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

NCJ Number
J A Gardiner; T R Lyman
Date Published
276 pages
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.
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.


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