Jonathan Ernst/Reuters

White House senior adviser Jared Kushner arrives to join his father-in-law, President Trump, and the rest of the U.S. delegation to meet with Saudi Arabia's King Salman bin Abdulaziz Al Saud at the Royal Court in Riyadh, Saudi Arabia, on May 20, 2017.

The Kremlin spy was happy to participate in a secret, back-channel relationship with the close advisor to the US president-elect. His bosses wanted to deal with the new American leader “on the basis of complete frankness,” he said.

It would help if the upcoming inaugural address contained a positive reference, the spy added. Perhaps it could refer to “open channels of communication to Moscow.”

Is this a read-out of from one of Jared Kushner’s meetings with a Russian during the presidential transition of 2016 and 2017? Nope. It’s a reference to a January 1969 discussion between Henry Kissinger, then a key adviser to incoming president Richard Nixon, and Boris Sedov, a KGB operative working undercover as a Soviet journalist in Washington.

What it shows is that clandestine back channels between adversaries have been common diplomatic tools. They date back to virtually the beginning of the nation-state system. They were a feature of US-Soviet relations throughout the 1960s – and a useful feature, too.

Thus the phrase “back channel” isn’t by definition nefarious when applied to Mr. Kushner’s activities. The important questions are larger: Whom did he meet with and why did he meet them? What did he talk about? Who knew?

In terms of any back-channel communications between Trump officials and Russia, “the issue at stake here is what is the purpose and to what extent is that purpose kept secret from one’s own government?” says Brian Balogh, a professor of history at the University of Virginia and co-host of the “BackStory” history podcast.

Those are things that federal and congressional investigators are currently looking at. In particular they are studying a meeting between Kushner, son-in-law of the then president-elect, and a Russian banker, Sergey Gorkov, that took place in mid-December. Mr. Gorkov is a close associate of Russian President Vladimir Putin. Mr. Putin's government controls Gorkov’s bank.

The Kushner-Gorkov connection occurred following an earlier December meeting between Kushner, former National Security Advisor Michael Flynn, and Russian Ambassador to the US Sergey Kislyak. Last week, the Washington Post reported that Amb. Kislyak told Moscow that at that meeting Kushner proposed opening a secret channel of communications, perhaps using Russian communications equipment at Russian facilities.

The White House has not denied that Kushner proposed a back-channel opening. Officials have told The New York Times that the purpose was to collaborate on ending the civil war in Syria and other policy issues.

But investigators find aspects of the meetings, as described, puzzling. Why was a banker involved? Did it have something to do with sanctions on Russia imposed by the Obama administration due to Russian aggression in Ukraine? Why would Kushner want to use Russian communications equipment, if it’s true he made that request?

Where bold ideas germinate

However, asking to open a back channel between adversaries isn’t per se suspicious. Lots of administrations have used them for sensitive discussions they’d rather not be covered by the press.

Back channels allow national leaders to speak frankly to each other. They shield half-formed ideas from the harsh light of public criticism. They keep domestic adversaries of a position from organizing to defeat a proposed action.

They can also be hugely important. A secret Washington-Beijing back channel, developed with the help of Pakistan, laid the ground for President Nixon’s historic rapprochement with China. This famous example is virtually a how-to guide for secret talks. At one point, during an official trip to Pakistan, a slumped-over Secret Service agent impersonated Kissinger, supposedly ill, riding off to recuperate in the hill country. The real Kissinger sneaked off to Beijing for high-level meetings.

“That was a constructive reason for using a back-channel mechanism. It’s all about keeping things secret from people like [the media],” says Prof. Balogh of the University of Virginia.

Back channels helped defuse the Cuban Missile Crisis, too. There were two: one via the Brazilian government, and another through Robert F. Kennedy’s own Soviet contacts. They helped Washington and Moscow work out a deal in which the US secretly promised to withdraw Jupiter nuclear missiles from Turkey in exchange for Soviet withdrawal of its Cuban nuclear weapons.

President John F. Kennedy was under tremendous pressure from some military leaders to take a hard line in the 1962 Cuba crisis, perhaps the most dangerous moment of the Cold War. The back channels allowed him to circumvent their influence and develop solutions.

“The key historical lesson of the missile crisis [is] the need and role for creative diplomacy to avoid the threat of nuclear Armageddon,” wrote Peter Kornbluh, Cuba analyst at the National Security Archive at the George Washington University, upon the declassification of relevant RFK documents in 2012.

Kissinger's ties with KGB spy

Many back channels develop on an ad hoc basis to handle specific geopolitical problems or needs. That generally occurs after a particular administration takes office. But that’s not always the case. Some are formed in the gray period of the transition, when the Americans involved are still civilians and have no real power.

Richard Nixon used two channels to communicate with Soviet leaders prior to his 1968 election, for instance. The first involved Nixon’s longtime aide and personal friend Robert Ellsworth, who met with Soviet Ambassador to the US Anatoly Dobrynin and other Soviet leaders.

The second was the connection between Kissinger and Mr. Sedov – meetings that would probably raise eyebrows today, says Richard A. Moss, an associate research professor at the US Naval War College’s Center for Naval Warfare Studies, and author of “Nixon’s Back Channel to Moscow: Confidential Diplomacy and Détente.”

Officially, Sedov was a correspondent for the Novosti Press Agency. He had met Kissinger, then a rising Harvard professor, in the course of his journalism work. In fact, he was a KGB officer charged with collecting political intelligence and developing relations with important figures.

