The Eyes of the Asp

I knew who she was. The Aesculapian Underground had warned me, but I would have known anyway. Call it clinical intuition if you will, but I have always had a sixth sense for deceit. I perceive it most often as a particular quality of the eyes—a remote, vitreous gaze—a mask that hides what lies within.

She was an ASP—an Auditor for the Special Program. We had a different rendition of the acronym: A Spy Patient, the monstrous creation of Bennett Moone, Commissioner of the Medicare Enforcement Authority.

With the collapse of managed care in the early 2000s and the subsequent expansion of Medicare to cover all citizens, the percentage of the GNP expended on health care had skyrocketed, and by 2010 had passed 35%. Nothing seemed to be able to stop it, not draconian fee reductions, not mandatory care pathways, not even the promise of large bounties to patients for reporting the “fraud and abuse” of their physicians.

But Moone had. Ex-attorney general, ex-FBI director, he was a brilliant political and legal tactician, and within a year of his appointment he had deployed an elite corps of highly trained agent-auditors, meticulously versed in medical histories and symptoms, empowered as federal marshals, and sent forth …