Sentencing Disparity Among Upper and Lower Class Health Care Professionals Convicted of Misconduct

Abstract

A longstanding debate in criminology and criminal justice has focused on whether white-collar offenders are sentenced more leniently than other types of offenders. This study uses a sample of approximately 1,200 adjudicated offenders who were employed in various types of health care professions at the time of their offenses—including both high-status and low-status positions—to explore whether the formal response to these types of occupational offenders are based on the status of the offender. The results show that certain types of high-status white-collar offenders appear to be punished more severely than lower status offenders from the health care field. Implications for policy, theory, and future research are provided.

Keywords

medical staff sentencing white-collar crime

Traditionally, it has been assumed that white-collar offenders receive lenient treatment when their cases are processed through the criminal justice system (Albonetti, 1994; Chambliss, 1964; Quinney, 1977). In the past, such an assumption was supported by anecdotal evidence or cases in which a highly publicized white-collar offender received a relatively lenient sentence (Benson & Cullen, 1998; Clinard & Yeager, 1980). Explanations for this lenient treatment tend to focus on the class of the offender and suggest that the white-collar offenders’ higher status or access to legal resources provide insulation from stern justice system responses. However, research as well as anecdotal evidence suggests that white-collar offenders are not necessarily immune from the formal justice process (Hagan & Palloni, 1986; Payne, 2003). Rosoff (1989), for example, has noted that offenses that deviate from a white-collar professional’s normative expectations (assigned by society) can suffer from a backlash of “status liability” and are thus likely to receive a stern response from members of society. In effect, Rosoff is drawing attention to the need to focus on the nature of the offense rather than the nature of the offender.

A common strategy among scholars interested in the sentencing of white-collar offenders is to assemble a sample of adjudicated property offenders coming from diverse occupational backgrounds and compare the sanctions of those employed in high-status or high-income (white-collar) jobs with those who were working in low-status or low-income (blue collar) occupations at the time they committed a property crime. These studies tend to show that white-collar offenders receive more severe sanctions than conventional offenders (Hagan & Palloni, 1986; Wheeler, Weisburd, & Bode, 1982). Other studies have focused on specific occupational groups and compared that occupational group to comparable conventional offenders convicted of different property crimes. For instance, Tillman and Pontell (1992) compared the sanctions given to Medicaid fraud by physicians to the sanctions given to offenders convicted of grand theft. This research shows that more severe sanctions were given to lower status offenders. As well, recent research by Maddan, Hartley, Walker, & Miller (2011) compared the sentences given to embezzlers with the sanctions given to auto thieves and found that auto thieves were given incarceration sentences 5 months longer on average than embezzlers.

The differences in this past research are possibly attributed to differences in occupational subcultures. Studies that combine different types of white-collar offenders and compare them to conventional offenders find stiffer sentencing, whereas those that limit the focus to one type of occupational subculture and compare the sanctions given to those offenders to the sanctions given to conventional offenders find more lenient sentence for white-collar offenders. It is entirely plausible that the impact of occupational subcultures, which is tied to social class, is masked through such comparisons. Noting that sanctions given to white-collar offenders are quite possibly influenced by occupational type, Hagan and Parker (1985) suggested “that the substitution of class for status measures is crucial” (p. 312). Rather than comparing different types of white-collar offenders (who have varying statuses) to conventional offenders, it may make more sense to compare white-collar offenders from similar occupations with one another.

The present study empirically examines the sentencing of white-collar offenders by focusing on offenders from one occupational system—the health care system. It is generally accepted that the health care system is staffed by a collective of occupations and professions (i.e., doctors, pharmacists, nurses, paraprofessionals skilled in a host of specialty functions, aids/orderlies, and administrators) that work in close contact and with a careful division of labor to deliver quality care to the public. Drawing on data from official reports of roughly 1,200 criminal cases prosecuted by Medicaid Fraud Control Units across the United States between 1987 and 2003, we examine the degree to which occupational status represents important predictive factors in sentencing outcomes for persons employed in the health case system. Such an exercise is important to understand the degree to which the status of the offender influences the way that formal authorities respond to crimes committed within the medical community. Determining whether white-collar offenders are sanctioned according to status type has important implications for research, theory, and policy.

