After the release earlier this month of a General Accounting Office report critical of former HHS Inspector General Janet Rehnquist, health lawyers and congressional aides said her replacement would be under even greater scrutiny in the already highly visible post.
They said the next inspector general, who oversees the civil enforcement of all Medicare and Medicaid regulations and statutes, will need astute political skills and a solid record of accomplishment in law enforcement, fraud and abuse law or as an inspector general for another federal agency.
In light of the heightened congressional oversight, healthcare providers can expect a stronger antifraud message from the new inspector general. Senate Finance Committee Chairman Chuck Grassley (R-Iowa) has suggested he wants someone who will attack Medicare and Medicaid fraud like a "junkyard dog" in the inspector general's position and likely will hold that officeholder's feet to the fire.
"The new inspector general will take that office's mission very seriously to ferret out waste, fraud and abuse," said Howard Young, a former attorney with the inspector general's office, now in private practice with the Washington office of Sonnenschein, Nath & Rosenthal. "The inspector general will very publicly send a message that defrauding federal healthcare programs in this post-Enron, HealthSouth era will be prosecuted aggressively."
At the same time, Young said, he hopes that the agency's focus on industry guidance, compliance and outreach will continue.
After a 19-month tenure that was marred by allegations that she was soft on fraud enforcement, lacked political independence and was prone to external pressure, Rehnquist, 45, announced in March she planned to resign June 1 to spend more time with her family. HHS Secretary Tommy Thompson announced May 30 that Dara Corrigan, 37, director of program integrity at the Centers for Medicare and Medicaid Services, would replace Rehnquist on an interim basis. Thompson has not announced who will permanently fill the position, which requires presidential nomination and Senate confirmation.
The daughter of U.S. Supreme Court Chief Justice William Rehnquist came under fire over the last nine months of her tenure from Grassley and former Senate Finance Committee Chairman Max Baucus (D-Mont.), who questioned her independence and leadership. They ordered the GAO to perform a study of her job performance.
The GAO released the 55-page report on June 10, faulting Rehnquist, a former assistant U.S. attorney in Alexandria, Va., for lapses in judgment. The GAO cited several multiple incidents of Rehnquist's alleged misconduct that compromised her ability to lead the department. It found Rehnquist:
* Delayed a politically sensitive pension audit in Florida until after the election of Gov. Jeb Bush.
* Ordered her former chief counsel, Mac Thornton, to "get rid of this case," referring to a fraud settlement with York (Pa.) Hospital that eventually was settled for one-third of what Rehnquist's lawyers said the case was worth after two U.S. senators from Pennsylvania and one congressman lobbied her.
* Oversaw sweeping senior management changes resulting in the resignation, reassignment or retirement of at least 20 high-ranking inspector general staffers.
* Inappropriately possessed a firearm in her office and obtained law enforcement credentials to which she was not entitled.
"During her tenure, the inspector general took a number of actions that damaged her credibility and ultimately created an atmosphere of anxiety and distrust within certain segments of the Office of the Inspector General," the report concluded. GAO investigators interviewed more than 200 current and former employees of the inspector general's office and examined 8,000 pages of documents to prepare the report.
Meanwhile, Rehnquist's temporary and possibly permanent replacement received high marks from the private health bar.
Kevin McAnaney, who formerly headed the industry guidance section of the inspector general's office and is now in private practice in Washington, said Corrigan is a "terrifically talented attorney who probably knew more about healthcare fraud law than any of her predecessors when they came in."
While he conceded that she hasn't previously supervised an agency of 1,600 employees and a budget of $170 million, McAnaney said Corrigan has served as an assistant U.S. attorney in Washington, in the civil division of the U.S. Justice Department, as deputy chief counsel at HHS and director of program integrity for the CMS.
"The person who succeeds in this position must have demonstrated knowledge of fraud and abuse and the Medicare programs and possess the gravitas and credibility to be taken seriously both on Capitol Hill and in the fraud-enforcement community," said McAnaney, who worked with both Rehnquist and Corrigan.
He said to restore morale and credibility, Rehnquist's successor must demonstrate political independence and the ability to stand up to powerful interests.
Rehnquist herself offered advice to her eventual successor.
"Keep in mind whom you work for-the taxpayer," she told Modern Healthcare last week. "The GAO report shows that over the past two years the OIG increased taxpayer savings dramatically to a record of almost $22 billion."
In Rehnquist's two-page written response to her critics, included in the final GAO report, she defended her administration and painted a sunny picture of her tenure there, citing the increase in cost savings to HHS and a survey indicating that morale remained positive.
"The GAO report consists largely of opinions, speculation, hearsay and pre-determined conclusions not supported by the weight of the evidence," she said.
Baucus said the next inspector general must be fair, firm and put the interests of taxpayers and program beneficiaries above all else, including politics. "The GAO's report confirms that Ms. Rehnquist was not the right person for this crucial job," he said.