The complexity of healthcare fraud - ethical and practical considerations

Abstract

When healthcare professionals suspect that healthcare fraud is being committed, they almost always find themselves in a new, unknown situation. They have many questions and feel unable to act adequately. With a growing attention on healthcare fraud, research was done on What is the right thing to do in case of presumed healthcare fraud and how to do this right? We started with a search of the literature on healthcare fraud, and the characteristics of a fraudster and a whistle-blower. For ‘doing the right thing’ we used Hannah Arendt and her distinction between labor, work and action. According to Arendt, the right thing to do is action. With action, the whistle-blower opens up space for other perspectives and discussion. For ‘doing things right’ we used the Cynefin Framework from Dave Snowden, which is based on complexity sciences. The decision model of the Cynefin Framework gives advice on how to respond. Still, revealing healthcare fraud and doing things right will always be a path of painful uncertainty.