Declassified documents make it clear that US officials were well aware of Sedov’s dual identity. Kissinger made use of it to begin to pass messages to the Kremlin about the approach Nixon planned to take in office. The basic message was that Nixon was not the anti-communist ogre he seemed. He would be open to improved relations between the superpowers once in office.

After Kissinger became Nixon’s National Security Advisor he dealt more directly with Amb. Dobrynin, and Sedov faded out of the picture. This channel virtually defined US-USSR relations during the period, with then-Secretary of State William P. Rogers kept out of the loop.

“Kissinger-Dobrynin was very successful,” says Prof. Moss. “There would have been no détente without it.”

Lessons for Trump, Kushner

Today, Jared Kushner’s problem is that the US intelligence community judges that Russia tried to influence the 2016 election via various means, including leaking stolen emails and inserting and amplifying fake news intended to damage Hillary Clinton’s chances.

In that context, hush-hush dealings with Russia prior to taking office could appear suspicious. The US has only one president at a time. If it is true that Kushner suggested using Russian communications, the logical conclusion is that he wanted to keep the contents of their discussions secret from the US government itself.

Going forward, the Trump administration (and future administrations) might do well to consider two important points about back channels, says Moss.

The first is that they work best as part of an overarching plan. They should supplement traditional, more open negotiations, not supplant them.

The second is that they’re useful.

“You should talk anytime you can,” he says. “Talk is good. In today’s world, the risks otherwise are too great.”

Houda Salehi knows she should vote in Britain’s June 8 general election.

But following the national race just two years ago, the Brexit referendum last year, and the immediate change of power that generated, the graduate student says she is simply overwhelmed by the number of votes and uninformed about the stakes.

“I will try to vote, but I’m just not even sure what I am voting for and why,” says Ms. Salehi at British Library plaza in central London on a recent day. Plus, she adds, it’s the end of the year and time to buckle down. “I have to pass my master’s!”

As Britain gears up for another electoral season – after a new election was called by Prime Minister Theresa May, a U-turn from her pledge not to hold a vote until the current term’s scheduled end in 2020 – many Britons have experienced a degree of democratic whiplash. 

It’s a sign of the angst of the political era, not just in Britain but around the world. As party allegiances have broken down and a mistrust of politics in general has grown, leaders have depended more heavily on votes or referendums to consolidate power and steer their nations, from everything from independence to controversial foreign policy decisions.

But the proliferation of votes is feeding electoral fatigue, leading to greater disillusionment in politics and more urgency to find a solution. Just as the financial crisis profoundly shook people’s faith in market capitalism, there are increasing doubts that politics today is working as it ought to be – and nowhere is that clearer than in Britain.

“We’re having lots of elections, lots of referendums, but what is not changing is people’s sense that they’re having a say and they’re influencing change,” says Alexandra Runswick, director of Unlock Democracy, a nonprofit in London seeking to make politics work better.

‘Not another one!’

Not only will Britons have had three national votes in two years, the various polls of the devolved governments in the United Kingdom have added to a perception of ceaseless balloting. Northern Ireland will have had five votes in just over two years. Scotland will also have had five since September 2014 – with Scottish First Minister Nicola Sturgeon warning of another referendum for Scottish independence, which would have repercussions from Inverness to Ipswich.

At the same time, as domestic policies reach far beyond national borders today – Brexit, for example, is a political shakeup with far-reaching impact on the 27 other members of the EU – a sense of political uncertainty hangs over the country, heightened by last week's attack at the Ariana Grande concert in Manchester which killed 22 people.

Perhaps it was “Brenda from Bristol” who captured best the zeitgeist of the moment, when a BBC reporter asked the pensioner how she felt about the snap election shortly after it was announced. “You’re joking? Not another one!” she replied in a reaction that went viral. “Oh for God’s sake, I can’t honestly... I can’t stand this.”

Polling reveals clear dissatisfaction with the status quo, though not a decline in voter participation. A 2017 audit of political engagement by the Hansard Society, a London-based charity that promotes democracy, shows 59 percent of the public saying they’d be certain to vote in June, the same percentage in last year's audit and the highest proportion on record. But the audit also showed fewer than a third of people satisfied with the way Parliament works. And the proportion of those feeling they have influence over national decisionmaking is just 16 percent, including among those respondents who found themselves on the winning side of Brexit.

When art facilitator Ali Avery and artist Alice Myers recently set off on a two-week “listening journey” across the four countries of Britain for a project called Indefinite Article, the overarching message that emerged in the 79 interviews they did was, essentially: “We desperately need change. And change is impossible.”

Stefan Rousseau/Reuters

Labour leader Jeremy Corbyn answers questions from the studio audience during an election program at Sky Studios in London, Sunday.

Democracy amid uncertainty

This frustration toward politics comes at a time when, because of the electoral cycle, several Western countries have held national elections recently, or will do so this year: the US, Austria, the Netherlands, France, Britain, and Germany.

With the rise of social media in an interconnected world where politics has necessarily become transnational, the uncertainty is shared across borders, says Katharine Dommett, a lecturer in the public understanding of politics at the University of Sheffield. “I think there’s a real sense of uncertainty about what the political future holds. There are a lot of variables at play in Britain and around Brexit, but also on the international field about what’s happening and how change is occurring,” she says. While it’s not entirely new, “it feels so at the moment because we’re living through it.”

And for some, leaders have contributed to a sense of instability by holding additional votes.

Ms. May, who came into power unelected after former Prime Minister David Cameron stepped down after losing his Brexit referendum, had promised not to call another election. Now with her Conservative party the clear frontrunner, she seeks a stronger hand on negotiations with the EU.

