Methodological challenges to government sampling techniques in civil fraud and abuse cases

This Article discusses the use of statistical sampling in Medicare and Medicaid fraud and abuse audits. The author reviews cases in which government sampling methodologies have been challenged. Finally, the author describes the various alternatives available for challenging the validity of the statistical sampling used by the government in its audits.     

The continuing search for proper perspective: whose reasonableness should be at issue in a prescription product design defect analysis?

This Article is based on a presentation given at Seton Hall University School of Law's Seventh Annual Health Law Symposium on February 12, 1999.     

Interdisciplinary problem-solving: Next steps in the Greater Yellowstone Ecosystem

The Greater Yellowstone Ecosystem, a 7.6-million-hectare region in the Central Rocky Mountains of the United States, is used to illustrate both the challenges and means to improve problem solving in the natural resources arena. The challenges in this world-famous region are contextual (rapid change, growth, pluralism, complexity, state/federal conflicts, and lack of a common perspective), institutional (multiple organizations with overlapping authority and control and disparate mandates, uneven leadership, lack of creativity in problem solving, and resistance to change), and human (diverse perspectives and values and epistemological limitations). To overcome these challenges, an interdisciplinary method that integrates knowledge to improve policy making is briefly described. It provides a framework with a comprehensive set of categories to use in investigating and analyzing problems and inventing alternatives for substantive, process, and structural improvements. Five programs or interventions, all of which are based on this method, are suggested to address the challenges facing Greater Yellowstone: (1) workshops for capacity building, (2) leadership, staff development, and student internships, (3) case analyses and appraisals for policy learning, (4) problem-solving exercises and decision seminars, and (5) prototyping exercises to improve interdisciplinary and interagency coordination. These are described, examples given, and benefits outlined.     

Market failure,government failure,and the private supply of public goods: The case of climate-controlled walkway networks

Two opposing models of public-goods undersupply are those of “market failure” and “government failure”. Empirical work on the relative explanatory power of these two frameworks has been limited by the scarcity of acceptable data. The case of climate-controlled walkways in major urban cores is a rare instance where such difficulties can be overcome. We investigate the supply of CCWs in 55 large city-cores in North America. We find that (1) CCW networks are well-supplied by market forces, when (2) such forces are not frustrated by government policy. We also find evidence that (3) rules-based regimes dominate discretion-based regimes. These results are consistent with the position that the “government-failure” paradigm is a viable alternative to the traditional “market failure” paradigm.     

Specificity versus representativeness: methodological approaches to the study of Mexico-U.S. migration

"This article compares two sources of data on Mexico-U.S. migration, based on radically different methodologies: the Mexican Migration Project (Promig) and the National Survey of Population Dynamics (Enadid).... This comparative study shows that a micro-social design drawing on multiple community samples, such as Promig, can solve the methodological conflict between specificity and representativeness.... The authors' research also highlights the problem of selectivity and specificity entailed by traditional surveys such as Enadid as a result of restricting their samples to international residents in Mexico and attempting to explain such a complex, socioeconomic process using a limited number of variables." (EXCERPT)     

The dilemmas of incrementalism: logical and political constraints in the design of health insurance reforms.

Health care reform became a premier issue on the U.S. policy agenda in the 1990s. While the comprehensive proposal put forth by President Clinton failed, states and the federal government successfully pursued a variety of lesser initiatives. This article focuses on a set of reforms intended to make private health insurance more accessible and affordable to individuals and workers in small firms. It outlines the key arguments made by experts to justify stronger regulation of health insurance and the options and difficult tradeoffs that must be considered in policy design. It then examines the scope and strength of legislation adopted by 45 states and the federal government from 1990 to 1996. The substantial variation in state policies demonstrates that even though insurance market reform was the one issue that commanded nearly universal support in the health care debate, few design features were universally accepted by those who crafted the reforms. The article concludes by assessing the pattern of state and federal action. The reforms represent some progress on nominal access to insurance but little progress on the affordability of insurance for individuals and small groups. Few of the reforms present a serious challenge to existing practices and interests of the insurance industry. This pattern of policy design reflects the logical and political constraints of incrementalism. In a system where insurance coverage is voluntary, changes to increase access for one group tend to increase costs and thereby decrease access for another segment of the population. In addition, because incremental reforms will not attract sustained attention and support from the general public, it is politically difficult to impose substantial new regulation on a powerful industry.