Fraud Control Game - State Responses to Fraud and Abuse in AFDC (Aid to Families with Dependent Children) and Medicaid Programs

• NCJ Number: 96209
• Author(s): J A Gardiner; T R Lyman
• Date Published: 1984
• Length: 276 pages
• Grant Number(s): 80-IJ-CX-0110
• Sponsoring Agency: National Institute of Justice (NIJ); US Dept of Justice NIJ Pub
• Sale Source: Indiana University Press
• Language: English
• Country: United States of America

Annotation

Efforts at the State level to control fraud and abuse in two means-tested programs, medicaid and Aid to Families with Dependent Children (AFDC), are reported.

Abstract

The volume defines welfare processes and organizations and examines the relationship between fraud control and policy issues in terms of an ecology of games. The players -- those who are interested in welfare and fraud issues on a continuing basis -- are recipients; providers; the Federal, State, and local agencies that fund or administer welfare programs; and the agencies that implement fraud or abuse control efforts. Intermittent players include voters, taxpayers, and the mass media. Recipients' and providers' perspectives on fraud control are examined, as are program administrators' perspectives on controlling medicaid provider fraud and abuse. Additionally, agency perspectives on recipient fraud and medicaid provider fraud and abuse are highlighted. The perspectives of the participants in these programs help explain the limited efforts to control fraud. For example, agencies' control goals often conflict both operationally and politically with their service goals. Further, medicaid administrators fear that fraud control techniques will substantially reduce provider participation in their programs. Suggestions for focusing priorities, targeting resources, focusing responsibility for fraud control, and developing alternative sanctions are included. Also provided are 142 references, 15 figures, and 19 tables.