Questions Arise Regarding HHS OIG’s Involvement in Medicare Dispute

In the latest "controversy" involving HHS Inspector General Janet Rehnquist, the AP/New York Times reports that Rehnquist intervened in a legal battle between two medical societies and Medicare regulators, even though the Office of Inspector General was not directly involved in the case. In the case, the American Lithotripsy Society and the Urology Society of America were challenging a decision by Medicare to strictly regulate payments to doctors who own lithotripsy machines, used to break up kidney stones noninvasively. Such doctors fall under reimbursement restrictions for physicians who have a financial interest in their own referrals, Medicare regulators determined. Thomas Buchanan, a personal friend of the inspector general's and a lawyer representing the societies, wrote Rehnquist in August asking for her assistance in the case and stating that the societies would sue HHS if it was not settled. According to current and former inspector general officials, Rehnquist asked OIG legal staff to try to settle the dispute but did not order staff members to take a particular position and did not attend the settlement meeting, which involved her staff members and lawyers for Medicare and the medical societies. The AP/Times reports that other officials and former inspectors general said that prior to this case, OIG "would have shunned involvement in such a matter" and would have advised the parties to bring complaints directly to Medicare regulators. But Ben St. John, a Rehnquist spokesperson, said that the inspector general acted "in the government's best interest." The HHS OIG is tasked with investigating fraud and abuse in Medicare, Medicaid and other government welfare programs (AP/New York Times, 12/26/02). The General Accounting Office is investigating the concerns of several senators that widespread personnel changes impacted operations at the OIG, as well as an OIG audit of a Florida government pension fund and alleged shredding of OIG documents (Kaiser Daily Health Policy Report, 12/12/02).