Medicaid Fraud Control Unit

The Medicaid Fraud Control Unit was the investigative team at the center of the Louisiana attorney general’s inquiry into patient deaths during Hurricane Katrina. In the Memorial case, its team-based approach brought investigators and prosecutors together as they assembled evidence, consulted forensic experts, and sought access to accounts held by hospital-company personnel. The inquiry also exposed legal and jurisdictional limits on how far the unit could pursue its investigation.

Structure and Investigative Role

The book distinguishes the unit’s working arrangement from that of the Orleans Parish District Attorney’s Office. At the Medicaid Fraud Control Unit, investigators and prosecutors worked in teams. At the district attorney’s office, prosecutors typically did not join an investigation—usually conducted by police—unless the investigating agency asked them to. That difference shaped the Memorial case: the attorney general’s office had not involved the district attorney’s office during the yearlong investigation, leaving prosecutor Michael Morales to confront the scale of the case only after it came to his attention.

The unit’s work drew on both documentary and scientific evidence. Investigators Virginia Rider and two nurses who had worked the case with her prepared charts and tables showing which drugs had been found in each body, then presented the material with toxicology laboratory director Robert Middleberg. Of forty-one bodies from Memorial and LifeCare analyzed by his laboratory, twenty-three tested positive for morphine, midazolam, or both. The experts did not treat those results as self-explanatory: because postmortem tissue concentrations could have changed during prolonged exposure to heat, they compared the laboratory findings with each patient’s clinical history and medical records.

Evidence, Expertise, and Uncertainty

The team’s examination of the toxicology evidence involved questions beyond whether a drug was present. Investigators and experts considered whether a patient might have received a single large dose shortly before death or repeated doses that accumulated, and whether conditions such as kidney or liver disease could have affected how drugs were processed. They also considered the drugs’ potential effects on breathing and blood pressure, whether those effects fit the known circumstances and timing of deaths, and whether a patient’s chart documented a clinical reason for the medication.

The inquiry’s case-by-case method made the distinction between a test result and a conclusion about cause or intent consequential. In the example of a LifeCare resident treated for pneumonia, morphine and midazolam were found in tissue, although her chart did not record either drug as prescribed and contained no documented complaints of pain or distress in the period before her death. The evidence prompted scrutiny; the unit’s investigation still had to establish what the findings meant in the context of each patient’s care.

Access to Witnesses and Legal Conflict

A major obstacle concerned Steven Campanini, Tenet Healthcare’s media chief, who had received an urgent call from Anna Pou days after she left Memorial and spoke with her extensively. The Medicaid Fraud Control Unit’s senior officials did not encourage Rider to travel to Tenet’s Dallas headquarters to interview him, at least at that stage. Pou’s attorney, Rick Simmons, had already gone to court to block the attorney general’s staff from questioning Campanini, arguing that conversations involving Tenet attorney Audrey Andrews were protected by attorney-client privilege and confidentiality.

Assistant Attorney General Butch Schafer challenged that argument. He maintained that Pou could not reasonably have believed Tenet’s lawyer represented her, pointing to her employment contract: Memorial had supported her recruitment and first year’s salary, but she was employed by Louisiana State University, not Memorial or Tenet. A district court ruling satisfied neither side, and the dispute proceeded on expedited appeal to the Louisiana Supreme Court. Attorneys for John Thiele and Cheri Landry also asked Schafer to wait for the court’s decision before seeking their clients’ accounts of conversations with Tenet personnel. The filing was styled as a matter involving an offense under investigation, rather than an official case against Pou.

Institutional Boundaries

The unit’s role was therefore defined not only by its cooperation between investigators and prosecutors, but also by the boundaries surrounding evidence and jurisdiction. Its investigators were building a record about deaths at Memorial while access to potentially important corporate witnesses was contested in court. Meanwhile, the district attorney’s office, operating under a different division of investigative and prosecutorial responsibilities, had been kept outside the inquiry until late in its course.

These arrangements shaped how the Memorial deaths could be investigated and who could participate in reconstructing events. The unit’s team structure supported coordinated review of records and forensic results; the dispute over Campanini’s interview showed that coordination could not by itself secure access to testimony. The resulting investigation unfolded through both evidentiary analysis and legal contest over who could ask questions, when, and under what protections.