Review of Literature

Ever since Edwin Sutherland first discussed white-collar offending more than six decades ago, criminologists have been exploring whether suite-based offenders receive more lenient treatment from the criminal justice system than street-based offenders (Benson & Cullen, 1998; Clinard & Yeager, 1980; Corporate Crime Reporter, 2005; Edelhertz, 1970; Reiman & Leighton, 2004; Weisburd, Wheeler, Waring, & Bode, 1991; Wheeler, Mann, & Sarat, 1988). The conventional wisdom is that preferential treatment exists and that it manifests itself as a lack of criminal prosecution or lighter or deferred sentences when white-collar crime cases are adjudicated by the criminal justice system. That said, there exists considerable disagreement over the factors that shape the adjudication processes and outcomes in white-collar crime cases. Some have argued that upper class offenders receive leniency throughout the criminal justice system because of the power and prestige they enjoy in our society (Albonetti, 1994; Chambliss, 1964; Quinney, 1977). Others note that prosecutors and judges are sensitive to the shame and public humiliation experienced by persons of high social status and factor, when doling out lighter criminal sanctions (Benson & Cullen, 1988; Mann, Wheeler, & Sarat, 1980). Still others have suggested that penalties given to white-collar offenders are related to ideals of general deterrence inasmuch as criminal justice officials aim to send a message via strict sentences, which were found to increase in the mid-1970s and early 1980s (Benson & Walker, 1988; Hagan & Palloni, 1986). Finally, there are those who note that the labels given to white-collar offenses are varied (Eitle, 2000; Friedrichs, 2010; Green, 1990; Piquero, Carmichael, & Piquero, 2008; Rosoff, 1989; Wheeler, Waring, & Bode, 1991), and that these different labels result in the offenses being defined and responded to in ways so as to be consistent with the labels rather than the behaviors.

Early white-collar crime sentencing research targeted corporations as the unit of analysis. Scholars such as Clinard and Yeager (1980), Cohen (1988), and Simpson and Koper (1992) relied on data from courts and/or regulatory agencies to provide descriptive information of the formal sanctions levied against corporations accused of wrongdoing. These studies paint a picture of leniency with low-level fines, community service, various forms of industry probation, and the like being handed out in response to conduct that resulted in significant social injury and significant monetary profit. For example, Cohen (1988) demonstrated that sentencing practices were impacted by the type and number of offenses under consideration and also by the characteristics of the offending corporation and vulnerability of the victims. Simpson and Koper (1992) found corporate culture and industry controls to be more predictive of corporate recidivism. This organization focused research suggested that individual level factors in the perpetration and response to criminal activity were also at play and warranted further consideration.

It is this individual focused research that seeks to predict the decision-making processes or sanctioning outcomes of those who serve as final arbiters in white-collar crime cases that is most germane to the present study. Among the first and most comprehensive study in this regard was based out of Yale University. This project relied on interviews with sitting federal judges and case files of white-collar cases adjudicated during a 10-year period. Rather than concentrate on offender status as the organizing principle of the project, the investigators targeted a select group of white-collar crime offenses and compared their disposition to more conventional crime types. The numerous resultant publications (Mann et al., 1980; Weisburd, Waring, & Chayet, 2001; Weisburd et al., 1991; Wheeler et al., 1988; Wheeler et al., 1982) reveal that the demographic characteristics, criminal histories, and recidivism patterns of persons adjudicated for white-collar offenses resemble those observed for persons adjudicated for more conventional property crimes.

Although some individual level research shows that white-collar offenders receive preferential treatment, other studies have shown that white-collar offenders are actually sentenced more severely than nonwhite-collar offenders (Hagan & Palloni, 1986; Wheeler et al., 1982). Three possible explanations are provided to explain this sort of sentencing disparity. First, from a conflict theory perspective, some authors argue that white-collar offenders will not see their case subject to the criminal justice process unless their crimes are so serious and the evidence so overwhelming that prosecutors have no choice but to pursue a criminal indictment (Gerber, 1994). They argue that it takes special circumstances for the prosecutor to indict a case, see it through to a guilty verdict, and have a judge hand down a sentence that includes a term of incarceration for a white-collar offender. Conflict theorists also point to the way that street criminals are sanctioned in criminal courts whereas white-collar criminals, if they are sanctioned at all, are usually done so in administrative or civil proceedings. One author team argued “the social processes of naming crime is significantly shaped by those who enjoy the economic and political power to ensure that the naming of crime . . . will reflect . . . their worldview and interests” (Kramer, Michalowski, & Kauzlarich, 2002; p. 266). In other words, white-collar offenders are getting away with less serious acts by having those cases diverted away from the criminal justice system.