The Brexit referendum itself, meanwhile, is part of a rise in the use of the tool across Europe. Bruno Kaufmann, a Swiss journalist and chairman of the Democracy Council and Election Commission in Falun, Sweden, says too many referendums are called by leaders to consolidate power rather than to consider public suggestions. Brexit, he says, was a question too reductive and a decision too consequential to be reasonably handled with just one referendum.

Engaging differently?

But while there is broad exasperation about the apparently endless wave of elections and referendums, that doesn’t mean that people are disengaging from democracy on the whole.

A recent YouGov poll shows mixed opinions on the flurry of votes put to Britons, with 37 percent saying there have been “too many” and 37 percent selecting “about the right amount.” For those affiliated with the parties that more strongly supported Brexit, like the UK Independence Party, support for the rate was higher.

Ms. Dommett says that “election fatigue” could lead to lower turnout, but notes that the trend is not definitively downward. Recent local elections saw an uptick in voter participation; Brexit saw huge voter turnout, she says. “A decline in turnout might not be problematic if people are engaging in different ways. Or it may be that people are not deciding to engage at a moment where they don’t feel their participation is valuable, but if something was at stake they would be back.”

And so much has changed politically since the last general election – such as plummeting support for the Labour Party – that this election may seem sufficiently different to voters. The last election “almost feels like it was a long time ago,” says Peter Sloman, a lecturer in British politics at the University of Cambridge.

To encourage more people to get involved in politics and feel they have a stake in the decisions affecting them, more participatory solutions are taking hold in Britain and beyond, from direct democracy to meetups with local MPs to sortition – a jury-type deliberative process that in some cases sees citizens acting in advisory panels to governments (as in Ireland).

“I think people are very politically aware, quite politically engaged, and almost universally disappointed in how the system is functioning now,” says Brett Hennig, co-founder of the Sortition Foundation in Cambridge.

"If Brexit goes badly, I think [Britain] could very much be open for some dramatic changes."

• Sara Miller Llana reported from Paris.

Afolabi Sotunde/ Reuters

Indigenous People of Biafra (IPOB) leader Nnamdi Kanu is seen at the federal high court in Abuja, Nigeria, on January 20, 2016.

When Nigeria’s brutal Biafran War ended in 1970, Sopuru Amah’s birth was still more than two decades away. The only knowledge the 22-year-old college student has of the war comes filtered through memoir and memory – the stories he has read and those he has heard from parents and relatives who survived the three-year civil conflict, which killed more than a million people between 1967 and 1970.

But today, nearly five decades later, Mr. Amah calls himself an “ever loyal, hardcore, and unrepentant Biafran,” referring to the short-lived state whose split from Nigeria began the conflict: the Republic of Biafra, which, had it survived, would have celebrated its 50th anniversary on May 30.

Amah and thousands of other young Nigerians like him are part of a new wave of Biafran nationalism building across the country’s southeast, where they say frustration over the glacial pace of development and job creation has sparked renewed interest in a cause that long seemed consigned to the history books – one more challenge for a country battling Boko Haram in the north, and corruption throughout.

Pro-Biafra movements like the Indigenous People of Biafra (IPOB) help Igbo remember the past, says Christopher Ejiofor, a Biafra War veteran who was an aide-de-camp to Biafra's military governor during the war. “IPOB is like a candle bearer, lighting the candle of remembrance about the ill that happened to Biafra,” he says. “With them, Biafra can never die.”

Post-war promises

Over the last decade, an alphabet soup of pro-Biafran separatist movements have emerged, including the Movement for the Actualization of the Sovereign State of Biafra (MASSOB), the Biafra Zionist Movement (BZM), and the IPOB. Images of the Biafran flag are appearing in southern cities, with its rising sun and bars of red, black, and green plastered on cars, tricycles, and buildings.

“Biafraland is still without basic government-sponsored infrastructure and development,” says Emeka Gift, the Ivory Coast national coordinator for IPOB, referring to Nigeria’s southeast. “Biafrans have continued to be subjected to a high level of political and economic marginalization.” (IPOB has dozens of branches around the world, attempting to raise awareness and gather support from Igbos abroad.)

Since the restoration of democracy in 1999, the country has never had a president who is Igbo, one of Nigeria’s largest ethnic groups. Many of the region’s roads are cut apart by potholes, with government buildings crumbling.

That under-development dates back to the three-year war, many here say, which left much of the southeast in disrepair or burnt down. In 1967, after anti-Igbo massacres left more than 30,000 dead the year before, military officer Odumegwu Ojukwu declared an independent Republic of Biafra, launching the battle against Nigerian forces. More than one million people died, mostly from famine and disease after the Nigerian army blockaded Biafra.

“There was no food in the inner Biafra, people were dying of starvation,” says Mr. Ejiofor, who is also a traditional ruler here. “We were just burying people, there were mass graves everywhere. Think about every city losing thousands of people every day, children in refugee camps dying every day.”

When Biafra finally surrendered in January 1970, Nigeria’s head of state, General Yakubu Gowon, promised the war would have “no victor [and] no vanquished” and pledged a policy of reconciliation, reconstruction, and rehabilitation in the former Biafran territories: a promise known as “the three ‘r’s.”

But the memories of the war’s brutality remained fresh for many, who say the promised rebuilding and development came slowly, if at all.

“If it was put in writing, it was never put in practice,” says Ejiofor, referring to the “three ‘r’s.” “In other words, it was only a theoretical statement made to deceive people. Theoretically it may have been said, but practically it was a political gimmick.”

