Fighting Healthcare Corruption with Smiles and Stickers

Compared to other EU countries, petty bribery in Lithuanian healthcare is quite common (see here and here). Though extortion seems rare, Lithuanians frequently make informal (and illegal) payments to doctors either to get better/faster treatment or as an expression of gratitude. When describing this practice, Lithuanians use the language of “giving a gift” or “giving a little envelope,” euphemisms that imply that these payments have come to be perceived as acceptable expressions of gratitude rather than bribes, despite the fact that the Criminal Code prohibits bribery and the Civil Code prohibits giving doctors any sort of gifts outside their private lives. Though formally bribery, giving money to a doctor in Lithuania seems to have developed a different social meaning—rather than implying that you are a dishonest or corrupt person, giving extra money to your doctor has come to be understood as something that reasonable people do in recognition that doctors work hard, are underpaid, and deserve gratitude. Offering gifts or money to a doctor has also become a way to express how much you care about the health of your loved ones who are unwell. So, in Lithuania, the practice of making illegal payments to doctors seems to have become a “social norm” – a shared understanding that such behavior is permitted or even obligatory. It has become a norm both in the descriptive sense (people make these payments because they think that everyone else does so) and in the injunctive sense (making an extra payment to your doctor is an appropriate expression of gratitude). That doesn’t mean it’s good, or something we should ignore or tolerate. But it’s something we need to take into account when thinking about how to combat this form of corruption.

Once we recognize that petty bribery has become a social norm, we should ask what tools could be used to disrupt that norm. Because the problem is so extensive and multifaceted, many of the solutions will require significant institutional reforms, changes in management style, budget reallocations, and the like. Without minimizing the importance of those more fundamental changes, it’s also possible that seemingly small, inexpensive, and non-coercive interventions might help disrupt this dysfunctional social norm. Back in 2011, when I was working for Transparency International Lithuania (TI Lithuania), we piloted one such initiative in collaboration with the Lithuanian Medical Students Association. Our objective was to disrupt social norms surrounding informal healthcare payments—not through loud or aggressive actions, but with stickers and smiles. Continue reading

I Caught the Sheriff: Why U.S. Anticorruption Officials Should Keep an Eye on Sheriffs

An unusual feature of US law enforcement is the important role of the county sheriff. As of 2013, over 3,000 sheriffs’ offices across 47 U.S. states employed 352,000 people—roughly one-third of the country’s law enforcement personnel. The sheriff’s job varies from state-to-state, but the common denominator is responsibility over county corrections, including the operation of jails and transportation of inmates to and from court. In some states—Massachusetts, for instance—that’s essentially the extent of sheriffs’ duties. In other states, though, sheriffs wield much broader authority. Texas sheriffs, for example, can enforce the state’s criminal laws anywhere in their county, even where municipal police departments have jurisdiction. Most states are somewhere in the middle, tasking sheriffs with general law enforcement duties only in unincorporated parts of the county and sometimes with security for state government buildings, in addition to their correctional responsibilities.

Despite the variety of roles played by sheriffs, many commentators view sheriffs as merely another kind of police. After all, they wear badges, can legally use force, and, in many parts of the country, patrol the beat. But sheriffs are distinct from their police counterparts in significant respects. Most notably, whereas police chiefs are appointed by city officials, sheriffs are popularly elected by the county they serve. And, unlike police departments, which are creatures of state statute, the responsibilities of a county sheriff are often rooted in the state constitution.

These differences render sheriffs more susceptible than police to corruption for three reasons:

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Corruption in Tennis, Part 2: Independent Review Panel’s Recommendations Are a Step in the Right Direction, But Prioritization Is Essential

As I explained in my last post, the game of tennis—because of its one-on-one format and unusual scoring system—is especially vulnerable to match fixing. This risk has become ever more significant with the explosion in the global sports betting market, particularly online betting. Professional tennis’s Governing Bodies (which include the Association of Tennis Professionals (ATP), Women’s Tennis Association (WTA), the Grand Slam Board, and the International Tennis Federation (ITF)), have demonstrated their concern about this sort of corruption for over a decade, publishing reviews on integrity in tennis in 2005 and 2008, establishing the Tennis Integrity Unit (TIU) to govern anticorruption matters in 2009, and adopting a mandatory anticorruption educational program for players and officials (the Tennis Integrity Protection Programme (TIPP)) in 2011. Yet, despite these efforts, match fixing and spot fixing continue to be a major problem. In January 2016, Buzzfeed and BBC published a bombshell report alleging not only that match fixing in tennis was pervasive, but also that the TIU and the Governing Bodies had suppressed evidence on the extent of the problem. The Governing Bodies quickly released a statement “absolutely reject[ing]” the suggestion that they had suppressed evidence of match-fixing, but they nonetheless immediately commissioned an Independent Review Panel to evaluate integrity in tennis.

