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.     

Enforcing ethics in social work

The attention paid by the social work profession to ethical issues has waxed and waned since the formal inauguration of the profession in the late 19th century. For the first half century of the profession's life, relatively little attention was devoted to problems of professional ethics, though social work's literature was filled with discussions of value-laden issues that arise in practice. In recent years, interest in professional ethics has increased substantially. This article discusses the growth of interest in professional ethics, the formulation of the social work code of ethics, the adjudication of grievances in social work, and the strengths and limitations of the profession's code.     

Consumer-sponsored prepaid group practice: restructuring the health care system

The traditional separation of health care delivery and financing systems is breaking down as various new types of health care facilities are established and as payment continues to be a major concern. Group Health Cooperative of Puget Sound (GHC) was organized as a prepaid group practice system responsive to consumers. Costs, methods of payment and delivery of care are interrelated and are all influenced by consumer ownership. GHC has been refining its benefit programs since 1945. Strategies for controlling use and costs focus on improved provider management and on flexibility. This article explains how the structure of GHC benefits the consumer.     

The voter as juror: Attributing responsibility for economic conditions

One assumption of Key's reward-punishment theory that has attracted comparatively little attention is that voters hold the incumbent party responsible for all manner of economic fluctuations. A brief review of the survey literature in economic voting indicates that this assumption is in need of revision. The handful of existing studies in political science on responsibility attribution suffers from a lack of conceptual clarity and a failure to develop a theory of the attribution process. This paper outlines a model of economic voting in which people act as intuitive jurors using various decision rules to evaluate the evidence surrounding the president's responsibility for national economic problems. The generalizability of the framework and directions for future research are discussed     

From IDA to IIROC: Has self-regulation in the Canadian investment industry evolved?

This article analyzes the enforcement practices of the Investment Industry Regulatory Organization of Canada (IIROC) and compares them with its predecessor, the Investment Dealers Association of Canada (IDA). The study collected data from IIROC's tribunal cases decided between June 2008 and December 2019 and compared them with data on the IDA's enforcement of complaints from 1984 to 2008. The findings reveal no statistically significant difference in the fines imposed by the two regulatory bodies. Furthermore, IIROC has refrained from issuing lenient penalties such as retaking examinations/courses or mandating terms and conditions for offenders. The results also indicate no significant impact on the number or distribution of offense types committed in the industry over time. Most notably, the Ontario Securities Commission, the Canadian Securities Regulators, and the new Self-Regulatory Organization of Canada should consider these findings when formulating policies concerning the role of self-regulation in the financial markets.