Louisiana Medicaid Fraud Control Unit

The Louisiana Medicaid Fraud Control Unit was one of the state bodies involved in investigating deaths at healthcare facilities after Hurricane Katrina. The book follows it through an unsettled process: investigators gathered forensic evidence and challenged what they viewed as gaps in the Memorial Medical Center grand-jury inquiry, while the wider effort eventually produced few successful prosecutions. Its role therefore lies not in a single verdict but in the contested passage from allegations, through investigation, to decisions about which cases could continue.

Investigations After Katrina

The Unit’s post-storm investigations formed part of Attorney General Charles Foti’s response to allegations of wrongdoing at several hospitals and nursing homes. The deaths at Memorial Medical Center became a central and highly visible case, but the inquiry extended beyond that hospital. Across Orleans Parish, a federal disaster mortuary team was asked to perform autopsies and collect tissue samples from patients who had died in hospitals and nursing homes after the storm; the initial estimate was about one hundred people. The breadth of that effort reflected the difficulty of separating individual allegations from a disaster in which multiple facilities had faced severe conditions.

At Memorial, the condition of the recovered bodies complicated the work. They had remained in the heat for more than a week, making blood testing for lethal drug levels impossible. A volunteer pathologist told Special Agent Virginia Rider that drugs might nevertheless be detected in more resilient tissues, including liver, brain, and muscle, or in fluid that accumulated in the abdomen after death. At the attorney general’s request, the overburdened Orleans Parish coroner Frank Minyard agreed to seek autopsies and tissue sampling through the disaster mortuary team. The Unit’s investigation thus depended on evidence that had to be recovered and interpreted under extraordinary practical constraints.

On September 22, investigators flew north with tissue samples from eighteen bodies from Memorial and delivered them to National Medical Services, Inc., a forensic toxicology laboratory in Pennsylvania. In an initial report on the eighteen cases, the laboratory identified morphine in nine and midazolam in about five or six more. Those findings supplied investigators with evidence of drug exposure, but they did not by themselves resolve every question about cause of death or intent. The book presents the forensic work as an important investigative step, not a substitute for testimony and a fuller account of the circumstances in which patients received medication.

Dispute Over the Grand-Jury Inquiry

As the Memorial case approached a grand-jury decision, members of Foti’s staff became alarmed at what they considered an incomplete presentation of the evidence. Virginia Rider had left the investigation months earlier. In her place, other staff members, working under Julie Cullen, the forceful head of Foti’s criminal division, drafted a sharply critical letter to the district attorney. They objected that essential evidence was being ignored and argued that the jurors had not received a thorough account of the case.

The staff’s concerns centered in part on how LifeCare’s role had been presented. According to the draft letter, some grand jurors appeared to believe that LifeCare personnel had failed to care for their patients and had not tried to evacuate them. The letter said jurors had not been shown emails and text messages documenting LifeCare staff efforts to arrange evacuation or the confusing messages they received from Memorial. It also emphasized that LifeCare witnesses had provided statements voluntarily and without immunity, yet none had been called to testify. The Unit’s staff feared that assumptions about LifeCare would shape the case without the people who could explain their actions being heard.

The draft further objected that the grand jury had not heard from forensic experts whose analyses the state had funded. Frank Minyard had recommended that the experts testify, and most of them, according to the letter, believed the deaths were homicides. Although they had been notified to prepare, none was called. The staff also identified the absence of testimony from Carrie Everett, Angela McManus, and Kathryn Nelson, family members who had been present at LifeCare shortly before the injections. A draft proposed that Memorial doctors be called without immunity as well, arguing that decisions about evacuation had shaped what happened to patients on the seventh floor. These were the Unit team’s criticisms of the inquiry; they did not change the grand jury’s course.

Public Findings and Closed Investigations

Foti publicly challenged the grand jury’s handling of the Memorial case. At a press conference in Baton Rouge, his staff distributed forensic reports that concluded the deaths at Memorial were homicides. He criticized the grand jury for not hearing from experts or from the families of the dead. The public release put the investigators’ conclusions into circulation even as the grand jury’s proceedings remained secret and the case’s legal status remained disputed.

Before leaving office, Foti’s Medicaid Fraud Control Unit closed its post-Katrina investigations into other healthcare facilities, including Lindy Boggs Medical Center and Touro Infirmary. At Lindy Boggs, the sickest patients had been left behind with pets and three medical professionals; at Touro, Odun Arechaga had been abandoned for dead and later found alive. Two closing memoranda concluded that a successful prosecution was unlikely. Federal officials also ended their part in joint investigations of hospitals and nursing homes, citing the unsuccessful results of the Memorial and St. Rita’s Nursing Home cases. The closures marked a practical limit on the investigations, rather than a resolution of every question raised by the events.

Records, Litigation, and Institutional Aftermath

The investigative files became the subject of a separate, prolonged dispute over public access. After Foti released the forensic findings, dozens of hospital employees, using the pseudonyms Jane Does and John Does, sought to prevent disclosure of the Unit’s thousands of pages of case records. The Times-Picayune and CNN pursued the records over several years. Anna Pou filed a brief supporting the employees’ position that the files should remain secret. A lower-court ruling in favor of release was reversed on appeal; after further proceedings, the Louisiana Supreme Court ruled for the employees in 2012. The files remained sealed because courts found that the case was not over and that further prosecutions remained possible.

The Unit’s records and investigative spending must be distinguished from the state’s separate payment of Anna Pou’s legal expenses. At Pou’s request, Louisiana’s general fund paid $456,979.41 in legal fees and expenses during fiscal year 2009–2010, reimbursing the LSU Health Network and the Dr. Anna Pou Defense Fund. That payment illustrates the broader institutional aftermath of the investigations, but it was not described as Unit spending. Together, the forensic work, criticism of the grand-jury presentation, closure of other facility investigations, and continuing secrecy dispute show how the Unit’s efforts became entangled with unresolved questions of evidence, accountability, and public access.