Triage Decision-Making by Welfare Fraud Investigators

Two studies explored triage decision-making in a welfare fraud investigation, specifically decisions concerning what evidence to collect when deciding whether to pursue a case to prosecution or to issue a warning only. An observational study revealed that triage decisions appear to be determined by subjective estimates of the ease of evidence collection and that these estimates are influenced by complexity of mapping evidence onto fraud types. This hypothesis was explored in an experimental study of investigators, managers, and students choosing evidence to inform triage decisions for cases that varied according to relevance and complexity. Student selections were unaffected by the nature of the case. In contrast, with a simple fraud case, investigators and managers tended to select evidence to support a prosecution decision, but with complex fraud they selected evidence that supported comparative evaluation of prosecution and warning decisions. The results demonstrate flexible expertise in choosing what evidence to sample. General Audience Summary Fraud is common in welfare claims and costs taxpayers billions of dollars, but little is known about decision making strategies used in welfare fraud investigation. Investigations begin with a triage decision: whether to seek evidence that might lead to prosecution or to terminate an investigation and issue a warning designed to discourage further claims. The first study explored the fraud investigation process through field notes and analysis of investigator interviews with clients. The study showed that investigators tend to make triage decisions based on the perceived ease with which evidence can be collected. A second experimental study compared choices made by investigators, investigation managers, and students as to what evidence they would seek to make a triage decision. Participants were shown case scenarios based on a tip-off that suggested fraud. Their task was to choose further evidence in order to decide whether to prosecute or issue a warning. Cases differed in how easy it was to map evidence onto the underlying fraud activity. Students' selections were unaffected by the nature of the case. In contrast, with a simple fraud case, investigators selected evidence to support prosecution, but with a complex fraud case they selected evidence that could equally support prosecution and warning decisions. The results suggest that investigators are flexible in the strategies they use in triage decision-making: they will seek evidence to discriminate between alternative outcomes but only when the case is complex, otherwise they tend to seek evidence to confirm initial suspicions.