If one accepts that OIOS was established to address such problems as fraud waste and abuse within the UN, and A/Res/48/218-B would seem to suggest that that was what the intention of the General Assembly; then it follows that the General Assembly ought to have been quite happy with the progress of this case.
And that much is true….. up to a point. 0496/11 should have been a fairly ordinary case. There should really not have been anything remarkable about it.
There is, however, such a thing as snatching defeat from the jaws of victory (though in this instance the word “victory” is probably hyperbole) and there is such a thing as sabotaging a perfectly sound investigation.
This is pretty much what happened…..
This is a story that is probably best started in the middle, which would not be the investigation itself, the hammering I was given for it in my Annual Appraisal
To describe that as ‘brutal’ would be no more an understatement as describing the first day of the Somme as ‘unsatisfactory.’ There was, however, only one problem, which I believe I demonstrated in my rebuttal, and that was that there was actually nothing wrong with it…….
The commendable thing about the 0496/11 investigation is that OIOS was not interested in any of the three other observations that arose during the course of the investigation. Then, knowing that the subject was due to retire, OIOS delayed the report for so long that no action could be taken against her. I never really understood why.
One: the kidney transplant that might not have been a kidney transplant
The investigation was into a number of fraudulent insurance claims received by the UN between two dates. The amount of money involved was in the region of $30,000; so it was more than just a couple of packets of aspirin. The claims were mostly for anti-rejection drugs which an insured person allegedly required following a kidney transplants.
The human body is programmed to reject “foreign bodies” and having a different kidney from the defective one that you used to have definitely counts as a “foreign body” as far as the auto immune system is concerned. I am not a doctor but I listen when they explain stuff like that. Being the sort of investigator that asks questions just to satisfy my curiousity, I am also familiar with something called wikipedia and learn stuff there from time to time as well.
I was, after all investigating claims for anti-rejection drugs submitted for a patient who was supposed to have had a kidney transplant, so I thought it might be a good idea to understand the context of what I was doing.
I am not a doctor, but I know that a kidney transplant is fairly major undertaking, and as an investigator, I get suspicious when I see that n the three months after having this (alleged ) kidney transplant, the patient only saw a doctor just once, as an out-patient.
That’s odd, I thought……… and the investigative radar in my head turned itself on.
Also, when interviewed, this staff member mentioned a hospital bill of $8,000. OK, fair enough, I don’t work in medical insurance either so I have no idea what a hospital would charge for such a procedure.
I do, however, have access to something called “the internet”…. you may have heard if it…. and after a few minutes poking about using a very sophisticated investigative research application – called “Google” – I found out that that the cost of a kidney transplant in that hospital is significantly more than that!
So guess what; there was a resounding “ding” sound from the little investigators bell inside by investigative head and my investigative reasoning said: ‘ello ‘ello ‘ello, what’s goin’ on ‘ere then…. because I suspect this patient never actually had a kidney transplant…
Now, if that were the case and he didn’t have a kidney transplant, it raises the likelihood of a longer history of fraudulent claims that we were not investigating, and that opens the door to the prospect of recovering more money for the UN.
So having probably spent perhaps 20 minutes on this little frolic, did I then go off and dig deeper? No, in fact I did not! I dutifully informed by supervisor and asked if this should be predicated for investigation.
The answer was no.
Two: the document from the hospital that might not have been from the hospital
Moving swiftly on… as I reviewed the various document that purported to be a medical prescription for these anti-rejection drugs, bearing a name of a real doctor in the hospital in question but the document did not make sense, so I began to suspect that it may have been a forgery. The document could have only one purpose, and that was to obtain these anti-rejection drugs.
That’s interesting; what do I do about it?
The document actually had no bearing on the investigation. I did not need it to prove the staff member had made fraudulent claims. The document might have been forged by the UN staff member, but we had no evidence of that. It might just as easily have been forged by someone else, or it may even have been genuine. I did not know for sure.
At the same time, if it was a forgery, I did not know who forged it, and if it had genuinely been signed by that doctor; I don’t know whether this was done to deceive pharmacies into selling prescription-only medicines to people who should not have them. Sall I could say for sure was that the document was suspicious.
