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Fraud enforcement should rely on algorithms, not assault rifles


There is a lot of discussion lately about who should and shouldn't have a gun. President Barack Obama says fewer people should have guns--specifically "criminals and dangerous people," the New York Times notes. Second Amendment supporters have distinctly different concerns about government overreach when it comes to gun ownership. All in all, it has all the makings of a nice, reasonable dinnertime conversation.

That's why I found it interesting that amid a barrage of gun violence viewpoints, there was a tiny discussion going on in some corner of the country about how state law enforcement agents are armed, specifically those who investigate white-collar crimes like healthcare fraud.

Texas Gov. Greg Abbott is taking some heat (sorry, easy pun) for his longstanding approach to arming investigators and law enforcement officials within the state Attorney General's Office. As attorney general, Abbott expanded the department's armed police force to 160 commissioned officers. He also pushed for more weaponry and tactical gear, including assault rifles and hollow-point bullets. The Attorney General's Office spent $134,000 over the last five years on ammunition alone, but agents fired a gun just once in that time period, and it had nothing to do with a fraud investigation, according to the Dallas Morning News.

Critics say the burgeoning police force and growing arsenal of weapons means more time and money devoted to training. Former Assistant Attorney General Rod Boyles told the paper this approach is "dumbing down" investigations.

"We actually do nothing," the former deputy director of the Medicaid Fraud Control Unit told the paper. "We spend so much time just doing standard peace officer training, firearms training, safety training."

Now, thanks to a new bill passed in September, 158 commissioned officers are set to receive significant raises that will cost taxpayers a projected $17 million over the next five years.

It's more than a little ironic that some are questioning the spending of a department that applies a similar level of scrutiny to payments made to healthcare providers. Suddenly, the tables have turned, and now the Attorney General's Office is facing a familiar question: Is this payment really necessary?

It some ways it is. Since 2010, healthcare fraud has become an increasingly dangerous endeavor thanks to an infiltration of gangs that boast a history of violent crimes. In 2010, Chief Counsel of the Office of Inspector General Lewis Morris told the House Subcommittee on Health that "the Medicare program is increasingly infiltrated by violent criminals," and fraud investigators have "seized weapons and ammunition, including assault rifles, submachine guns and handguns, as well as bulletproof vests" during raids.

A year later, Inspector General Daniel R. Levinson echoed similar concerns in testimony for the Senate Committee on Finance. He pointed specifically to a $163 million scheme involving an Armenian-American organized crime ring that "used violence and threats of violence to ensure payments to its leadership."

This new breed of fraud justifies the need for a new level of law enforcement, but the level at which the Texas Attorney General's Office is operating appears to be more than just unnecessary--it's distracting. When it comes to uncovering fraud, that time spent at the firing range is likely better spent in front of a computer, or leafing through billing claims. And the money devoted to ammunition and training would be better spent on predictive analytics programs that can uncover questionable billing claims at a faster clip than any assault rifle.

It's worth noting,o, that fraud investigators are relying increasingly on partnerships with other enforcement agencies. It seems to me the Texas Attorney General's Office would be better served coordinating its investigative efforts with other agencies that already use officers with tactical training when they know a scam involves a dangerous target.

As I read through the statistics and financial figures in Texas, I couldn't help but think of just about every picture I've seen accompanying a healthcare fraud raid. The investigators look more like movers than SWAT team members as they carry out boxes of medical files. Their most well-worn tool is usually a dolly, while their guns remain holstered at their hips. - Evan (@HealthPayer)