Second, adopting a deterrence perspective, some have argued that white-collar offenders are held to higher standards than conventional offenders and that these higher standards result in stricter sentences (Podgor, 2007). The stiffer sentences, then, are justified on the grounds that the sanctions will deter other white-collar professionals from engaging in similar misdeeds. Indeed, incarceration has been hailed “as the most effective deterrent for white-collar offenders” (Ryan-Boyle, Simon, & Uebler, 1991, p. 756). In fact, three decades ago, one scholar noted, “White-collar criminals are more deterrable than common criminals because their crimes are more rational and calculating and because they have more of all of the things that can be lost through criminal justice sanctions” (Braithwaite, 1982, p. 760). Whether stiff sentences are actually being meted out to white-collar offenders remains to be seen.

Third, some scholars have suggested that class (rather than status) and occupational routines play a role in sentencing decisions. Hagan and Parker (1985), in particular, wrote, “the punishment of white-collar crime is not only a function of class position, but also of the kinds of organized white-collar criminal behavior that certain class positions make possible.” In other words, the type of class (or occupation/profession) within which an offender works will present different opportunities for crime and will set the stage for a different response system on the part of criminal justice officials. This is in line with the routine activities perspective which suggests that crime will occur if three elements are present: (a) a motivated offender, (b) a vulnerable target, and (c) a capable guardian (Cohen & Felson, 1979). The degree to which vulnerable targets and capable guardians are present varies across occupations. Some jobs may have no vulnerable targets—meaning there would be less crime in those occupations, whereas others might have more vulnerable targets—meaning there would more crime in those occupations. In some occupations, no capable guardian may be present, affording more opportunities for offending and less opportunities for sanctions. In other occupations, the presence of a capable guardian either prevents or detects wrongdoing. In the latter case, the presence of the capable guardian provides a higher likelihood that cases will be brought into the justice system and sanctioned accordingly.

To address whether sentencing disparities exist and if those disparities can be attributed to preferential treatment, deterrence ideals, or structural factors related to different occupations, the task at hand is to identify how offenders are punished within a specific occupational subculture that includes varying degrees of employment status but whose crimes are all enforced by the same crime control units (or capable guardians). Such a focus would allow a determination as to whether job status within an occupational subculture is predictive of sentencing outcomes for persons convicted of crimes committed while performing their job duties.

In this study, attention is given to the way that a occupationally diverse sample of health care professionals prosecuted for committing several different types of occupational crimes were sentenced for their misdeeds. The occupational groups include high-status profession types such as physicians, psychologists, psychiatrists, and pharmacists, as well as low-status occupation/profession types such as nurses, nurse’s aides, home health care professionals, and nursing home directors.¹ Likewise, individuals in the sample were convicted for a range of offenses including violent crimes, financial crimes, and drug offenses. In short, we seek to determine the degree to which authorities allow the status of the offender shape their sanctioning decisions with respect to one type of white-collar crime: health care misconduct. By addressing sentencing outcomes in this manner, we seek to advance scholarly debate among white-collar crime scholars and subsequently offer meaningful guidance to policy makers and practitioners as they engage the adjudication process.

With this as a backdrop, the following research question is addressed: Do high–status health care offenders (doctors, pharmacists, psychiatrists, psychologists, and directors) receive lighter sentences than lower status health care offenders (nurses and nurses’ aides)? Insight in this regard will provide important insight for criminological theory as well as criminal justice policies and practices guiding the response to white-collar offenders.

Method

To address this research question, the authors collected data from official reports of health care crimes prosecuted by Medicaid Fraud Control Units across the United States between 1987 and 2003. These years were selected as part of a broader study on medical crimes. The fraud control units are responsible for prosecuting a range of health care crimes that are committed in health care businesses that receive Medicaid funding. The units focus on occupational crimes (rather than crimes by Medicaid recipients). The units exist at the state level, with 42 states having fraud control units. The units routinely publish descriptions of the cases they prosecuted in a report titled Medicaid Fraud Reports. We used this source to develop a data set including various types of health care crimes.

