Let’s do more than talk tough
Medicaid fraud, which is both widespread and hard to detect, has become an obsession of law enforcement in some states. But not in Massachusetts.
State Auditor Suzanne Bump says she is determined to do something about that.
“I really have two concerns,’’ she said. “The reality of shrinking dollars demands that every dollar be accounted for and well spent, and my other concern is people’s confidence in government.’’
Since taking over as auditor this year from A. Joseph DeNucci, Bump has fired many longtime employees, reorganized the office, and is now turning her sights to neglected areas that cry out for more aggressive scrutiny. At the top of that list is Medicaid fraud, which is rampant in other states and might be in this one, too.
Pursuing Medicaid abuses fits that agenda in two ways. By many accounts, this is an area Massachusetts has done a poor job of policing, and, if the experience of other states is any indication, there is probably plenty to police, if you know where to look and can mobilize law enforcement agencies to cooperate in taking on this problem.
It isn’t that DeNucci ignored it. One audit uncovered $4.3 million in potentially fraudulent claims last year. His office also implicated a dentist who appeared to be performing multiple unnecessary X-rays on children, not only cheating the government, but endangering the health of his patients, as well.
Suspicion persists, though, that there is a lot more abuse out there, as Bump acknowledged in an interview. Also, collaboration with other agencies was never a DeNucci hallmark, even though it is critical to bringing criminal cases.
Bump has named a former prosecutor to head Medicaid fraud investigations, and she vows a closer working relationship with Attorney General Martha Coakley than her predecessor enjoyed.
“I determined right off the bat that we needed some new energy in the office and that it ought to be led by someone with a prosecutorial background, who could bring some new thinking to the office,’’ Bump said. “I think, as we work in a new way with better coordination, we are going to get much better results.’’
For another law enforcement perspective on Medicaid abuse, I talked to Chris Swecker. He is a former FBI agent who ran security for
“The new model is that you deal in data, you find vulnerabilities in the system, and exploit them,’’ Swecker told me. “The detection system is broken. You learn where the system can be beat, and you just systematically go after it.’’
“If you talk to analysts and investigators [in Massachusetts], they’re waiting for the phone to ring,’’ he said. “There’s a heavy reliance on waiting for the phone to ring.’’
Most of the fraud, in his view, is driven by providers who take advantage of loopholes in regulations to process claims that would be detected by more rigorous analysis. The better investigators become at analyzing large batches of data and looking at patterns, he insisted, the more abuse they will uncover.
“There’s a lot of low-hanging fruit,’’ he said.
Bump was not always the most impressive candidate last year, but she seems determined to shake up an office that was unaggressive even by State House standards. While Inspector General Gregory Sullivan has won high marks for aggressive investigations - his office first discovered the bizarre contract that brought down House Speaker Sal DiMasi - the auditor’s office has long seemed content to make few waves and fewer enemies.
Obviously, there’s a big gap between talking tough about investigations and actually making cases. But Medicaid fraud is certainly a battle worth fighting, however late Massachusetts is coming to it. “This isn’t just about money,’’ Bump said, and she’s right.
Adrian Walker is a Globe columnist. He can be reached at email@example.com.