Q&A Interview
An interview with Robert Miller
Public Aid inspector general hopes to tackle franco abuse
By JENNIFER HALPERIN

After 22 years in law enforcement, Robert Miller Jr. finds himself heading a large unit in one of the country's biggest welfare agencies. That's quite a jump from his days as a deputy sheriff in Warren County, where he began his career as a jail guard and radio dispatcher in Monmouth.

Gov. Jim Edgar recently tapped Miller, 42, to become inspector general for the Illinois Department of Public Aid, a position created this year as part of the Medicaid managed care program. Miller will oversee nearly 300 employees as they investigate and prosecute welfare fraud and abuse throughout the state. It's a daunting job, he says, not only because of the huge number of people involved in the welfare system — either as clients or service providers — but because some people will try to cheat the system no matter how hard he tries to stop them.

Q: Why do we need an inspector general at the public aid department?

A: I think the role of inspector general is first and foremost to coordinate all the government's efforts to combat any kind of public assistance fraud. There's a lack of public awareness of how serious these crimes [are] to the taxpayer. Everybody has their stories about standing in line at the grocery store and, "I saw this person use a food stamp and they bought steaks and got in a nicer car than I drive."

Everybody has said that. And I'm sure occasionally it's happened. But the fact is food stamps can be spent on any food product, and although that may not be the best use of them, it's not a crime. The more serious crimes involve, for example, people going to more than one doctor using a false name so they can load up on prescription pills.

Q: Why don't people pay more attention to these types of crimes?

A: There's no single taxpayer, no single victim of this crime. And there's no single group that you can identify for carrying these crimes out; the Mafia isn't responsible for this, it's just thousands of people spread across a base of clients and medical providers that abuse the system. It's hard to focus attention on how serious the problem is, and so I think one of my responsibilities, besides trying to coordinate the department's functions, is to try to do the best job I can to focus governmental and public awareness on the seriousness of the issue so that enough resources can continue to be marshalled toward combating fraud and abuse.

Q: Will the new managed care Medicaid program do anything to stem these abuses?

A: Managed care is going to go a long way toward preventing inappropriate expenditures because it sets up a fee for every service provider. We're going to pay a monthly fee and the HMO or the managed care entity will have to provide all services necessary. In the past, a medical provider that was unscrupulous would encourage a client to overutilize his services so that he could submit more claims, or he would just submit claims that were wholly false and hope he wouldn't get caught.

There will still be fraud and abuse that occurs because a lot of people won't get into managed care for a while, or ever, maybe, because certain categories are excluded. But in the managed care setting we'll have to be cognizant of a different type of problem. There, it would be in the managed care entity's financial interest to encourage a client not to come in — to underutilize services.

Q: How will your law enforcement background help in this job?

A: That type of background is necessary, I think. I was an investigator myself for years — I've conducted hundreds of investigations if not thousands. The people who are under me now are basically conducting investigations:

finding facts and trying to draw conclusions. I understand that process. At the same time, I'm not a hard, law-and-order, hang-'em-high kind of cop, which has allowed me to develop an understanding that while we will not compromise the ethics and integrity of our system, we don't necessarily criminally prosecute every client we find in violation. They do have to be sanctioned, and hundreds are every year. But there's a balance between mowing everybody down, saying they're all guilty, and identifying the worst cases, prosecuting them to the hilt, while we try to collect overpayments from others.

Q: How will you improve detection?

Robert Miller Jr.

A: We're doing a pilot study in which we'll electronically fingerprint clients. We want to study the effectiveness of that technology in preventing multiple fraudulent enrollments. For instance, if Rob comes in as Client A now in one office, he can go to another office and say he's John. We don't know the extent of that problem now. But with electronic fingerprinting, if you come in the second time and put your finger down, the office will be able to say, "Wait a minute — you're listed as a client in another office." What will happen in all likelihood, if our study reflects the findings in New York and California, is that once the program is announced in those offices where we'll test it, enrollment will drop because some people will realize they can't come in a second time and submit a new identity.

We also have the option of using retinal scanning as a means of identifying our clients. Technology now allows your retina to be measured and then compared against future retinas to see whether it's on file. The technology we have today is really growing; it's incredible.

Q: Will all this lead one day to zero abuse of the welfare system?

A: Something I learned as a deputy sheriff is that it is in the nature of some people to cheat. As a criminal investigator I was amazed at some of the lengths people would go to to lie when telling the truth would have gotten them off the hook. No matter how big a hammer we bring down on people, there will be some who continue to cheat.

The vast majority of medical providers, contractors, clients and public aid employees are honest, hard-working people trying to do the best job they can in a system that's imperfect, and a system that deals with the 6 or 7 percent poorest of the poor in this state. There are an unscrupulous few who take advantage of the system. I have to find a balance where we're not so onerous and so Draconian in trying to crack down on people that we can't deliver services to 1.5 million people desperate for medical treatment. 

November 1994 / Illinois Issues / 13