Lekan Oyekanmi/AP

Members of the Biafran separatist movement gathered during an event in Umuahia, Nigeria. The members are commemorating their fallen heroes 50 years after Nigeria's civil war saw more than 1 million die to create the state for the Igbo people.

Heavy-handed response

Though many people here were frustrated with the underdevelopment of the region for a long time, few protests took place during Nigeria’s most recent era of military rule. Since the installation of a democratic government, however, protests have gradually built, stoked in part by the government’s heavy-handed response. IPOB, for instance, saw a surge of popularity in late 2015 after its leader, Nnamdi Kanu, was arrested for treason.

Mr. Kanu, who also doubles as the director of the incendiary London-based internet radio station Radio Biafra, was granted bail on health grounds in late April, though he was barred from holding rallies, granting interviews, and staying in a crowd of more than 10 people.

Meanwhile, the military killed 150 peaceful Biafra protesters between August 2015 and August 2016, according to an Amnesty International investigation, in what the human rights group called a “chilling campaign” to stifle separatists.

“This deadly repression of pro-Biafra activists is further stoking tensions in the southeast of Nigeria,” Makmid Kamara, the interim director of Amnesty International Nigeria, said in a statement at the time. “The Nigerian government’s decision to send in the military to respond to pro-Biafra events seems to be in large part to blame for this excessive bloodshed.”

For the 2017 anniversary, pro-Biafra leaders have called for a stay-at-home protest. Dozens of supporters have been arrested in recent protests. 

Some aspects of the pro-Biafra movement have been charged with promoting violence. Many supporters turn to nationalist outlets like Radio Biafra, which critics have accused of hate speech for its fierce anti-Nigerian messages.

“The mission of Radio Biafra is very simple – to get Biafra, by every means necessary and possible ... including war … [and] Nigeria will be completely bombed to the ground,” Kanu warned in a 2015 broadcast. “Be prepared for that.”

Two months earlier, at the World Igbo Congress, held in Los Angeles, he told listeners that “We need guns and bullets from you people in America.”

Erasing history

But some analysts say there may also be a less-obvious reason Biafran nationalism is surging again – the slow disappearance of the country’s history from its school curricula.

For several years, history has been removed from primary and secondary school lessons as a stand-alone subject – a trend the government made official in 2009. When asked to defend its decision, the government has said that students who studied history had less market value, and typically wound up as teachers, a vocation that does not have high prestige in Nigeria.

As a result, many young people only learn about the civil war from personal recollections of survivors in their families and communities and, more recently, from outlets like Radio Biafra. Indeed, few Nigerians can remember the Biafra war at all: Only about 7 percent of the population is over age 55.

“Why has the war not been discussed, or taught to the young, over 40 years after its end?” prominent Nigerian author Chinua Achebe, himself an Igbo, asked in his 2012 memoirs of the war, “There Was a Country.”

However, change may be afoot. The minister of education has encouraged history in school curricula, although the lower house of the legislature rejected a bill last fall to make it a compulsory subject.

For many young people here, however, the past has already invaded the present, and at least for now, the idea of a new Biafra remains a powerful source of political inspiration.  

“I pray that God will deliver us from the hands of our enemies,” says Chinedu Daniel, who completed high school last year, referring to the national government. “God will help us to achieve our struggle for freedom and restoration.” 

There are no high-tech forensic gadgets or state-of the-art surveillance devices in Mike Cohen’s work station here. The federal investigator’s “office” appears about as exciting as an insurance company cubicle.   

But Dr. Cohen is at the cutting edge of a law enforcement innovation that is helping federal agents level the field in the fight against large-scale health-care fraud. 

“No other reporter has ever seen this,” he says, tapping out a command on his computer keyboard. “But just to give you an idea of the metrics we look at.…”

Line after line of data begins to appear on his computer screen, forming a long list of companies and addresses with columns of related measures and rankings assigned to each business.

“Your standard pharmacy that is just billing Medicare is going to be $300,000 to $1.5 million,” Cohen says. “Maybe $3 million if you have a really intense population.”

Cohen scrolls through the list on his computer screen. Nine pharmacies at the top of his list show Medicare billing of $100 million or more.

“We are not talking about a couple of prescriptions here that are out of sorts,” he says.

Not long ago, it would have taken an entire squad of health-care fraud investigators a decade worth of shoe leather to connect all the dots and compile such a list, Cohen says. Today, he can do it in a few seconds. 

“There is no shortage of ways we can twist and crunch numbers to look for targets,” Cohen says. “And there is no shortage of targets.”

Health-care fraud has become a big, lucrative enterprise in the United States. No one knows the full extent of the drain on Medicare, Medicaid, and private health insurers. Experts suggest it may cost $100 billion each year.

Whatever the actual loss, fraud diverts critically needed resources from patient care, undermining the ability of the government and others to help those most vulnerable. 

For decades, federal agents have struggled to keep pace with growing numbers of health-care fraudsters. Now, the hope is that data analytics can inject a new level of oversight and enforcement into the system.

Depending on commands Cohen types into his computer, the displayed results could be a list of the most suspicious doctors, pharmacies, hospitals, drug companies, medical device manufacturers, or others operating in the US health care industry.

The metrics seek to identify patterns in Medicare billing data that resemble known examples of fraud. Health-care swindlers get rich by finding a way to cheat the system and then using that deceptive practice over and over again. Since every transaction in the government-run health-care system is documented, a successful fraud depends on the ability of the swindlers to hide in plain sight amid hundreds of millions of transactions. 