Almost three years later, in December 2018, the Panel published its conclusions and recommendations in a 113-page Report, which the Governing Bodies endorsed. While the Panel found no evidence suggesting that the TIU or the Governing Bodies had covered up any wrongdoing, the Panel did conclude that the sport’s current anticorruption efforts are “inadequate to deal with the nature and extent of the problem,” and recommended changes to the sport’s governance policies and institutions.

The Report’s greatest strength—its no-stone-unturned thoroughness—is also its greatest flaw: More academic than pragmatic, the Report neither prioritizes its proposals nor sufficiently considers their financial feasibility. Given that the Panel attributes economic challenges—such as the under-compensation of lower-ranked players and the lack of resources allocated toward the TIU—as major reasons for widespread corruption in tennis, it seems unrealistic to think that the Governing Bodies could afford an across-the-board implementation of the Panel’s proposals. Thus, the Governing Bodies’ implementation plan should prioritize the Panel’s various recommendations, with an eye toward financial feasibility. Specifically, the Governing Bodies should: Continue reading

Corruption in Tennis, Part 1: Why the Sport Is Especially Vulnerable to Corruption

Although wagers on tennis make up only a relatively small fraction of the global sports gambling market (estimated at around 12% of that market in 2015, compared to 65% for soccer), tennis seems to account for a disproportionate share of gambling-related match fixing and other forms of corruption. For example, ESSA (a non-profit dedicated to integrity in sports betting) reported that of the 496 cases of “suspicious betting” that it flagged across all sports in 2015, 2016, and 2017, 336 (68%) stemmed from bets on tennis matches. Of course, a suspicious betting alert does not necessarily indicate that match fixing or other corrupt activity actually occurred (see, for example, here and here), but still, that a sport comprising just 12% of the global sports betting market could generate over two-thirds of suspicious sports betting activity is striking, and consistent with expert assessments on the prevalence of corruption in tennis. Indeed, in 2005, Richard Ings, then the Executive Vice President for Rules and Competition for the Association of Tennis Professionals (ATP), wrote that “if a sport could have been invented with the possibility of corruption in mind, that sport would be tennis.”

Two factors in particular make tennis particularly susceptible to gambling-related corruption: Continue reading

Getting State Anticorruption Commissions to Work

In the elections last November 6, citizens in New Mexico and North Dakota voted to amend their state constitutions to establish state anticorruption commissions. In doing so, they joined the vast majority of American states (currently 44 out of 50) that have created similar (or at least similarly-named) commissions—starting with Hawaii back in 1968. The impulse to create a special commission to deal with a significant problem like public corruption is certainly understandable. Indeed, many state commissions were created immediately after a major public corruption scandal, when public frustration was running high. At the same time, though, the record of such state-level anticorruption commissions in the US is mixed at best (see, for example, here, here, and here). And despite the similarities in their names, many of these commissions actually do quite different things—with some functioning like ethics commissions that publish quasi-legislative standards and others functioning more like mini-prosecutors’ offices. Indeed, it’s not entirely clear that voters in New Mexico or North Dakota knew exactly what they were voting for when they went to the ballot boxes. In New Mexico, the referendum measure left to it to the state legislature to determine how the commission would operate, while the language in the North Dakota referendum suggested that the commission’s duties would be largely optional.

Despite their diversity and admittedly mixed track record, state anticorruption commissions have many potential benefits. They can provide clear reporting channels for individuals who have witnessed corruption; they can evaluate systemic corruption risks by sector and recommend more targeted reforms to state legislators; and they can enhance accountability by investigating ethics complaints and corruption allegations, and referring appropriate cases to state prosecutors’ offices. But in order to be effective, state commissions need to have certain institutional features and safeguards.

