The fight against fraud and abuse: analyzing constituent support.

Most efforts to combat fraud and abuse have relied on a punitive-deterrent approach, assuming that higher penalties and stricter enforcement will both punish present offenders and deter potential ones. Social science perspectives, particularly that of systems theory, suggest that a more effective approach is prevention grounded in an understanding of the constituencies involved. Constituency analysis can identify the constellations of social and political power that sustain existing opportunities for fraud and abuse, and those that will support countermeasures. Illustrations are drawn from the author's experience with New York State's attempt at reform in nursing homes and with efforts by the General Accounting Office and the Office of Management and Budget to combat fraud and abuse in federal programs.