Using Lexus Nexus Academic File, Medicaid Fraud Reports from 1987 to 2003 were searched using the following search words: “patient trust funds,” “psychiatrists,” “psychologists,” “home health care,” “sex* AND abuse,” “prescription,” “physician* AND fraud,” “drug diversion,” and “patient abuse.” With the exception of “patient abuse,” all cases generated by the specific search words were included in the analysis. For “patient abuse” cases, every third file was included if the perpetrator received a sentence. If the case did not fit the sentence criteria, the next immediate case considered. If this case failed to meet specifications, the following case was considered for inclusion. Case inclusion resumed to the original “third case” regardless if it was the first, second, or third case was included.²

A coding sheet was developed that allowed graduate student coders to collect data on each case. The coding sheet included information about the offender, the offense, and the sentence given to the offender.

Sample

In all, we collected data on 1,185 different health care criminal cases (See Table 1). Just more than half of the offenders were female (51.8%) and just less than half were male (48.2%). About 56% of the offenders served in positions or job roles generally deemed to be low-status occupations (e.g., aides and nurses) within the health care system and 32% held job designations commonly afforded a high-status designations (e.g., doctors, psychiatrists, psychologists, and directors).³ We were unable to definitively categorize job status in 12% of the cases because the occupations were classified as “other” and appear to include a combination of low- (e.g., orderlies, pharmacy technicians) and high-status (e.g., hospital administrators not holding a director title, specialty practitioners) positions. Turning to the issue of offense type, the data in Table 1 indicate that roughly one fourth of the cases were patient abuse cases, one fifth were thefts from patients, just more than one tenth were home health fraud cases, and one tenth were sexual abuse cases. The rest were some sort of fraud cases, involved drug diversion, or were categorized as “other.”

Table 1.

Sample Characteristics (N = 1,185).^a

	n	%	$\bar{x}$	SD
Offender gender
Male	571	48.2
Female	614	51.8
Occupation of offender^a
Aide	572	49.7
Nurse	73	6.1
Director	86	7.1
Psychologist	34	2.8
Pharmacist	51	4.2
Psychiatrist	62	5.1
Doctor	129	10.7
Other	144	12.0
Missing	34	3.8
Offense type
Patient abuse	314	26.1
Patient trust Fund theft	242	20.1
Home health care fraud	132	11.0
Prescription fraud	114	9.5
Fraud by a physician	105	8.7
Fraud by a psychologist	75	6.2
Fraud by a psychiatrist	45	3.7
Sexual abuse	127	10.5
Drug diversion	51	4.2
Other	21	1.7
Sentence
Prison (days)	132	11.1	1,898.73	3,948.21
Jail (days)	197	16.6	113.12	117.93
Probation (days)	651	54.9	2651.52	39,162.15
Fine (dollars)	744	62.8	67,080.90	2.61514E5
Community service (days)	226	19.1	55.80	128.56

. = percentages do not add up to 100.0 due to rounding.

Findings

Referring to Table 1, we note that fines were the most common sanction given to more than 60% of the offenders, followed by probation which was given in 54% of the cases. Prison and jail sanctions were handed down in far fewer cases, 11.1% and 16.6%, respectively. Community service was ordered in almost one in five cases. That incarceration was a sanction used in more than one fourth (27.7%) of the cases suggests, at least on the surface, that white-collar offenders (and offenses) are treated somewhat severely by criminal justice officials. The task at hand is to identify factors that seem to predict the sanctions for offenders.

To determine how this sample of white-collar offenders was sentenced, crosstabs were conducted to identify the relationship between the offender’s occupational status and sanction. Results are outlined in Table 2. We observe that high upper status offenders were more likely to be sentenced to prison, given community service, and fined. In particular, one fourth of doctors and psychiatrists were sentenced to prison, whereas just 9% of aides and 7% nurses were sentenced to prison. Half of the psychologists were given community service, whereas just 15% of nurses were given this sanction. All of the psychologists, more than 90% of the directors and pharmacists, and more than 80% of the doctors, psychiatrists, and psychologists were fined. In comparison, approximately 70% of low-status (nurses and aides) health care offenders were fined. It appears that sentencing differences exist between high and lower status medical offenders, though these differences might be in a different direction than expected.