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South Africa Exhibits the Pitfalls of Private Prosecutions for Corruption

In March 2018, after several years of investigation stemming from allegations of corruption and mismanagement, South Africa’s National Prosecuting Authority (NPA) announced that it would not pursue charges against former South African Revenue Service Commissioner Tom Moyane. But this was decision short lived. A few weeks later, the NPA abruptly reversed course, explaining that it had reopened its investigation into Moyane and was reconsidering its decision not to prosecute. In the interim, the South African civil rights group Corruption Watch had publicly requested from the NPA a certificate of nolle prosequi—a document formally affirming the NPA’s decision not to prosecute. Obtaining such a certificate was a preliminary and necessary legal step for Corruption Watch to launch its own private prosecution of Moyane—which, under South African Law, Corruption Watch would have been able to do if the NPA formally declined to prosecute. Corruption Watch was calling NPA’s bluff, saying, in effect, “prosecute Moyane or else we will.”

Corruption Watch’s implicit threat stems from Section 7 of South Africa’s Criminal Procedure Act (CPA), which permits a citizen to criminally prosecute another person or entity if the NPA formally declines to prosecute. These prosecutions are similar to civil suits but with all the trial rights and potential penalties associated with a state prosecution. Moreover, at any time during a private prosecution the NPA may request permission from the supervising court to step back in and take over the case. South Africa is not unique in this regard: There are provisions for private prosecutions in other countries—especially Commonwealth countries—including the UK, Canada, Australia, Zimbabwe, and Kenya, as well as in China and Israel.

Many commentators in the international community have been optimistic about the potential of private prosecutions, particularly in combating corruption (see here, here, and on this blog here). And forces inside South Africa have been especially enthusiastic; in 2017, the South African civil society organization AfriForum launched its own dedicated private prosecutions unit focused on prosecuting corrupt government officials, with other organizations expressing similar interest. Much of this optimism stems from sheer frustration with the current prosecution regime in South Africa, a country that has long been plagued by selective prosecution, especially in the area of corruption.

South Africa could certainly use more pressure on the NPA to act; the country would also benefit from more resources, whatever the source, devoted to investigating and prosecuting corruption cases. And the fact that the threat of private prosecution appears to have spurred the NPA to action in the Moyane case is encouraging. Nevertheless, South Africa’s recent flirtation with private prosecutions actually illustrates why countries—including and perhaps especially South Africa—should be cautious about embracing organized, comprehensive private prosecution regimes to supplement traditional state prosecution. Continue reading

A Border Patrol Surge Will Lead to a Border Corruption Surge

The United States Customs and Border Protection service (CBP) is the largest law enforcement agency in the United States—and one of the most corrupt. CBP employs 59,000 people, of whom almost 20,000 are Border Patrol agents. Every day, these agents process over a million incoming U.S. travelers, 300,000 vehicles, and 78,000 shipping containers. On any given day they might seize over 5,000 pounds of narcotics and apprehend nearly 900 people at or near U.S. borders. Yet according to “conservative [] estimate[s],” about 1,000 Border Patrol agents—5% of the total—violate their official duties in exchange for bribes. To take just a handful of some of the most egregious examples: One CBP agent permitted smugglers to bring over 612 kilograms of cocaine into the U.S. in exchange for $1,000 for each kilo he waved through his checkpoint. Another allowed 1,200 pounds of marijuana to enter into the U.S. in exchange for $60,000. Yet another CBP agent permitted vehicles containing undocumented immigrants to enter the U.S. at a price of $8,000-10,000 per vehicle.

In response to this widespread corruption, the Department of Homeland Security convened an independent Integrity Advisory Panel in 2015. But the Panel’s 2016 report fell on deaf ears, as almost none of its 39 recommendations were implemented. Instead, in line with his hardline stance on immigration, President Trump signed a 2017 executive order mandating hiring an additional 5,000 Border Patrol agents and “appropriate action to ensure that such agents enter on duty . . . as soon as practicable.”

Increasing the number of agents by 25% without devoting significant resources to combat the pervasive corruption in CBP is a terrible idea, and is likely to exacerbate current corruption problems, for three reasons: Continue reading