NCJ Number
60519
Editor(s)
R A BOWERS
Date Published
1979
Length
256 pages
Annotation
A STUDY OF FRAUD AND ABUSE CONTROL ISSUES IN 15 GOVERNMENT BENEFIT PROGRAMS IS DOCUMENTED.
Abstract
THE STUDY INVOLVED INTERVIEWS WITH 134 FEDERAL, STATE, AND LOCAL PROGRAM ADMINISTRATORS, FRAUD INVESTIGATORS, PROSECUTORS, QUALITY CONTROL OFFICIALS, AND OTHERS CHARGED WITH RESPONSIBILITY FOR BENEFIT PROGRAM OPERATIONS, INTEGRITY, AND CONTROL, PLUS QUESTIONNAIRE SURVEYS OF STATE ATTORNEYS GENERAL AND 123 OTHER STATE OFFICIALS. IT WAS FOUND THAT THE MOST COMMON OFFENSE--MISREPRESENTATION OF ELIGIBILITY--WAS BEING COMMITTED BY RECIPIENTS, PROGRAM SPONSORING AGENCIES, AND THIRD-PARTY PROVIDERS. DIFFERENT TYPES OF PROGRAM BENEFITS WERE FOUND TO BE VULNERABLE TO DIFFERENT ABUSES, ALTHOUGH CERTAIN POINTS OF VULNERABILITY WERE COMMON TO ALL TYPES OF BENEFITS. THERE WAS SOME EVIDENCE OF A LINK BETWEEN LEVEL OF FRAUD/ABUSE DETECTION AND BOTH STAFF-CLIENT RATIO (WITH STAFF TRAINING AS A MEDIATING VARIABLE) AND PRESENCE OR ABSENCE OF STATISTICS ON FRAUD AND ABUSE. ENFORCEMENT EFFORTS WERE FOUND TO BE SUFFERING FROM AN AD HOC, REACTIVE POSTURE. TEN GENERAL STRATEGIES FOR FRAUD AND ABUSE CONTROL WERE IDENTIFIED: EDUCATION/TRAINING, LEGISLATIVE SUPPORT, QUALITY CONTROL, INVESTIGATION, FINANCIAL AUDITING, HARASSMENT, CIVIL AND CRIMINAL PROSECUTIONS, ADMINISTRATIVE ADJUDICATIONS AND REMEDIES, ORGANIZATIONAL REDESIGN, AND RESEARCH. THE DANGERS OF EMPLOYING THESE STRATEGIES, EITHER SINGLY OR IN COMBINATION, WITHOUT ANALYZING THEIR STRENGTHS AND WEAKNESSES ARE POINTED OUT, AS ARE SHORTCOMINGS IN EFFORTS TO COMPUTERIZE BENEFIT PROGRAM OPERATIONS. RECOMMENDATIONS ARE DIRECTED TO LEGISLATORS, PROGRAM ADMINISTRATORS, AND PROGRAM ENFORCEMENT STAFF. DETAILED SUPPORTING MATERIALS, INCLUDING PROGRAM PROFILES AND SURVEY INSTRUMENTS, ARE APPENDED. A SUMMARY, SUPPORTING DATA, A BIBLIOGRAPHY, AND A GLOSSARY ARE PROVIDED. THE FOLLOWING PROGRAMS ARE INCLUDED IN THE STUDY: FOOD STAMPS, SUMMER FOOD SERVICE PROGRAM FOR CHILDREN, RURAL HOUSING, MEDICARE, MEDICAID, AID TO FAMILIES WITH DEPENDENT CHILDREN, VOCATIONAL EDUCATION, REHABILITATION HOUSING LOANS, FEDERAL DISASTER ASSISTANCE, UNEMPLOYMENT INSURANCE, COMPREHENSIVE EMPLOYMENT AND TRAINING PROGRAM, MINORITY BUSINESS DEVELOPMENT, PHYSICAL DISASTER LOAN ASSISTANCE, VETERANS EDUCATIONAL ASSISTANCE, AND VETERANS HOME LOAN GUARANTY PROGRAM.