If those hundreds of millions of transactions can be organized in a way that identifies patterns of fraud, the suspected perpetrators of that fraud are no longer able to hide from federal agents.

“For decades Medicare has been a spigot of money flowing into the hands of fraudsters,” says James Quiggle of the Washington-based Coalition Against Insurance Fraud. 

“The system has finally woken up to the size of the losses and is taking powerful strides to turn off that spigot,” he says. “But it is going to take years before health care turns the corner on these scams.”

$1 billion – and that's just one case

Law enforcement operations provide only a hint of the size of the nation’s health-care fraud problem. 

• In 2007, the Justice Department established a Medicare Fraud Strike Force to battle rampant health-care scams in Miami. In the years since, similar strike forces have been set up in eight other cities. They have charged more than 2,900 individuals accused of submitting $8.9 billion in false bills to Medicare. 
• In June 2016, federal agents conducted a nationwide health-care fraud takedown, charging 301 individuals who allegedly submitted $900 million in false billings. Those arrested included 61 physicians, nurses, or other licensed medical professionals. Officials called it the largest such health-care fraud enforcement operation in US history.
• In July, federal prosecutors in Miami indicted Philip Esformes for running a network of more than 30 assisted living facilities and skilled nursing centers that allegedly billed for unnecessary tests and services for 14,000 poor and elderly patients. Prosecutors estimate the network submitted $1 billion in fraudulent claims, making it the nation’s single largest health-care fraud case – so far.  

LM Otero/AP

The closed office of Medistat Group Associates is seen Thursday, March 1, 2012, in DeSoto, Texas. Dr. Jacques Roy, who ran the business, and six other associates were indicted in a massive health care fraud scheme that allegedly bilked Medicare and Medicaid of nearly $375 million.

There are not nearly enough federal agents to stop all health-care fraud, officials say. But with the help of computer technology, there is hope that the most egregious criminals can be identified and brought to justice.

Cohen is an investigator with the Office of Inspector General (OIG) at the Department of Health and Human Services. He is among 600 OIG agents and staff members who work every day on the front lines in the fight against health-care fraud. 

As an attorney and former physician assistant in emergency and family medicine, Cohen brings a broad perspective to his work from both the health-care side and the law enforcement side. (Editor's note: The story has been updated to correct Cohen's background.)

“They are killing our program financially. This is as big as some of the Wall Street crimes,” Cohen says. But he says his is job isn’t just about locking people up. 

“We have a dual role,” he says. “We have to protect against both patient harm as well as financial harm.” 

Based on the honor system

The high level of fraud in government-run health care programs is partly a function of its founding premise. Both Medicare and Medicaid were intentionally set up under the honor system, officials say, to make it as easy and as fast as possible for health-care providers to receive payment from the government. The problem is that the honor system approach also makes it fast and easy for the dishonest and corrupt to steal from the government. 

“It is a terrible crime,” says Gary Cantrell, deputy inspector general for investigations at HHS, and the top health care fraud investigator in the US government. 

“These are some of the most deplorable individuals doing the worst kind of crime,” he says. “It affects tax payers and in a significant way it compromises the health of patients.”

For many years, too few agents pursued a growing number of swindlers while following a law enforcement strategy called “pay and chase.” In essence, investigators were attacking the problem on the back end, after the fraud had already taken place, rather than addressing it on the front end before the money was paid out. 

“Pay and chase is not the most fruitful model, to pay them and try to recoup the money after the fact,” Mr. Cantrell says. “If you can stop the payment on the front end, you are in a much better situation.” 

Cohen agrees. “We’ve done this back-end stuff for years and it is not working,” he says. “We cannot prosecute our way out of this problem.” 

That’s where Cohen’s computer comes into play. 

Sniffing out pharmacies with questionable billing

To illustrate this capability, Cohen uses data from a 2012 research project conducted by the OIG’s Office of Evaluation and Inspections. 

The report examined billing records of pharmacies participating in the Medicare Part D program, which helps senior citizens pay for their prescription drugs. The program started under President George W. Bush and has become a prime target for fraud.

Of the 59,000 retail pharmacies in the US that billed the government under the Part D program, researchers identified 2,600 that had questionable billing.

Most of the problem pharmacies are independently owned. It is rare for a CVS or a Walgreens to show up on such lists, Cohen says. 

The researchers examined metrics such as the total amount billed to Medicare, the amount billed per beneficiary, the number of prescriptions written per prescriber, and the percentage of prescriptions for various types of drugs.

With his computer keyboard, Cohen zeroes in on pharmacy sales of controlled substances, drugs that include highly addictive prescription painkillers such as oxycodone and fentanyl. These are among the drugs that have fueled the nation’s epidemic in opiate addiction and drug overdose deaths. 

Such controlled substances account for only about 6 percent of pharmacy sales, he says. 

“So when we are looking at a pharmacy here,” he says, “and we see 61 percent [of bills are for] controlled Schedule II drugs – that’s a problem.”

He adds: “Here are pharmacies dealing with almost 75 percent controlled drugs. That’s crazy,” he says. “Sixty percent, 50 percent, these are really high [for billing] in scheduled drugs.”

But that is only part of the problem, he says.

In addition to policing the sale of highly addictive drugs, OIG investigators are also responsible for the sale and distribution of all other prescription drugs. 

While the market in controlled drugs is about $8 billion a year, the national market for other prescription drugs is $129 billion, Cohen says. From where he sits, that’s a lot of potential fraud.

