That simple truth is that vast sums of money are stolen from the health care system every year. A significant proportion of each health care dollar goes not for the provision of health care, but to criminal enterprise.

How much gets stolen? The magnitude of this problem is measured in terms of hundreds of billions of dollars each year. How many hundreds of billions of dollars? For the time being, nobody knows for sure. If we were lucky, perhaps just one hundred billion. More likely, two or three. Quite possibly four, and conceivably five. (That would be $500,000,000,000.)

My examination of this subject began seven years ago with two research grants from the National Institute of Justice (NIJ). The task was to examine the state-of-the-art of fraud controls used within the health care industry. That task, and my continued involvement with the issue since, has taken me to countless major national conferences over the last nine years. Even when attendance at such conferences runs close to a thousand, I am invariably the only "academic" present, and I am often asked by other attendees why I am there. The reason I have been there seems all too plain: I believe this is an important public policy problem, a potentially massive drain on the nation's health care resources. Health care fraud not only bleeds the system but also represents a colossal injustice as crooks enrich themselves at taxpayers' expense. Surely the question should be, "Why are there not more serious researchers paying attention to this problem?"

One possible answer, I suppose, is that because fraud control does not fit neatly under the rubric of criminal justice, health care policy, medicine, public administration, economics, political science, or other wellestablished academic disciplines, no one has ever really studied it before. None of the officials responsible for controlling fraud within the Medicare or Medicaid programs, nor anyone within the commercial insurance industry, ever took "Fraud Control 101" in college, because no one ever taught it. Within the industry, one can find training on fraud investigation, but very little attention to fraud control. Investigation focuses on the cases that come to light (i.e., the visible slice of the pie), whereas control focuses on the invisible mass. With health care fraud, as with many other forms of white-collar crime, what you see is not the problem. The problem, by its very nature, is largely invisible, and we make a grave mistake if we inform ourselves about the problem only by paying attention to what comes to light. Fraud control, as a science, is little studied; as an art, it is scarcely appreciated. It is hardly yet even a subject, though-as we shall see--it presents an extraordinary array of complicated intellectual challenges.

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