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 R and D contract and democratic theory

The purposes of this essay are to describe how federal research and development policy has altered authority relationships and to suggest a new concept of legitimacy in accord with the changed conditions. Research and development (R and D) creates an indeterminate future. Thus, the politics of research and development incorporates an apparent contradiction : political leadership demands that jobs be done which require creative and unpredictable actions on the part of private organizations, while it also demands that contractors be held responsible for fulfilling goals efficiently, avoiding deleterious secondary consequences, and refraining from abuses of power. The paradox can be resolved by creating norms of responsibility that allow for judgments on how a job is done rather than what is to be done. New institutions for technological assessment to check on unintended consequences of projects and citizen review boards to estimate the quality of life engendered by projects may provide such norms of responsibility.