OIOS certainly did not have the jurisdiction to investigate doctors who were not UN staff members for something that might be criminal or might be professional malpractice in that Member State. Still, I had a very suspicious document which should have been of great interest to law enforcement, drug enforcement or the medical regulatory authorities in that country. I didn’t know – but I could not see how UN privileges and immunities applied, and I thought this was worth passing on to the national authorities.
That was not all. I had pharmacy receipts that the pharmacies in question had identified to be forgeries,.
When interviewed, the staff member had said that she confirmed that these were forgeries, but that she herself had been deceived and that a Third Party (not a UN staff member) was responsible; so again, no UN privileges and immunities could apply here.
All in all, there was definitely something suspicious here, and I thought this was worth passing on to the national authorities.
So once again; did I then go off and investigate this on my own? No, I did not! I dutifully informed by supervisor and asked if this should be predicated for investigation, and Dzuro said that he would prefer it if Baldini answered it and of course Baldini said the answer was no.
Three: the sick leave for the staff member who might not have been sick
So I carry on doing what I am doing and a third oddity emerged. I had to check if the staff member was in the Mission on certain key dates, so I pulled her leave records, and the third suspicious thing related to months of suspicious Certified Sick Leave.
I had interviewed this staff member, she was a particularly garrulous woman who would not stop talking. I could barely get a word in edge-ways as she insisted on spinning a long yarn about her husband’s medical condition and everything else peripheral to it, including the damage to her house, how long it took to get to the hospital on the bus, her relationship with all the medical staff, and how she was so well known for caring for everyone. She went on at length about how her husband was very sick and she had to ensure he was properly cared for. Then she went on about how her daughter was sick and she had to pay for her medical care too, and I heard about where her daughter lived and how she could not work. I could hardly get her to shut up, and trying to get her to answer was specific questions was like pushing the start button on a high speed Ted Talk on all the medical woes her extended family had ever suffered, going back three generations.
The was only one person she never mentioned was sick, and that was herself, and yet she was on Certified Sick leave for a long period of time.
By now, I was suspicious, because this could have implicated the certifying medical practitioner, and if one person was being signed off work sick, it was possible that many more were similarly abusing the system, and the word we use to describe that starts with F and rhymes with ‘prod.’
You probably don’t need to stand on a box to see where this is going…..
Yes, I was aware of that, but if that confidentiality is absolute, it makes it a little bit difficult to investigate any kind of medical-related fraud. Roberta Baldini’s claim to fame was the train wreck she called the Insurance Fraud Working Group, and that involved medical insurance fraud…. but let’s not worry about that.
Never mind, I don’t appreciate being spoken to like the naughty kid in the kindergarten but I let it drop. At the end of the day, if the UN wants to let itself be bled dry by fraudulent claims; that is a decisdion way above my pay scale.
Writing the report turned into a three ring circus. There was more of a fuss over the draft of that report than any other I knew of in my time in OIOS. I am convinced there was less debate over the drafting of the UN Charter than over that report, not because there was anything substantively wrong with it but because Roberta Baldini could not help herself from micro-managing the process.
Prior to joining the UN I had had over 20 different articles published in a wide range of business magazines and professional journals, and yet the report in the 0496/11 investigation involved more editing than all of them combined The actual substance of the report was fine, but revising the language in it became an exercise in the practical application of Roget’s Thesaurus. Commas had to be turned into semi-colons. The word ‘replied’ had to be replaced with the word ‘responded’. Long sentences had to be split into two shorter ones while in other places, two short sentences had to be combined into one longer one.
After a while, one loses the will to live, particularly because the whole exercise was a waste of time anyway, because as soon as she decised the report was in a final acceptable form, it would go to the ‘Professional Practices Section’ and they would re-write it. The UN is a world leader in unneccessary duplication of effort.
There was so much nit-picking over that report it may have set the standard for the Brexit negotiations.
But then, at last, and after having spent an unconscionable amount of time on multiple revisions of the same thing – mirabile dictu – Roberta Baldini was finally satisfied with it and it was off my desk at last.
The date was 27 February 2013, and we knew that the subject was going to retire in a few months.
Then I asked a question and the wheel came off the wagon.
So how do you manage to waste 16 months on an investigation that is actually finished? Well…………