What if the Senate confirmed a new HHS inspector general and no one knew?
On Aug. 3, the Democratic-led U.S. Senate confirmed the appointment of Janet Rehnquist as the new inspector general before leaving Washington for the summer recess. President Bush nominated Rehnquist, the 44-year-old daughter of U.S. Supreme Court Chief Justice William Rehnquist, for the post on June 1. Modern Healthcare disclosed the likely nomination two months earlier (April 9, p. 12). And on Aug. 8, Rehnquist was sworn into office.
However, neither Rehnquist; the U.S. attorney's office in Alexandria, Va., where Rehnquist worked as an assistant U.S. attorney; the inspector general's office; HHS itself; or the White House announced the confirmation. Though she's been on the job nearly two weeks, there has been no public acknowledgement of her confirmation or swearing in.
Why was there no announcement of what's being called a "stealth appointment"?
A spokesman for the White House said the president doesn't announce appointment confirmations.
Inspector general officials deferred comment to HHS, as did the U.S. attorney's office in Alexandria.
HHS spokesman William Pierce said the department doesn't routinely announce when appointments are confirmed or appointees are sworn in, even for high-ranking officials. "It's just not something we do," he said.
After her quiet swearing-in ceremony, Rehnquist began her new job as head of the federal agency charged with enforcing all Medicare and Medicaid statutes and regulations.
She replaced acting Inspector General Michael Mangano, principal deputy inspector general and second-in-command of the department, who assumed the top position when June Gibbs Brown retired late last year after seven years as inspector general. Brown was appointed by President Clinton and retired partly because of the change in administration and because of poor health.
When Brown was confirmed, HHS touted the former inspector general's vast experience as a previous inspector general with the U.S. Interior Department, Defense Department, the National Aeronautics and Space Administration and the U.S. Navy's Pacific fleet. That's in stark contrast to the confirmation of Rehnquist, who is the second child of a U.S. Supreme Court justice appointed to high-ranking federal posts by Bush. Earlier this year the Senate confirmed the nomination of Eugene Scalia, son of Justice Antonin Scalia, as solicitor of the U.S. Labor Department. Last December Justices Rehnquist and Scalia voted with the court's majority to deny a recount of the Florida presidential vote, effectively handing Bush the contested election.
Pierce denied that the department was keeping a low profile to avoid calling attention to the potential volatility of the selection.
"I suppose the Bush administration could be forgiven for downplaying the elevation of Supreme Court Chief Justice (William) Rehnquist's daughter to a significant political appointment," observed San Francisco whistleblower attorney Stephen Meagher of the firm Phillips & Cohen.
"I find the silence about her confirmation strange mainly because her appointment wasn't controversial," said healthcare defense attorney John Boese of the Washington firm of Fried, Frank, Harris, Shriver & Jacobson.
Rehnquist has served as assistant U.S. attorney in Alexandria since 1994. Although Rehnquist has prosecuted healthcare fraud for the U.S. attorney's office and is well regarded as a lawyer, she has limited managerial experience to administer a department with 1,500 employees and a budget of $163 million.
A number of healthcare lawyers contacted by Modern Healthcare politely declined to comment on Rehnquist's confirmation to the post, saying they have had and likely will have further dealings with HHS' inspector general's office.
Meagher said it's difficult to predict how the inspector general's office will approach healthcare fraud enforcement under Rehnquist.
"Those of us who practice in the area are hopeful that she will be able to resist what appears to be industry pressure to shift the focus away from fraud enforcement," he said.
Boese said the Bush administration is aware of the implications of naming the daughter of a chief justice to a high-level position.
"They know that being tough on healthcare fraud plays very well in the public arena, and this administration was elected with less than a majority," he said. "I don't think (the Bush administration) has figured out what its position should be on pushing the envelope on healthcare fraud. I do know that Janet Rehnquist had a reputation as a very good and aggressive prosecutor, and I expect she'll be very tough on healthcare fraud."
Rehnquist previously served as associate counsel to the president in the White House during the first Bush administration. She also served as counsel to the permanent subcommittee on investigations for the U.S. Senate and worked with the Washington law firm of Baker & Hostetler.