In a long-expected nomination that may provide some sparks in the newly Democratic-controlled U.S. Senate, President Bush has tapped Janet Rehnquist, the daughter of Supreme Court Chief Justice William Rehnquist, to serve as HHS' inspector general.
Janet Rehnquist, 44, has been an assistant U.S. attorney in Alexandria, Va., since 1994. A trial lawyer and litigator who has prosecuted healthcare fraud cases, she has limited managerial experience. As HHS' inspector general, she would supervise nearly 1,500 employees and oversee a budget of $163 million for a department with great power over healthcare providers and their business practices.
Modern Healthcare disclosed Rehnquist's likely nomination in April (April 9, p. 12).
The inspector general's office helps enforce civil antifraud laws in federal healthcare programs and negotiates with providers on settlements, including corporate integrity agreements. It has the authority to issue civil monetary penalties and exclude providers from Medicare and Medicaid. The office also collaborates with a wide array of federal prosecutors and investigators on healthcare fraud investigations.
If confirmed, Rehnquist would replace acting Inspector General Michael Mangano, who took over following the departure earlier this year of veteran Inspector General June Gibbs Brown.
Healthcare lawyers who know her praise Rehnquist's skills as a prosecutor.
HCFA Administrator Thomas Scully, former president of the Federation of American Health Systems, said he's known Rehnquist for 20 years, attended college with her at the University of Virginia and looks forward to working with her again.
"She is an incredibly smart lawyer and nice person," Scully said. "She will be a terrific partner at the office of the inspector general."
But some health lawyers, who asked to remain anonymous, questioned her qualifications to lead a large, complex bureaucracy.
They pointed out that her nomination is the second in the past two months involving a child of a Supreme Court justice who voted to deny a recount of the Florida presidential vote last December. The court's majority vote to deny the recount effectively handed Bush the presidency.
Earlier this spring the Senate confirmed Eugene Scalia, son of Supreme Court Justice Antonin Scalia, as solicitor of the U.S. Labor Department.
Besides the clout of her father, Rehnquist has the backing of Virginia Gov. James Gilmore III, national chairman of the Republican Party. Also in her corner is Timothy Flanigan, deputy counsel to President Bush, with whom Rehnquist served during the first Bush administration as associate counsel to the president.
Flanigan has been on the other side of the courtroom from Rehnquist in recent years while he was with the Washington law office of White & Castle.
"Not only is she very, very smart, but she has a good understanding of the essence of the Medicare program and a really good sense for what (constitutes) fraud," Flanigan said. "She has a good nose for distinguishing what is bad behavior from what everyone would agree is some poor doctor or provider trying to comply and getting it wrong."
Flanigan said it's common with a change in presidential administration for political appointees to be thrown into managing large organizations without prior experience.
"I try to look at the qualities the person brings to the table. Janet is aggressive in asking questions but not confrontational, a really good listener not given to snap judgments. She's someone who builds consensus and respects other people, and I think that's the essence of managing a diverse and complex organization like that office," he said.
Flanigan said nepotism played no role in Rehnquist's nomination. He said her record in prosecuting Medicare fraud cases and her years in public service would more than qualify her for the job.
"She is not derivative of her father's position and certainly not related to anything with the Supreme Court decision last December," he said. "It was the furthest thing from anyone's mind that they would reward the chief justice for last December's decision on the Florida elections," Flanigan said. "It's just preposterous."
A spokeswoman for the American Medical Association refused comment and a spokesman for the American Hospital Association could not be reached by deadline.
Rehnquist has also served as counsel to the permanent subcommittee on investigations for the U.S. Senate and worked with the Washington law firm Baker & Hostetler.
Rehnquist confirmation hearings have not been scheduled.