Another possible answer, slightly less academic and a little more sinis-
ter, is that serious research on this issue is not much appreciated. Scores of
professionals are heavily invested in the status quo, will profit greatly if
the health care fraud problem remains invisible, and have powerful in-
centives to reject or ignore research findings that elevate the visibility of
the issue. "A lot of fuss over nothing," they will say. "Find a more serious
problem."

Within the academic community, and even among health policy spe-
cialists, I have found that the issue of fraud, waste, and abuse--if men-
tioned at all--is more often presented as a question of political rhetoric
than as a serious intellectual or practical challenge. And, on the few occa-
sions when fraud earned a second mention, the context usually included
some phrase like "not such an issue under managed care," the implication
being that fraud in the system is no longer a matter for serious concern.

I am puzzled that health care economists, in trying to account for med-
ical costs inflation, pay scant attention to the subject of fraud and abuse;
when I ask them why directly, they tell me that "there is no data on that."
Without aggregate data on fraud loss rates (they are correct; it does not
exist), their econometric models simply cannot accommodate the issue so
the economists leave it out. Their models fail to explain the inflation of
medical costs, year after year after year. When I first presented the findings
of the NIJ study in 1996, in the form of the first edition of this book, Judith Randall's
review in the Washington Post pointed out the tendency of
policy makers (and economists in particular) to ignore this issue:

There are some economists who dismiss health fraud as relatively trivial and
irremediable in any case. . . . Sparrow's account will not only shatter their
complacency, but will also show them that . . . reform is possible. ³

Four years after the publication of the first edition of License to Steal,
there are a number of compelling reasons to bring this subject to the fore
once again. First, Congress and the Clinton administration have paid un-
precedented attention to the issue over the last six years, and consequently
we have learned much about the nature of the beast and the difficulties of
controlling it. Those lessons need to be drawn together and shared.

More important, with the Clinton administration drawing to a close, we
face a major decision point with respect to health care fraud-control ef-
forts. Whatever new administration follows, its senior officials will need to
decide rather soon how much emphasis to place on the control of health
care fraud, or whether to emphasize it at all. And as they contemplate that

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