Corruption as Culture and Health Care Fraud in Brooklyn

The astonishing prevalence of health care fraud in the Russian-speaking communities of Brighton Beach and Coney Island in New York City presents an interesting case study on the causes of corruption. The Brighton Beach-Coney Island area is populated by people who immigrated from one of the most corrupt countries in the world to one of the least. You can take the person out of the corrupt system, but does this remove the propensity to engage in corrupt acts from the person?

In the wake of a recent spate of health care fraud scandals in Russian-speaking New York City communities (as well as a scheme to defraud Medicaid perpetuated by dozens of Russian diplomats), the facts and some commentators suggest no. Brighton Beach has the second highest rate of Medicaid and Medicare-related malfeasance in the United States. In February 2012, federal authorities uncovered the largest no-fault insurance fraud scheme in United States history, which was operated out of Brighton Beach-based clinics. A law-enforcement official drew a direct link between “the Russian mind-set” that “if you’re not scamming the government…you’re looked upon as a patsy” and this widespread fraud. Professor Mark Galeotti expanded on this point, suggesting that “from cradle to grave” Russians have been inculcated to “bureaucratic systems that are parasitic and hostile, almost designed to make you pay bribes.”

I think “old habits die hard” as an explanation is too simplistic and uncomfortably resembles notions (discussed elsewhere on this blog) that corruption is an inherent cultural touchstone in certain societies. Furthermore, emerging evidence shows that Russians within Russia are developing a moral aversion to bribery.

An alternative explanation for the puzzle of the Brighton Beach health care fraud phenomenon is below. Under this model, culture is not the only, and perhaps not the first, link in the chain of causation. Continue reading

Objective Validation of Subjective Corruption Perceptions?

As discussed on this blog and elsewhere, one of the big concerns about the most popular cross-country datasets on corruption (the Transparency International Corruption Perceptions Index (CPI), the World Bank Institute’s Worldwide Governance Indicators (WGI), etc.) is that they are based (largely or entirely) on perceptions of corruption. As Rick noted in a recent post, and as the critical literature has pointed out ad nauseam, perceptions, while perhaps important in their own right, are not necessarily based in reality. Indeed, some recent research (including, but certainly not limited to, nice papers by Claudio Weber Abramo, by Mireille Razafindrakoto and Francois Rouband, and by Richard Rose and William Mishler) indicates that national corruption perceptions are only weakly correlated with survey results asking about individuals’ personal experience with bribery. This raises serious questions about whether the perception-based indicators are useful either for general assessment or for testing hypotheses about the causes or consequences of corruption.

But might there be more objective measures that could be used to assess whether the corruption perceptions indices are picking up something real? Off the top of my head, I can think of four quite clever recent papers that demonstrate a strong correlation between a subjective corruption perception index and some more objective measure of dishonest behavior. I’m sure there are more, but let me note the four examples that I can think of, and then say a bit on what this might mean for the use of perception-based indicators in empirical corruption research.

Continue reading