Seema Verma at Trump Tower to meet with then-President-elect Donald Trump on November 22, 2016 (Photo by Drew Angerer/Getty Images)

The Trump regime’s pick for Health Secretary, Tom Price, was confirmed by the Senate overnight and some people are concerned about how he’ll dismantle everything from Obamacare to the FDA. But there’s another nominee for the Department of Health and Human Services that Americans should be just as terrified about.

Seema Verma has been nominated to oversee Medicaid and Medicare, and if her track record with states like Indiana is any indication, she’s not exactly a beacon of sound ethical judgment. In fact, Verma’s company received millions from the state of Indiana crafting the state’s Medicaid laws while simultaneously getting paid by Hewlett-Packard, one of Indiana’s biggest Medicaid vendors.

Back in 2001, Verma founded SVC Inc., a health care consultancy firm that has worked on state health plans in Ohio, Iowa, and Kentucky. But it’s Verma’s work in Indiana under now-Vice President Mike Pence’s governorship that has raised red flags about how she’ll manage the Centers for Medicare and Medicaid Services, which has a budget of roughly $1 trillion.

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The Indianapolis Star first broke the story of Verma’s conflicts of interest back in 2014, explaining in the headline that she “served two bosses.” The newspaper explained that by taking money from both the state of Indiana and HP it, “put Verma in the position of making decisions about a state contractor that is also paying her hundreds of thousands of dollars.” And the case deserves renewed attention now that Verma is poised to serve under the Trump regime.

During Verma’s time consulting for the state of Indiana she helped mold the Healthy Indiana Plan (nicknamed HIP 2.0) for low income residents. The plan has been criticized by health policy experts for creating unnecessary hurdles to coverage. People who qualify for Medicaid in the state are now required to pay monthly premiums, seen by Republicans as having “skin in the game” even if the fees are minimal.

But the HIP 2.0 program has been a disaster in practice, as low income residents miss payments and get kicked off for bureaucratic hurdles they’re not able to overcome. One woman lost coverage for herself and her three children because she missed a payment of $1.

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And all of this leads to questions about whose interests Verma was actually serving while taking money from both the state of Indiana and HP, a company with over $500 million in health contracts with the state.

At the time Verma denied any wrongdoing, claiming that any time there was a potential that for conflict, she stepped aside.

“SVC has disclosed to both HP and the state the relationship with the other to be transparent,” Verma told the Indianapolis Star in 2014. “If any issue between HP and the state presented a conflict between the two, I recused myself from the process.”

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To their credit, Indiana lawmakers were surprised when they learned about the potential conflict of interest. But the state has no laws that prohibit such a set-up. The federal government, on the other hand, does have very clear and stringent conflict of interest laws. And if Verma is confirmed by Congress, as she’s expected to, she’d do best to abide by them.

Gizmodo has reached out to SVC and Seema Verma and will update this post if we hear back.