The complexity of healthcare fraud - ethical and practical considerations




Ethics, Healthcare fraud, Whistle-blower, Complexity


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.

Biografia do Autor

Dineke Smit, Social Sciences, Radboud University Nijmegen, The Netherlands.

PhD candidate Radboud University Nijmegen, Netherlands European Forum for Primary Care, working group Mental Health Director Steunpunt GGZ (Fulcrum Mental Health), Utrecht, Netherlands. 

Jan Derksen, Radboud University Nijmegen, Department Social Sciences, Netherlands.

Emeritus Professor Clinical Psychology and Pschotherapy - Radboud University Nijmegen, Department Social Sciences, Netherlands. 


Ainsworth, P.B. (2001). Offender profiling and crime analysis. Portland, Oregon: Willan Publishing.

Arendt, H. (1958). The human condition. New York.

Bredemeier, H. C. & Stephenson, R.M. (1967). The analysis of social systems. New York: Holt, Rinehart and Winston.

Brooks, G., Tunley, M., Button, M., & Gee, J. (2017). Fraud, error and corruption in healthcare: a contribution from criminology.

Byrd, J., Powell, P., & Smith, D. (2013). Health care fraud: An introduction to a major cost issue. Journal of Accounting, Ethics and Public Policy, 14(3). Page 524.

Coleman, J. W. (1987). Toward an integrated theory of white-collar crime. American Journal of Sociology, 93(2), 406-439.

Cressey. D.R (1950): The Criminal Violation of Financial Trust. American sociological review 15 (6) pp 738-743, December. Pp 1-15 retrieved from

Dooley, K. J. (2009). The Butterfly Effect of the" Butterfly Effect". Nonlinear dynamics, psychology, and life sciences, 13(3), 279.

EHFCN. Waste typology matrix: European Healthcare Fraud and Corruption Network. 2016. 4-ehfcn-waste-typology-matrix/welcome.

European Commission (2013). Study on Corruption in the Health Sector. HOME/2011/ISEC/PR/047-A2, October 2013. Retrieved on 30th March 2020 from

Gleick, J. (2011). Chaos: Making a new science. Open Road Media.

Kalcheva, K. (2015). Whistleblowing and the NZA case: Managing change and Human Resources. Anchor Academic Publishing.

Kurtz, C. F., & Snowden, D. J. (2003). The new dynamics of strategy: Sense-making in a complex and complicated world. IBM systems journal, 42(3), 462-483.

Mannion, R., & Davies, H. T. (2015). Cultures of silence and cultures of voice: the role of whistleblowing in healthcare organisations. International journal of health policy and management, 4(8), 503.

Martin, G. (n.d.). “Whistle-blower” - the meaning and origin of this phrase. Retrieved on 23 March 2020, on

Nader, R., Petkas, P., & Blackwell, K. (1972). Whistleblowing. NY.

Ogunbanjo, G. A., & van Bogaert, D. K. (2014). Ethics in health care: healthcare fraud. South African Family Practice, 56(1), S10-S13.

Sauter, W., Mikkers, M., Vincke, P., & Boertjens, J. (2017). Healthcare fraud, corruption and waste in Europe: National and academic perspectives.

Sehgal, P. (2017) Can Whistleblowers live ‘Happily Ever After?’ A Review of Literature on Whistleblowing and its Implications. 1,s.l.: IRJMST,2017, International Research Journal of Management Sciences & Technology,Vol.8.

Smit, E. (2017). De klok luiden doe je niet in een ongeloofwaardig overheidshuis. Follow the Money. Retrieved on 23 March 2017, from

Snowden, D. J., & Boone, M. E. (2007). A leader's framework for decision making. Harvard business review, 85(11), 68.

Sorunke, O. A. (2016). Personal ethics and fraudster motivation: The missing link in fraud triangle and fraud diamond theories. International Journal of Academic Research in Business and Social Sciences, 6(2), 159-165.

Starkey, P. L. (2000). Whistleblowing behavior: The impact of situational and personality variables.

Sturmberg, J. P., & Martin, C. M. (2010). The dynamics of health care reform--learning from a complex adaptive systems theoretical perspective. Nonlinear dynamics, psychology, and life sciences, 14(4), 525-540.

Sturmberg, J. P., O'Halloran, D. M., & Martin, C. M. (2012). Understanding health system reform – a complex adaptive systems perspective. Journal of evaluation in clinical practice, 18(1), 202-208.

Thompson D. (2013). Two concepts of corruption: Edmond J Safra Center for Ethics. papers-series.

Thornton, D., Brinkhuis, M., Amrit, C., & Aly, R. (2015). Categorizing and describing the types of fraud in healthcare. Procedia Computer Science, 64, 713-720.

Uys, T., & Senekal, A. (2008). Morality of principle versus morality of loyalty: The case of whistleblowing. African Journal of Business Ethics, 3(1).

World Health Organization. (n.d.). Ethical principles. Retrieved on 30th March 2020, from





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