Practitioner fraud and abuse in medical benefit programs: government regulation and professional white-collar crime

Physicians who defraud and abuse medical benefit programs provide a unique group of lawbreakers for scientific study. They could be considered to epitomize white collar criminals given their exceedingly high socioeconomic status and power as a professional group. Using official reports and documents, as well as interviews with enforcement and program personnel at both state and federal levels, this study examines the problem of physician fraud and abuse in Medicare and Medicaid. Major areas relevant to understanding this phenomenon and its control are presented and policy implications of present knowledge in the area are discussed.     

Evolution von Staatlichkeit — mit einem Exkurs zu N. Elias’ „Soziogenese des Staates“

If “the state” is considered as a historically grown social institution — and not only as a clearly defined set of institutions of legitimate order —, and if the evolution of legitimate and sanctioned state interventions in society is analysed from a functional politico-sociological perspective, than the emergence of new patterns of state functions in an increasingly global and interdependent socio-economic context is revealed. The paper analyses the following questions: How do recent state theories try to understand and explain the functional change of state institutions in their societal context? Can Norbert Elias’ theories of civilisation processes, of the emergence of the state, and his figuration theory facilitate the empirical analysis of the evolution of (post) modern state functions? Does an evolutionary perspective provide a basis for an “enlightened theory of the state”? What follows in terms of a theoretical and empirical investigation of present and future state functions?     

Democratization and Transitional Justice

Any country which attempts to establish accountability for past abuses of human rights during the process of democratization faces political, judicial, and ethical problems. With regard to politics, the question of which transitional justice measures are appropriate, functional, and feasible has to be decided for every individual case. A judicial approach has to decide which judicial standards to apply and how to justify prosecution. Finally, the ethical dilemmas of dealing with historical injustices have to be understood. There are no ready-made concepts to define guilt and justice. In many cases it is even difficult to tell the victims from the perpetrators. This study examines the different strategies subsumed under the term ‘transitional justice’ used by emerging democracies to deal with a legacy of human rights abuses. It explores the problems and challenges posed by different mechanisms of reconciliation and societal reintegration. While existing analyses of the contribution that transitional justice measures make to the process of social re-integration stress the importance of consensus among citizens and social groups for the emergence of trust and solidarity, this study suggests also thinking about how conflicts over competing ‘truths’ can help to build social capital and reconciliation. Noting a global diffusion of international legal norms, which means at least formal universal acceptance of basic rights and judicial procedures, it is argued that international justice cannot be a substitute for transitional justice measures taken by the domestic regime itself.