Interview with Senior AAG Thomas Worboys

To research our recent article, “The Cost of U.S. HealthCare is Prohibitive. Anti-Fraud Initiatives Can Slash Costs,” The Daily Muck interviewed Senior Assistant Attorney General (AAG) Thomas Worboys. AAG Worboys serves as the Director of the Medicaid Fraud Control Unit in the New Hampshire Department of Justice.

The Daily Muck: What cooperation efforts are occurring between federal and state entities to combat medical fraud? Would you like to highlight any recent significant operations or future plans in response to joint or state efforts?

AAG Worboys: The cooperation among federal and state agencies to combat healthcare fraud is extensive. My work involves Medicaid fraud, which is a joint federal and state program that gives health coverage to people with limited income and resources, whereas Medicare is, generally speaking, federal health insurance for anyone age 65 and older. The federal government has an equal 50/50 financial stake in New Hampshire Medicaid, and because fraudsters don’t care whether they’re stealing from Medicaid, Medicare, Tricare, private insurers, or people paying out of pocket, the various state and federal law enforcement agencies are united in achieving a common goal.

The New Hampshire Attorney General’s Office contains a Medicaid Fraud Control Unit (MFCU), which is just one of 53 MFCUs nationwide. MFCUs investigate and prosecute Medicaid provider fraud, as well as abuse or neglect of residents in health care facilities and board and care facilities and of Medicaid beneficiaries in noninstitutional or other settings. The MFCUs are mostly federally funded, and the United States Department of Health and Human Services Office of Inspector General (OIG) is the federal agency that oversees and annually recertifies and approves federal funding for each MFCU. The support we’ve received from OIG over the years has been fantastic, and efforts from the MFCUs last year collectively resulted in $1.2 billion in criminal and civil recoveries.

The Daily Muck: Do you have an estimate of how much medical fraud costs the State of New Hampshire annually?

AAG Worboys: Nobody can say for certain what the cost of health care fraud is to the health care system, but HHS estimated a combined national total of over $100 billion in improper payments in the Medicare and Medicaid programs in fiscal year 2023. In 2023, Medicare spent over $1 trillion to provide health care services for approximately 66 million elderly and disabled individuals, and state Medicaid programs spent approximately $849 billion, so for every dollar spent, roughly five cents were lost to fraud, waste and abuse. To the best of my knowledge, the loss to New Hampshire Medicaid from fraud, waste and abuse has never been quantified, but given that the annual Medicaid budget is over $2 billion, the cost of fraud, waste and abuse to New Hampshire Medicaid annually could be as high as $100 million.

The Daily Muck: How should Medicare recipients respond to phone calls soliciting their Medicare information, including account numbers?

AAG Worboys: Just last month, Attorney General Formella issued a Consumer Alert for New Hampshire residents, especially New Hampshire Medicare recipients, warning of scammers posing as Medicare representatives to obtain personal identifying information. The full Consumer Alert is available at www.doj.nh.gov, but briefly, to protect yourself from Medicare fraud:

• Do not answer calls from numbers you do not recognize.
• If you receive a voicemail from someone claiming to be a representative of Medicare, do not return the call using the number provided. Call 1-800-MEDICARE (1-800-633-4227) for all Medicare-related inquiries.
• Treat your Medicare card like a credit card and only give your Medicare number to your health care providers, your health insurance company, and people you trust that work with Medicare, such as your State Health Insurance Assistance Program; and
• Never provide personal identifying information such as account numbers, Social Security numbers, mother’s maiden names, passwords, or any other self-identifying information in response to a call you are not expecting.

If you or someone you know has fallen victim to this or another scam, you should immediately report it to your local police department and the Consumer Protection and Antitrust Bureau of the Attorney General’s Office at (603) 271-3641.

The Daily Muck: What else should people know about medical/Medicare fraud?

AAG Worboys: Health care fraud is not a victimless crime. We, as taxpayers, fund our health care programs, and when funds are lost to fraud, waste and abuse, it affects us all. We take proactive steps to detect, investigate, and prosecute health care fraud, but many of our most successful investigations and prosecutions start with a tip from the public. Check your explanation of benefits (EOB) regularly, and make sure the dates, locations, and services billed match what you actually received. If there’s a concern, you should contact your health insurance provider, and if that provider is New Hampshire Medicaid, you should contact the Attorney General’s Office. You can reach the Medicaid Fraud Control Unit by telephone at (603) 271-1246 or by e-mail at mfcu@doj.nh.gov.