Gerton interviews Barry.
Terry Gerton: You’ve done some looking into a data set that the DOGE team inside the Health and Human Services agency released. It described it as the largest Medicaid data set in department history. From your legal perspective, what was different about this release compared to prior transparency or fraud prevention efforts?
John Barry: Well, there’s a couple things. This is the first time that the Department of Health and Human Services has ever released provider-level Medicaid data to the public.
Terry Gerton: So this is a bit like crowdsourcing research.
John Barry: That’s right, that’s right.
Terry Gerton: The federal and state agencies already have specialized fraud units to identify improper billing. How does opening this kind of data to the public change that fraud detection model, and what risks might it introduce?
John Barry: I think that this data set presents opportunities, and as you mentioned, significant risks. The opportunities are that you have private — what I’ll call sleuths, or even data scientists, particularly with the advent of AI and data analytics and the access that individuals have to that, that you almost kind of make it a little bit of a game for these people to try to rout out fraud and find what they can and share that with the public. The issue is that data on its own is a starting point. It is not the end point. It does not tell you the whole story. And I think that there is a risk that certain people publicizing data that they may have found, and think that it is clearly fraud, may really not be fraud at the end of the day. And when you have the Department of Justice and the OIG within the Health and Human Services and the FBI and the Financial Crimes Network within the Department of Treasury, those people live and breathe that and are more specialized and have training on really knowing where to spend their time and what to do with data. And so the risk is that there could be some wild goose chases going on, particularly when it’s referred from the public to the state and federal agencies. You do have that risk that maybe some institutions — even just reputational damage from being publicized on social media networks that, hey, this provider seems to have increased their billing 50% over the last four years. Well, that alone is not indicative of fraud. And I think there is a significant risk that people may be getting a bit ahead of themselves in calling something fraud when it isn’t.
Terry Gerton: So does this mark, then, sort of a new front in the anti-fraud war, and might we be expecting to see more data set releases, perhaps around student loans or grant recipients or Social Security payments?
John Barry: You know, that’s a very interesting question. I think what you see here is this data set is focused on provider fraud. But we may see a movement towards data sets — and this would be very controversial — towards individual or beneficiary fraud.
Lambert here: Digilantism.
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