Anna Fifield from the Washington Post reported on April 25 that the North Korean government insisted U.S. officials sign a pledge to pay a $2 million medical bill for treatment of the U.S. student Otto Warmbier before they were permitted to bring the young man home in June 2017. The story struck most Americans as particularly outrageous because the health problems for which he was being treated were the direct and sole result of his imprisonment and ill-treatment by North Korean security officials.

The presentation of a medical invoice and the demand that the United States make a payment has been done in a number of cases involving U.S. detainees in the past. Kenneth Bae, a U.S. citizen who was one of the longest detained Americans (November 2012-November 2014), was surprised when he was told as he was flying back to the United States that the North Korean government had not presented a medical bill. According to Bae’s own calculations, his bill would have been over $300 thousand dollars for the medical treatment he received during his two years in prison there. (Kenneth Bae, Not Forgotten , p. 234-235.)

The real question is why Anna Fifield’s Washington Post story about the $2 million medical bill is being reported now—nearly two years since Otto Warmbier was brought back to the United States. Fifield does not identify the source for the account of the North Korean government’s demand for a signed pledge from the United States to pay the hospital bill, but she reports in her initial story that the State Department’s public affairs spokesperson and former Ambassador Joseph Yun, who headed the United States delegation that brought Otto Warmbier back to the United States, both refused to comment for her initial story.

In response to media queries following the appearance of Fifield’s piece, White House press secretary Sarah Huckabee Sanders said: “We do not comment on hostage negotiations, which is why they have been so successful during this administration.” The story was apparently of sufficient concern to the president that he issued a passionate 4:12 AM tweet on April 26: “No money was paid to North Korea for Otto Warmbier, not two Million Dollars, not anything else.” When the president spoke with the press before boarding Marine One later that same day, he again emphatically denied that any money was paid for the return of the U.S. student.

The intensity of Trump’s denial is probably the result of numerous headlines pointing to the president as having agreed to pay the medical bill. For example, CNBC said, “Trump reportedly approved a $2 million hospital bill from North Korea for Otto Warmbier,” andReuters noted, “Trump approved payment of $2 million North Korea bill for care of Warmbier.”

The day after the first Fifield story appeared in the Washington Post, a second article was published, which reported Trump’s denial that the bill was paid. She also was able to get comments from Ambassador Joseph Yun, who as we noted earlier was the senior U.S. official sent to Pyongyang to bring Otto Warmbier back to the United States. According to Fifield’s first article, Yun had requested authorization from Secretary of State Rex Tillerson to sign the commitment to pay the $2 million hospital bill as required by the North Korean government in order for Warmbier to return, and that was apparently approved by the Oval Office. Ambassador Yun reiterated that in an interview with CNN.

There is reason to believe that the United States government has not paid the bill. According to Fifield, the bill went to the Treasury Department, where she was told that it was not paid during 2017, though it is not clear if it was later paid. The president was quite vehement in insisting that the bill has not been paid, though his personal reputation for telling the truth still leaves some doubt. Fred Warmbier, Otto’s father, said he was never told about the hospital bill, which he called a ransom demand from Pyongyang.

U.S. policy says that medical and other expenses incurred by U.S. citizens traveling abroad are the responsibility of the individuals involved. The Office of U.S. Citizen Services at the Department of State can help Americans who encounter legal or other problems when traveling abroad, but that service is limited to providing information (a list of English-speaking attorneys, a visit to U.S. citizens being held by foreign police authorities, providing information upon request to family members about an American being held, help in transferring funds from the United States, and such). United States law and policy does not provide funds for paying legal fees, medical bills, fines or other charges for Americans who encounter problems while traveling abroad for personal reasons.

Unfortunately, the situation is more complicated when it comes to North Korea and other countries where U.S. citizens have been held hostage. In the case of Iran in 1979-1981 where 52 U.S. diplomats and other U.S. citizens working with the embassy there were held hostage for more than 14 months after a group of radical Iranian college students associated with the Iranian Revolution took control of the U.S. Embassy in Tehran. In that instance, the United States was directly involved in seeking their release.

With North Korea, however, the circumstances involving U.S. citizens being detained has been somewhat less clear cut. U.S. citizens have been detained for violating North Korean laws, but those laws are frequently unusually harsh and not consistent with legislation in most other countries in the world. Otto Warmbier, for example, was accused of attempting to steal a framed political poster which displayed a statement by Kim Jong-il. In the United States, a similar such action would be considered a misdemeanor subject to a minor fine. In North Korea, his action was considered a hostile political act and a serious crime against the state. He was sentenced to prison for 15 years at hard labor.

The United States does not have diplomatic relations with the North Korean government, and neither country has diplomatic representatives in the other’s capital. Because circumstances involving North Korea are unique, the detention of U.S. citizens almost always involves the difficult political relationship between Washington and Pyongyang. Such cases require the U.S. government’s direct involvement by the United States with the North Korean government in efforts to secure the release U.S. citizens held there. Former or current senior U.S. government officials have almost always been involved in the release of Americans detained by North Korea, including visits to Pyongyang to secure the release of Americans by former presidents Bill Clinton in 2009 and Jimmy Carter in 2010. (As U.S. Special Envoy on North Korean Human Rights Issues, in May 2011, I negotiated the release of a U.S. citizen being held.)

The fact that the release of detained U.S. citizens often requires the involvement of high-level government officials clearly indicates a significant political component in the decision by Pyongyang to detain U.S. citizens. (For a list of Americans held in North Korea, see “U.S. Detainees in the DPRK” by the National Committee on North Korea, which has a good summary of Americans detained from 1994 through October 2014; “Wikipedia’s List of foreign nationals detained in North Korea” includes a listing of individuals detained through the present, though it has fewer details.)

Why does North Korea detain U.S. citizens? Why does it engage in the petty thuggery of arresting and detaining U.S. citizens and charging some Americans huge hospital bills for medical treatment that was required because of how they were treated while they were imprisoned?

First, North Korea is a corrupt mafia state. Bribes, corruption, and crime are key to understanding the Kim regime, now with its third generation family “godfather.” Inflated medical bills are simply a way to pick up extra cash, and totally consistent with the corrupt mode of operation in Pyongyang. Some of these inflated bills have not been paid, though some probably are have been.

Second, detaining visiting U.S. citizens is a way for Pyongyang to irritate Washington and demonstrate Pyongyang’s ability to provoke the despised U.S. superpower, which has prevented the North from achieving its goal of forcible reunification since 1950. Because of families’ concern for detained Americans being held at Pyongyang’s mercy, the administration and members of Congress are pressured to deal with North Korea to end the individual imprisonments. The media, of course, loves the controversy and conflict. Thus, North Korean keeps needling and harassing the U.S. diplomatic agenda by mistreating U.S. citizens.

The bottom line is that the detention of U.S. citizens in North Korea is part of a corrupt effort to increase the regime’s perceived standing, to garner international attention, and even to make a bit of money from excessive hospital fees. It serves to emphasize again the Mafiosi nature of this rogue regime.