Table 2.

Offender Characteristics by Sanctions.

	High status					Low status
	Doctor	Psychiatrist	Psychologist	Pharmacist	Director	Nurse	Aide	Other	Chi square	Sig.
Prison	32 (25.4)	11 (25.6)	1 (4.0)	10 (21.3)	8 (12.9)	4 (7.3)	46 (9.0)	28 (23.1)	43.27	.000
Jail	16 (12.7)	7 (16.3)	7 (28.0)	6 (12.8)	11 (17.7)	6 (11.1)	116 (22.7)	25 (20.7)	12.42	.087
Probation	73 (57.9)	23 (53.5)	16 (64.0)	28 (59.6)	38 (61.2)	39 (70.9)	336 (65.8)	85 (70.2)	8.50	.290
Community service	31 (24.6)	9 (20.9)	13 (52.0)	11 (23.4)	14 (22.6)	8 (14.5)	117 (22.9)	18 (14.9)	19.04	.008
Fine	104 (82.5)	37 (86.0)	25 (100.0)	43 (91.5)	57 (91.9)	39 (72.2)	365 (71.4)	83 (68.6)	38.90	.000

Note. The mean is the top number. The standard deviation is in parentheses.

To provide additional insight into the sentencing of these offenders, an ANOVA was conducted to determine whether sanction severity (e.g., fine amount and length of probation, prison, jail, and community service) was linked to offender status. Results are outlined in Table 3. Significant differences (p < .05) were found with regard to the length of jail and probation sentences, as well as fine amounts. As shown in the table, doctors, psychiatrists, and pharmacists received the longest jail sentences, whereas psychologists received the shortest jail sentences. In terms of probation, aides received the shortest probation sentences, whereas nurses received the longest probation sanctions. Not surprisingly, high-status offenders received higher fines than lower status health care offenders did.

Table 3.

Offender Characteristics by Sentence Lengths (In Days and Dollar Amounts).

	High status					Low status
	Doctor	Psychiatrist	Psychologist	Pharmacist	Director	Nurse	Aide	Other	F	Sig.
Prison	1385.00 (1451.21)	725.30 (537)	2190.00 (0.0)	912.33 (783.02)	1585.00 (1707.16)	2258.75 (1051.95)	2732.34 (6474.72)	2361.96 (3026.90)	0.507	.828
Jail	180.80 (92.83)	167.86 (144.71)	38.71 (47.02)	196.40 (113.07)	78.91 (110.67)	81.00 (80.35)	100.83 (117.07)	121.28 (111.41)	2.25	.032
Probation	1385.89 (860.34)	1356.87 (609.85)	2235.62 (2507.20)	1370.81 (744.01)	1297.24 (889.70)	27221.84 (162072.54)	890.12 (879.57)	80 (1421.21)	2.20	.033
Community service	59.16 (80.02)	136.20 (192.33)	55.45 (37.39)	49.13 (89.08)	51.33 (80.83)	23.91 (18.04)	58.19 (16.60)	37.59 (47.26)	0.589	.764
Fine	177904.18 (4.08000E5)	96570.62 (1.07332E5)	82573.19 (1.36683E5)	119510.07 (2.09176E5)	147199.71 (5.52091E5)	13727.94 (49027.51)	5624.81 (21580.71)	119406.99 (369348E5)	7.12	.000

Note. The mean is the top number. The standard deviation is in parentheses.

Discussion

These findings show that this sample of white-collar offenders are sentenced to a wide range of sanctions, and that some types of high-status health care offenders were more likely to be sentenced to prison than were their lower status counterparts. Community service and fines were more likely to be given to high-class offenders. From this, several implications for research, theory, and policy arise.

In terms of theory, these findings provide insight into deterrence theory, routine activities theory, and conflict theory. With regard to deterrence theory, although we were unable to test specific deterrence ideals, the fact that severe sanctions were given more often to high class offenders suggests that prosecutors and judges were trying “to send a message” to high-status offenders that their transgressions will not be tolerated. Many judges and prosecutors have made a career out of appearing to be hard on white-collar offenders. On one level, the premise is that stiff sentences against white-collar offenders, which the public supports (Almond, 2008; Piquero et al., 2008; Piquero, Exum, & Simpson, 2005), will provide the judge and the prosecutor with good will from the public. On another level, prosecutors and judge likely assume that their stiffer responses against white-collar crime will help to deter future white-collar misconduct (Benson & Cullen, 1998; Wheeler et al., 1988).

