Last week, President Donald Trump named Rene Alexander Acosta to be his new Labor secretary pick.
Some benefits lawyers glanced at Acosta’s biography and assumed that he must not know much about health insurance.
Acosta has a bachelor’s degree and a law degree from Harvard.
He served as a member of the National Labor Relations Board from 2002 to 2003; as the assistant attorney general for civil rights at the U.S. Department of Justice from 2003 to mid-2005; and as the U.S. attorney for the Southern District of Florida from mid-2005 to mid-2009.
Since 2009, he’s been the dean of the Florida International University law school.
Trump nominated Acosta to be his Labor secretary after Andrew Puzder, a California fast-food chain executive, withdrew his name from consideration.
Many news organizations have covered Acosta as if he is just a mild-mannered law school faculty member who apparently knows something about Americans with Disabilities Act compliance.
In reality, from 2005 through 2009, while Acosta was the U.S. attorney for the Southern District of Florida — the top federal prosecutor for the region that includes Miami, and all of the federal crime that occurs in Florida from Key West up past West Palm Beach — he started the country’s first health care fraud task force.
While Acosta was managing the effort to prosecute Jack Abramoff for fraud and major cocaine importers for importing cocaine, he was also leading an effort to charge about 700 people with $2 billion in health care fraud, or about $1,900 in fraud per Medicare enrollee in South Florida.
Related: Medicare fraud attracts gangsters
Acosta testified in 2011 at a House Energy and Commerce oversight subcommittee hearing that, in 2008, his district accounted for 32 percent of the country’s health care fraud investigations.
Knowledge of health care claim fraud could be useful to a Labor secretary, because the U.S. Department of Labor is the parent of the Employee Benefits Security Administration. EBSA oversees group health benefits and other employee benefits, such as group disability insurance. Acosta may not be a specialist in the Employee Retirement Income Security Act, but he knows plenty about something that may be even more important to the plan sponsors, administrators and insurers: minimizing waste, fraud and abuse.
Here’s a look at some of what Acosta knows and has said about fraud against Medicare, Medicaid and private health insurance programs, based mainly on testimony from a 2011 House hearing and from testimony at a 2008 hearing on Medicare and Medicaid fraud organized by the Senate Special Committee on Aging.
In 2003, Acosta faced Ted Kennedy, Orrin Hatch, Jeff Sessions and other senators at a nomination hearing for a Justice Department post in the George W. Bush administration.
To become Labor secretary, Acosta needs to get a majority vote in the Senate, at a time when Democrats are facing intense pressure from constituents to vote against all Trump nominees, and a few Republican senators are crossing party lines to vote against some nominees.
Acosta has already gone through Senate confirmation processes to serve on the National Labor Relations Board, to become the assistant attorney general for civil rights, and to become the U.S. attorney for South Florida.
In 2003, when Acosta was on his way to becoming the assistant attorney general for civil rights, the members of the Senate Judiciary Committee panel that reviewed his nomination included Orrin Hatch of Utah, who is still serving in the Senate, and the late Ted Kennedy. Another member of the panel was Jeff Sessions of Alabama, who just been confirmed as Trump’s attorney general.
Sessions asked Acosta about ways to protect voters’ rights while speeding up the Voting Rights Act claim review process.
Acosta’s health care fraud fighters fought hard to get access to unidentified Medicare claim data. (Image: NASA)
2. Claim data
Acosta testified at the 2011 Medicare and Medicaid hearing that the South Florida health care anti-fraud office was as productive as it was because it had persuaded Medicare program managers to provide access to Medicare claim data, with the patient names stripped out.
The office hired a nurse practitioner to go through the data and look for billing spikes.
Related: Dealing with the Data
Acosta has been a major advocate for increased use of predictive analytics in health care anti-fraud efforts. (Image: Thinkstock)
Acosta testified at the 2011 hearing that health care fraud investigators need predictive analytics tools, or statistical data, to look for unusual billing patterns.
“[With]credit cards, if your spending patterns deviate at all, they call you up,” he said, according to the hearing transcript. “Why can Medicare not do the same thing?”
Acosta said a health care program, insurer or vendor has to screen the claims before the claims are paid.
Acosta’s fraud fighters used a wheelchair to show members of Congress and others what they were doing. (Photo: Thinkstock)
4. Visual aids
Acosta testified at the 2011 hearing that he likes to bring members of Congress and others along on health care fraud-fighting ride-alongs, and that he likes to show guests a wheelchair stored in the fraud-fighting unit’s facility.
“The wheelchair was billed again and again and again,” Acosta said. “The same wheelchair not used by patients. We call it the million-dollar wheelchair, because it was billed that many times.”
In another case, Acosta said, his office had a picture of a “pharmacy” that was supposed to be selling large numbers of brand-name asthma inhalers.
“In fact,” Acosta said “the pharmacy was a broom closet. There was nothing there.”
Some of the South Florida health care fraud battles involved requirements for long-term care providers. (Photo: Thinkstock)
5. Long-term care facilities
At the 2009 Senate hearing, Acosta talked about federal Medicaid standards for nursing homes and assisted living facilities. He described efforts to market antipsychotic drugs to nursing homes for off-label uses, and efforts to identify and investigate long-term care facilities “that provide services so substandard as to constitute worthless services and constitute a complete ‘failure of care.’”
Acosta’s anti-fraud team handled complaints about HIPAA privacy violations. (Image: Thinkstock)
The Health Insurance Portability and Accountability Act of 1996 includes provisions that were supposed to support efforts to fight health care fraud, protect patients’ privacy, and improve health data security.
At the 2009 and 2011 hearings, Acosta did not talk about the HIPAA data security provisions, but he did talk about the HIPAA fraud-fighting and patient privacy provisions.
In 2009, for example, Acosta said that the U.S. attorney’s office in South Florida worked with the U.S. Department of Health and Human Services Office for Civil Rights on prosecuting criminal HIPAA privacy violations.
Acosta made a point of mentioning private health insurers at the 2009 hearing. (Photo: Thinkstock)
7. Private health insurers
Both Democrats and Republicans in Washington often talk as if health insurers are a necessary evil, and they sometimes seem to have a hard time understand the insurers’ point of view.
Acosta testified at the 2009 and 2011 hearings that his office worked regularly with private health insurers, because health care fraud schemes frequently affect private health insurance plans.
Acosta quoted data from the National Health Care Anti-Fraud Association, group that includes private insurers along with government officials, and he noted that his office ran working groups that included health insurance investigators.
Have you followed us on Facebook?