kool Smiles to pay $23.9 million" sounds like they're being punished?

They typically settle and sometimes pay a fine.

https://ag.ny.gov/press-release/2015/ag-schneiderman-announc...

I suspect they still make more profit than they lose in fines.

Having an unexpected cost and thereby not making a profit isn't actually a punishment - it makes the risk calculus a tame "I probably won't get caught", while the expected value remains positive. I realize I'm criticizing our entire enforcement philosophy for white collar crime here. But still, unless there are actual routine-disrupting punishments like jail time for violating basic professional responsibilities, we would expect unethical behavior to just continue increasing.

And this goes double for setups to make such violations "nobody's fault" like the creation of perverse incentive structures. In the context of blue collar crime, that's called a "conspiracy".