Utilizing Health IT to Fight Healthcare Fraud, Waste, and Abuse

Howard Apple, EVP, Integrity Management Services, Inc.

I retired from the FBI after a 27 year career as the Assistant Special Agent in Charge of a large field office investigating all white collar crime. It was then I was able to truly understand the devastation our country faces as a result of healthcare fraud, waste, and abuse. Upon retirement, I took a job as head of security for Electronic Data Systems (EDS), but was immediately shifted to the business unit which was branching into the field of program integrity at The Centers for Medicare & Medicaid Services (CMS). Our team bid on the Program Safeguard Contract IDIQ and won. After much growth and success, we became a wholly owned subsidiary of EDS and changed our name to SafeGuard Services (SGS), which I lead as its President. In 2012 I retired from Hewlett Packard (they bought EDS) and became the Executive Vice President of Integrity Management Services, Inc. (IMS) and am still active in the fight against Medicare and Medicaid fraud, waste, and abuse.

While the public only hears about the big headline cases, it is by having feet on the ground that one realizes how significant this problem is, and how it not only costs the tax payers money, but more importantly, affects the quality of care for many patients. After hearing about cases where the chemotherapy medicine was diluted, or where oxygen tanks were improperly filled, I realized the fight against healthcare fraud, waste, and abuse required folks who were not just looking for jobs, but who were passionate about their roles in fighting this horrific problem.

At SGS, and at IMS, I told all employees from the very beginning, if their work only translated into a job and a paycheck, they needed to go elsewhere. I only want folks who have the passion and desire to fight this fight with all their heart, and to understand that they are foot soldiers in this war against the criminals who target the most vulnerable victims, our older population.

Some ask me why I don't just sit back and retire and enjoy life. To me, nothing is more rewarding than protecting Medicare and Medicaid dollars.