These findings can be partly understood through an application of routine activities theory. Note that the health care providers can be described as the motivated offenders, the Medicaid system and patients can be seen as the vulnerable target, and the activities of the fraud control units parallel what is meant by capable guardianship. Others have used routine activities theory to address how these officials respond to patient abuse cases (see Payne & Gainey, 2006). It is plausible that the efforts of fraud control officials to control all forms of health care crimes can be understood from a routine activities approach. The motivated offenders include a range of offenders (e.g., doctors, psychiatrists, nurses, aides, psychologists, pharmacists, and so on) who commit crimes against vulnerable targets (e.g., patients and the insurance industry). Fraud control officials are called upon to be guardians on the lookout for offenders and offenses regardless of occupational status. That the offenders are sanctioned differently suggests that different levels of guardianship are needed to protect vulnerable targets from future harm.

In terms of conflict theory, these findings on the surface call into question suggestions that high-status offenders are sentenced more leniently than lower status offenders. Consider that high-status offenders were more likely to be imprisoned. Also, some would point to the finding that probation was given more often to low-status offenders (nurses and aides) as additional evidence refuting conflict theory. Such an assumption, however, could be misleading. Probation is rarely seen by criminologists and theorists as a punitive sanction, but recent research has demonstrated that offenders tend to define certain types of probation as more severe than incarceration (May & Wood, 2010). In effect, probation can, in fact, be a tool that the powerful can use to control the lower class. The irony is that by sending a handful of white-collar offenders to prison and jail, those with power are able to mask their controlling efforts and use a different tool (e.g., probation) to exert even more control over the lower class. Also, it is entirely plausible that cases involving high status offenders were dropped from the system without prosecution more often than cases involving lower class offenders, and only the most egregious cases resulted in full prosecution. If this was the case, this would explain the more severe sanctions found among the upper class offenders. Finally, it is plausible that members of the criminal justice system (law enforcement, prosecutors, and judges) are oblivious to the status designations present in the health care industry and view all health care workers as holding higher status than the conventional street criminal.

The nature of the fines given to offenders also lends itself to an application of conflict theory. Research shows that being fined is among the most punitive experiences for individual offenders (Payne & Gainey, 1998). The very nature of the fine, as a sanction, is based on capitalist ideals. Given that conflict theory sees capitalism as structurally criminogenic, sanctions that are based on capitalistic ideals are called into question by conflict theorists. The use of fines for white-collar offenders can be seen as relevant to conflict theory in four ways. First, note that money is being used to control offenders in that offenders are expected to give money to the justice system. Second, the impact of fines must be seen as relative—a doctor would experience a US$5,000 fine differently than a nurse would. Third, note that fines are designed to benefit the state (not the victim). Fourth, the fine is defined as a way that the criminal justice system can profit from wrongdoing. One fraud control unit official recently noted that his office recovered US$1.6 million in funds in 2008, but his office budget from his state was around US$300,000 (Kramer, 2009). What this means is that his office fines offenders to fund efforts to respond to other cases of misconduct (see also Payne, 1995). In the end, for the conflict theorist, it is plausible that fines are simply another tool that makes the powerful even more powerful, and the less powerful weaker.

Several implications for policy and practice arise from these findings. First, the high proportion of high-status offenders being sentenced to prison suggests that prisons and jails must be prepared for the demands of incarcerating these offenders. To be sure, the majority of inmates is, and will remain, conventional offenders who are not members of the health care system. Still, the fact that some white-collar offenders are being sentenced to jail and prison means that corrections officials must be able to effectively control (and protect) white-collar offenders during their incarceration. The fact that they will make up such a small percentage of the total facility’s population presents challenges to administrators in and of itself (Payne, 2003).

Second and somewhat related, probation officials should also be prepared to deal with white-collar offenders (Mason, 2007). In this context, health care offenders sentenced to probation would present different needs and levels of risk than conventional offenders would present to probation officers. If probation officials fail to recognize the unique needs of these offenders, their ability to effectively supervise white-collar offenders will be reduced. Alternatively, recognizing white-collar offenders’ needs (and skills) will help offenders become reintegrated into society (and reduce their likelihood of reoffending).

