ABSTRACT
Employees closest to the work of fraud control habitually feel frustrated, unappreciated, sometimes ostracized by their own organizations, and deeply resentful of management’s deaf ears to the whole subject. Fraud control is a miserable business. Failure to detect fraud is bad news; and finding fraud is bad news too. Senior managers seldom want to hear any news about fraud, because news about fraud is never good. The general pathology of fraud control needs to be understood, as backdrop, before considering the health care industry more specifically. The danger, of course, is that organizations vulnerable to fraud lull themselves into a false sense of security by imagining that their “caseload” reflects the scope and nature of fraud being perpetrated against them. The introduction of fingerprinting as a welfare-fraud control in New York State serves as a case in point. Fraud control is played against opponents: opponents that thinks creatively and adapts continuously, and who relish devising complex strategies.
