The Right Prescription

Donald Berwick’s Replacement

Marilyn Tavenner is a woman with a past.

By 12.2.11

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Oscar Wilde famously wrote, "I like men who have a future and women who have a past." We can thus assume that, were he with us today, he would turn up his nose at Donald Berwick and offer Marilyn Tavenner his most charming smile. This is Berwick's last day as Administrator of the Centers for Medicare and Medicaid Services (CMS), and Tavenner is his replacement. If it's not obvious why Wilde would beam on the latter, it soon will be. First, however, it's necessary to recall a sentence from Obama's first address before a joint session of Congress. During that speech he talked a lot about fraud. He was particularly effusive about his intent to end the widespread bilking of government health care programs: "We will root out the waste, fraud, and abuse in our Medicare program that doesn't make our seniors any healthier."

Still confused? Well, Marilyn Tavenner is a former executive of Hospital Corporation of America (HCA), which was responsible for the largest single example of Medicare fraud in history. As the Boston Globe reports, "While Tavenner worked for HCA, the company was busily enhancing its profit margin by defrauding the Medicare, Medicaid and TRICARE systems." HCA ended up paying nearly $1.5 billion in fines before the smoke cleared. CMS falls under the aegis of HHS and, as its administrator, Tavenner would work with the Office of Inspector General in fraud cases. Thus, as the Globe points out, "It hardly seems wise to put her in charge of the government system her company helped defraud." And yet Tavenner is the President's nominee to replace Donald Berwick.

There is no indication that Tavenner was directly involved in HCA's billing skullduggery. However, after the Berwick controversy, it's surprising that even the famously tone deaf Obama would nominate someone with such problematic ties to the industry she will regulate. These ties have also been ignored by most major media outlets, whose coverage of Tavenner has consisted primarily of puff pieces focusing on her early years as a nurse. This contrasts sharply with the coverage received by Republican Rick Scott, who was the CEO of HCA during the investigations. Scott was never implicated in the fraud scheme either. But it did happen on his watch, and every "news" story written about him while he was running for Governor of Florida insinuated that he was somehow involved in the fraud.

Obama's tone deafness and disparate treatment of Scott and Tavenner by the media are less important, of course, than the latter's likely policies as the head of CMS. Unfortunately, there is little comfort to be gleaned from the record. For example, as Deputy Principal Administrator of CMS, Tavenner had responsibility for the Center for Consumer Information and Insurance Oversight (CCIIO) and its director, Steve Larsen. If this bureaucracy and its director sound familiar it is because they were the fount from which the infamous Obamacare waivers spewed forth. And the CCIIO continues to ignore congressional requests to provide the criteria by which its decisions to grant the waivers were made. In other words, that supreme symbol of corruption and bureaucratic arrogance answered to Obama's new nominee to head CMS.

If the high-handed behavior of the CCIIO is a harbinger of things to come, the only real difference between Marilyn Tavenner and Donald Berwick is that she didn't run her mouth as much as he did before leaving the private sector and going to work in government. After leaving HCA, she joined the administration of Virginia's Democrat Governor Tim Kaine as the Old Dominion's Secretary of Health and Human Resources. She left that position when Republican Bob McDonnell replaced Kaine and joined CMS as Berwick's deputy in February of this year. Despite her obviously important role at CMS and her direct connection to the controversial CCIIO, she has managed to keep a low profile. This, and her ability to survive the HCA scandal unscathed, suggests that she is more politically savvy than Berwick.

There is no sign, however, that she holds different views than her controversial predecessor. She spoke to the National Association of Medicaid Directors last month and echoed refrains often heard from Berwick. Her position on giving the states control of their own Medicaid programs, which are funded by state as well as federal funds, is virtually identical to that of the good doctor: "That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above." In reality it won't necessarily force them to do any of these things. It would, however, allow the states to develop creative ways of covering the poor, reduce administrative costs, and reduce the coercive power of Washington over the states. One suspects that the last is Tavenner's primary concern.

Nonetheless, she has earned the tentative approval of at least one Republican. Yesterday, House Majority Leader Eric Cantor said, "Obviously, I'm not in the Senate, so I don't have that vote, but I do think she is qualified." Other interested parties have been less supportive. Her history produced the following remark from Dr. Jane M. Orient, Executive Director of the Association of American Physicians and Surgeons. "Tavenner has served the largest for-profit operator of medical facilities in the world, and the gubernatorial administration of a strong Obama supporter and rising star in Democrat Party politics, neither of which has a sterling record of integrity." In other words, Tavenner is a woman with a past, and Dr. Orient is less fond of such people than was Oscar Wilde. The Senate would be wise to heed the former.

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About the Author

David Catron is a health care revenue cycle expert who has spent more than twenty years working for and consulting with hospitals and medical practices. He has an MBA from the University of Georgia and blogs at Health Care BS.