Cohen is careful to qualify his analytic results. They are not evidence of fraud, he insists. Data analytics is collecting and organizing information in a way that should raise a number of red flags. 

“Overall, the stuff I am filtering to the top is probably fraud, but I’m not going to say that 2,600 pharmacies are fraudulent,” he says. “They just have aberrant billing.” 

What that means is that these businesses are good candidates for a federal investigation. An investigation may uncover fraud, or it may reveal a specialty pharmacy that is involved in an expensive – but legitimate – niche business, he says.  

Prioritizing and advancing key investigations

Cohen uses additional data filters to try to identify the worst of the worst. In that way federal agents can be directed to the largest and most urgent cases.

“Years ago, what we would do is poke around, basically. Someone would say, ‘Let’s go look at Joe’s Pharmacy.’ It may or may not pan out. So there was a lot of wheel-spinning,” Cohen says.

“Here,” he says, pointing to his computer screen, “this is like – BOOM.” 

Fast access to computerized billing information can also help agents advance ongoing investigations, says Cantrell. 

When he started work as an investigator in Atlanta more than 20 years ago, it would often take 90 days or more to obtain Medicare billing records related to the subject of an investigation, the deputy inspector general says.

If in the middle of the investigation more data was needed, they would make another formal request followed by another long wait for the information.

“We didn’t have direct access to data, much less direct access to real-time or near-time data,” Cantrell says.

Such quick access to data also helps investigators identify and contact witnesses who might provide evidence against a crooked doctor or other fraud suspect.

Data analytics also allows agents to discover patients who were referred to a particular doctor or health-care service by another physician or service. That information can uncover kickback schemes involving patient brokers. 

It helped make the case against Dr. Jacques Roy, a Texas physician who was convicted in April 2016 of providing false certifications authorizing home health-care services for some 11,000 Medicare beneficiaries, officials say. Prosecutors estimate that $375 million in fraudulent claims were submitted to the government. 

Most of the raw data used by Cohen has already been organized by researchers in the OIG’s Office of Evaluation. Their role is to identify and study vulnerabilities in the health-care system.

“Criminals migrate to this area because the rewards are high and the risks are relatively low,” says Erin Bliss, assistant inspector general in the Office of Evaluation. “We are trying to change that equation.” 

Similar to credit-card safeguards

Some observers have likened data analytics in law enforcement to the safeguards used by credit card companies to protect against fraudulent purchases. When they suspect fraud, credit card companies refuse payment.  

The model is similar, but not an exact match. “We are trying to use big data and analyze it as quickly as possible to detect an anomaly and check it out immediately,” says Ann Maxwell, who is also an assistant inspector general in the Office of Evaluation.

But paying for health care is different than someone trying to use a stolen credit card, Ms. Maxwell says. “If I am paying for something [by credit card], it is being adjudicated immediately and they know right away if this is me and I don’t normally buy two televisions at a time,” she says.

“But your doctor may bill one week later, two weeks later, up to a year later, so you don’t have that instantaneous feedback loop to immediately detect and stop [a fraudulent health-care payment],” she says.

While officials have been successful in using analytics in the Medicare system to identify trends in fraud and to direct task force operations, those same techniques are not yet possible under the Medicaid program.

That’s because Medicaid, which provides health care for low income individuals, is run by each of the 50 states and the states do not yet have a uniform system of data collection. 

Thus someone who is identified as a fraudster in one state may be able to move his illegal operation to another state without the new state learning of his criminal past.

Efforts to close this gap are under way. Currently 35 states have agreed to submit uniform information about their Medicaid transactions to a national database. Federal officials are encouraging the remaining 15 states to comply as well.

Jessica Mendoza/The Christian Science Monitor

Marcus Stevenson talks about his journey from frustrated grocery store clerk to aspiring tech executive at the Year Up Bay Area campus in San Francisco on May 8, 2017.

On his daily commute across the bay, Marcus Stevenson looks up at the new Salesforce tower under construction in downtown San Francisco and thinks: I’m going to work there someday.

“It’s really inspiring because I can see it from my house, all the way in the East Bay in San Leandro,” says Mr. Stevenson, who has been interning for the tech company for about three months. He chuckles at his newfound ambition. This time last year, the 22-year-old was stocking inventory at a grocery store and thinking only about his next paycheck.

“What I wanted was just to be promoted at Whole Foods,” Stevenson says, marveling at the turn his life has taken. “Today I’m looking at what decisions I can make that’ll help me get to that spot 10 years from now, where I can be a certified representative of my company and travel around the world.”

His new attitude comes after about nine months at Year Up Bay Area, the San Francisco chapter of a national nonprofit that provides urban youth with the skills, support, and experience they need to launch stable, profitable careers. Students – mostly young people of color from low-income families – spend 40-hour weeks learning everything from how to troubleshoot a computer and draft a business plan to how to write thank-you notes and give an authoritative handshake.

After six months, each student is placed as an intern with one of Year Up’s corporate partners.

“It’s kind of like a finishing school and a technical school at the same time,” says Renée Archer, the organization’s lead IT instructor.

It’s a model that’s beginning to gain steam in the workforce development world, as continuing demand for “middle-skill” jobs – positions that require postsecondary and often specialized training – clashes with the rising costs of higher education. From California to Texas to New York, organizations are developing strategies to effectively equip young people like Stevenson with in-demand skills and connect them to the sectors and companies that need them most.

These efforts don’t yet constitute a movement, researchers say. But there is growing interest in evaluating what these groups have learned in terms of turning out graduates who can land and sustain middle-class jobs – and what it takes to level the playing field for young people who lack the opportunity and resources to complete a traditional college-to-career path.