Third, health care administrators, criminal justice officials, policy makers, and educators should make sure that health care professionals (and students) are aware of the penalties that are given to the offenders for their misdeeds. Doing so fits in with the ideals of general deterrence theory. It is plausible that some instances of health care crime are tied to assumptions that white-collar offenders are never punished. By making sure that current and future professionals know that health care offenders are, in fact, caught and punished, the ability of sanctions to effectively deter future behavior should be improved.

Fourth, criminal justice officials should use penalties and supervision strategies that are tied to offender and offense. Penalties such as community service, fines, and restitution can be linked to offender and offense characteristics. For example, doctors, lawyers, psychologists, nurses—and many other high-status white-collar offenders for that matter—have skills that would lend themselves well to community service sanctions. One should not look solely at the offender, however, and determine the penalty; instead, it is more appropriate to look at the offender’s characteristics and the offense characteristics. A pharmacist who stole drugs to feed an addiction, for instance, would be given a different type of community service than a pharmacist who stole money to pay for the purchase of luxury items. In a similar way, when assigning probation conditions for white-collar offenders, the judge and probation officer must consider who the offender is and what the offender did.

These findings should be approached with a degree of caution. We focused solely on those offenses that were brought into the justice system, and systemically ignored that large dark figure of white-collar crime. Decision making occurring at earlier stages may have kept certain types of offenders or offenses out of the justice process. Also, our data only included those cases that were reported in the fraud reports. Fraud control officials may not consistently report cases to the fraud reports. As well, our findings about health care crimes cannot be assumed to be generalizable to other forms of white-collar crime. It is also worth noting that the nature of the data precluded multivariate modeling that would allow us to isolate and articulate the net effect of various forms/levels of sanctions or other important predictor variables. Severity of offense type, for example, could not be assessed in our data. In addition, our data set includes crimes that were sanctioned between 1987 and 2003. A great deal has changed since 2003 in terms of federal sentencing policies for white-collar offenders and these changes are not reflected in the current study. Although these data are derived from state-level sources that have not experienced as much change in the interim years, future research should look to more recent and more complete datasets to accomplish a more nuanced analysis of the issues at hand. Such research could focus on the importance of severity and the impact of new sentencing policies on the sanctioning of white-collar offenders.

Despite these limitations, the findings support the need to focus on different levels of status in an effort to understand the sanctioning of white-collar offenders. A full picture of the misconduct appears by approaching the topic through this broader lens. In doing so, insight that is useful for scholars and practitioners will come out of such scholarly pursuits. The challenge is for criminologists to expand efforts to identify those factors that influence the way white-collar offenders are sanctioned.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

Author Biographies

Brian K. Payne is professor and chair of the Department of Criminal Justice at Georgia State University. He received his PhD in 1993 in Criminology from Indiana University of Pennsylvania. His research focuses on elder abuse, crime policies, family violence, and community-based sanctions. He is the author of five books including Crime and Elder Abuse: An Integrated Perspective, Crime in the Home Health Care Field, and Family Violence and Criminal Justice and he has published more than 120 scholarly journal articles. His works have been reviewed in outlets such as the New England Journal of Medicine, AgeVenture News, and The Gerontologist. He is a recipient of numerous awards including the Southern Criminal Justice Association’s Outstanding Educator Award and the Indiana University of Pennsylvania’s Department of Criminology Distinguished Scholar Award.

Dean A. Dabney is an Associate Professor in the Department of Criminal Justice at Georgia State University. He received his doctorate in sociology from the University of Florida in 1997. Since 2007, he has served as the editor of the Criminal Justice Review and International Criminal Justice Review. His scholarly interests include the organizational culture within law enforcement agencies, forms of deviance and/or criminal behaviors that occur in organizational settings, and qualitative research methods. He has published 2 books and several dozen articles appearing in such outlets as Criminal Justice & Behavior, International Journal of Offender Therapy & Comparative Criminology, Prison Journal, Journal of Drug Issues and Justice Quarterly.

Jessica L. Ekhomu earned her BS in Criminal Justice and her Master’s in Public Health from Georgia State University. She served as Managing Editor for the Criminal Justice Review and the International Criminal Justice Review. Her research interests include penology, correctional health care, social determinants of health, and social policy.

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