Thomas is the Inspector General for the Department of Health and Mental Hygiene for the State of Maryland. As the watch-dog for the entire department, Mr. Russell’s office has two main responsibilities: 1. the investigation of fraud, waste, and abuse in the state’s Medicaid program, and 2. the internal audit of state employees and contractors who do business with the department.
Transcript
>> This is Tom Russell, Office of the Inspector General, may I help you? My name is Thomas Russell. I'm there inspector general for the Department of Health and Mental Hygiene for the state of Maryland. My responsibility as inspector general is the watch dog for the Department of Health. We have 2 sections within the department of the office of of the inspector general. We do fraud waste and abuse investigations and the Medicaid program. And we also conduct audits, internal audits and investigations of employees, contractors, et cetera. For persons that are going to business with the Department of Health and Mental Hygiene. We've all cases of our own employees that set up fictitious providers over a 10 year period. We had 1 employee that had stolen 2 million from us and one of our programs. That was referred to us anonymously. Our auditors and investigators looked into it. That person was prosecuted. They got to testify, certainly, in court. And receive prison terms and restitutions. We work very closely with prosecutors and the attorney general's office. That actually prosecute these cases criminally and civilly under the False Claims Act. Our investigators attend regional task forces that were members along with the FBI and other law enforcement agencies of our tri-state area. Virginia, Pennsylvania, Delaware, and the D.C. area. Many healthcare providers will upcode a service when a lesser service was actually performed. So we do those types of reviews, too. And with companies, we've had multi, multimillion dollar settlements that we're involved with that occur with large pharmaceutical firms. As I said, large laboratories, integrated health systems, et cetera. All the way down to maybe a social worker who is billing for hours of counseling that they didn't provide or inflating those hours. But that too can get into healthy 6, 7 figure settlements. On a criminal side, jail is certainly an option. And they do get that and restitution is has to be paid through the courts. Through a probation, parole type of situation. But what the states and the Federal Government is more interested now because of the amount of money is getting that money back. If it goes either the civil or criminal route, our investigators, auditors, clinicians, will testify in court. They are the experts that the prosecutor will rely on to demonstrate what, in fact, happened.
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