“The most successful organizations work strategically to connect people to good jobs they can’t get on their own,” says Mark Elliott, president of the Economic Mobility Corporation (EMC), a research group in New York City that evaluates workforce training initiatives, including Year Up. “If we really want to make a difference in people’s lives, the opportunity is there. We just have to be willing to make an investment.”

Adjusting to new mindset

Like most Year Up students, Stevenson joined the program feeling hopeful but uncertain.

After high school he had powered through community college, relying on his supermarket job to keep him afloat. He earned an associate’s degree in social sciences after four years, only to find that no one would hire him because he didn’t have enough experience. “I tried to get a county job. I must have applied to any library within a 30-mile radius of my house,” Stevenson says. “I was not qualified enough.”

He considered applying to a four-year institution, but reeled at the cost. His dad is a caretaker for the local parks and recreation department, and his mother is a stay-at-home-mom who occasionally picks up restaurant shifts. Neither would have been able to support him for another four years at school, he says. “I’m making $11 an hour,” Stevenson recalls thinking. “I can’t take out a $30,000 loan.”

When a friend at work first told him about Year Up, he thought it was a scam. A program that practically promised a job in tech after a year of training? A place where people used phrases like “growth mindset” and attended things like Monday Morning Kickoff? “It was hard to buy in at first,” he says.

But Stevenson was tired of working a job he didn’t care about. He wanted to challenge himself and grow. He decided to commit to the program, “corny stuff” and all.

It was easier said than done, he says. Year Up strictly enforces its rules: Everybody has to dress professionally and come in on time. Swearing and cell phones are prohibited in the building. And while one of Year Up’s main distinctions is the stipend – every student gets $150 a week to attend – a major infraction equals a $15 pay cut for the week. Students also follow a point system that tracks their infractions, and everyone’s points are read out every Friday.

The “ROTC model,” as Ms. Archer calls it, teaches students to be accountable for their actions, and ready to give and receive useful feedback.

Stevenson says he grappled with those requirements – and the changes he had to make to fulfill them. “It was forced and fake at first,” he says. “Like, who am I? What am I turning into?”

But over time he saw his writing and public-speaking skills improve. He grew more confident in his ability to face a range of challenges and social situations. He found he could take constructive criticism without feeling personally insulted. And he began to embrace this new side of him as part of the man he was becoming.

“We’re allowed to be different people in different situations,” Stevenson says. “I’m realizing that this person was always who I could’ve been, but I never had the insight to bring it out.”

The positive response goes both ways. Year Up’s corporate partners see the program as a way for them to help address a societal issue while benefiting from the skills Year Up students offer. As program veterans like to say, “It’s not a handout, it’s a hand up.”

“This is not philanthropy,” says Carrie Varoquiers, vice president of global impact at Workday, a San Francisco company that develops financial and human resources software. “We are getting access to great talent that comes from every background. This is adding value to our business.”

“If you want someone who can look you in the eye and tell you feedback about the work environment, you ask a Year Up student,” adds Ebony Frelix, senior vice president for philanthropy and engagement at Salesforce. "These interns are taking leadership roles. All these kids have needed is an opportunity.”

Close relationships with corporate partners

In 2014, an evaluation of the Year Up by the EMC found that participants earned nearly $13,000 more than their peers three years after completing the program, with wages averaging at $14.21 an hour compared to about $11.70. Year Up graduates were also significantly more likely to be working full-time in IT or finance.

Other organizations that have developed similar models over years – and sometimes decades – have seen comparable success. The Jewish Vocational Service in Boston, Per Scholas in New York, and the Wisconsin Regional Training Partnership in Milwaukee were all shown to have had a significant effect on participants’ earnings over time.

Another that more recently caught researchers’ attention is Project Quest in San Antonio, Texas. Program graduates were earning about $38,000 a year six years after signing on to the program, compared to an average of $11,400 before enrolling, according to a study also conducted by the EMC. Notably, even those who dropped out were making double their income before joining the program. The project has spurred at least three other initiatives across the state.

Part of the secret, Elliott says, is a combination of factors that include being attuned to current and future employer demands in a specific region; offering curriculum that teaches corporate behaviors and attitudes as well as technical skills; and providing support at all levels of the program – even after the initial job placement.

The best programs also build close relationships with corporate partners who are willing to invest significantly in student success. Year Up, for instance, receives 60 percent of its funding from its employer partners, who spend about $25,000 per student.

They’re also flexible. Salesforce began its partnership with Year Up with a focus on interns with an IT background, Ms. Frelix says. Over time the company realized it also needed people with training in project management and quality assurance – both of which are now designated tracks at Year Up. “We were able to go to them and say, ‘We need other skills,’ ” Frelix says.

“They’re adapting and changing all the time as the economy and the labor market changes,” Elliott adds.

But the intensive and customized training that makes these initiatives successful has also made broadening their impact a challenge.

“These programs are privately supported. They’re not operating at scale,” says Shayne Spaulding, a senior research associate at the Urban Institute in Washington and former director of workforce development for the City University of New York. For that to happen, she says, industry and government will have to come together and invest more than the usual time and money into crafting feasible strategies.

In 2014, the federal government showed its continued support for workforce training by extending the Workforce Investment Act of 1998 through 2020. The WIA primarily funds one-stop career centers that help low-income youth and families prepare resumes and find work.

“But there’s not enough money in substantial investments in individual participants,” Elliott says. “Without more resources, the amount we’re investing is really small.”

Pushed to meet the challenge

Those who do gain access to programs like Year Up say the opportunity is transformative.

Valentino Lei’a, who spent the latter years of high school living with friends while his mom tried to overcome her alcohol addiction, says he never imagined he would break into the tech industry. When he joined Year Up in 2014, he was coasting through community college with a vague plan to teach physical education. 

“I was fine with sticking in the corner and not saying a word,” Mr. Lei’a says. “But I wasn’t given the luxury to sit in the back. I had to participate. You’re pushed to challenge yourself.”

Today, at 22, Lei’a works full-time as a quality assurance engineer at Workday. When he started in 2015, he says, “I couldn’t wait to make $20 an hour. Now I’m coming from the perspective of, ‘Man, $20 an hour? I won’t accept that.’ ”

Stevenson, who’s halfway through his internship at Salesforce, is seeing his horizons open up, as well. He’s found himself a mentor and hero in Tony Prophet, the company’s chief equality officer. He envisions a future where he gives keynote speeches about product releases in cities like Amsterdam and New York. And he brims with a confidence he admits he didn’t have even a few months ago.

“I feel like I’m just as smart, I feel like I’m just as qualified as some of the people I work around who have their bachelor’s in this and their master’s in that. And I just didn’t have the opportunity to show it,” Stevenson says. “Year Up gave me that opportunity. As long as you earn it, it levels the playing field.”

Reuters

A 8,000-square-meter poster is pictured on the Plainpalais square in Geneva, Switzerland May 14, 2016. The committee for the initiative for an "Unconditional Basic Income" crowdfunded the "world's biggest poster," posing the question "What would you do if your income were taken care of ?". Swiss citizens voted against the proposal on June 5, 2016.

 This summer, the government of Ontario begins a social experiment that will put the character of some 4,000 people to the test. The Canadian province will give as much as $16,989 (Canadian; US$12,616) a year to selected low-income individuals, whether or not they are working or on government assistance. Over three years, the recipients will be tracked to see if they have squandered the free money or, as Ontario Premier Kathleen Wynne hopes, they “get ahead and stay ahead.”

The experiment is similar to a pilot program launched in Finland earlier this year. That plan is giving about $7,200 annually to 2,000 unemployed people but taking them off normal government assistance. Even if they do find work, recipients keep receiving the cash payments.

These are two of the boldest attempts yet to move toward a much bigger idea called universal basic income, or the government providing a guaranteed financial floor to everyone regardless of their personal wealth.

The idea of an unconditional safety net, which has been proposed for centuries, has lately gained popularity among some liberals and conservatives. Those on the left see it as a way to allow workers to survive the loss of their jobs to automation, help reduce income inequality, and provide stability for people to start a business or get retrained. Those on the right hope it might end a complex welfare system that often encourages a degrading dependency on taxpayer revenue.

Much of the advocacy for the idea has come from high-tech celebrities. Last week, for example, Facebook founder and chief executive officer Mark Zuckerberg told the graduating class at Harvard University, “We should explore ideas like universal basic income to make sure that everyone has a cushion to try new ideas.”

Last June, Switzerland considered a full-fledged plan of about $2,500 a month for everyone– not a only those who are jobless or on state aid. Yet in a referendum, nearly 80 percent of Swiss voters rejected it. By one estimate, the plan would have cost 30 percent of gross domestic product. Yet more important, many worried about the potential effects on people’s work ethic and self-reliance.

The question of character keeps rising in the debate over universal basic income. If given minimal financial security, would people still be willing to find a greater purpose in work or other activities that contribute to society? Or would they become inward-looking and lazy?

In a recent TED Talk, Rutger Bregman, a Dutch historian and an advocate of basic income, argued that such plans would curb many bad habits of the poor. “Poverty is not a lack of character. Poverty is a lack of cash,” he said. He quotes economist Joseph Hanlon: “You can’t pull yourself up by your bootstraps if you have no boots.”

Others are more nuanced. In a new book, “Basic Income: A Radical Proposal for a Free Society and a Sane Economy,” Belgian academics Philippe Van Parijs and Yannick Vanderborght explore all sides of the arguments but contend that any basic income plan must be universal. Otherwise, giving money only to the poor or jobless will turn them “into a class of permanent welfare claimants.” And to avoid a backlash against the higher taxes needed to pay for a basic income, they suggest each individual in the United States receive $1,163 per month. That is about a quarter of the average per capita income and, by their estimate, would still provide an incentive to find work.

In the US, a political debate over people’s character in relation to government programs often divides Republicans and Democrats. Can ethics and morals be tested, nudged, or molded by force of law or bureaucratic incentives? Or is it more influenced by family, peers, media, or religion?

In a new paper from the Brookings Institution, liberal scholars Richard Reeves and Dimitrios Halikias argue that “questions of character have moved front and center in US politics.” Developing “self-efficacious” attributes of character are vital for social opportunity and to “live under your own steam.”

“The research is clear enough that a great many valuable soft skills, including persistence, attentive listening, and social competence, can indeed be shaped and nurtured by parents, teachers, and others,” they write.

“Character goes well beyond the rational response to economic and political incentives. Character relies on norms, not paternalistic nudges; it is cultivated through culture and role models, not directly engineered by technocratic government policy.”

And the authors add: “A humane, liberal society is one in which men and women possess the discipline, self-command, and personal autonomy needed to live with a sense of purpose and direction.”

As different governments test out the feasibility of a guaranteed basic income, the question must be answered: Will such schemes reduce character or enhance it?