The Department of Health, Education and Welfare (HEW) directly serves 115 million United States citizens. Beyond its budget and number of employees, HEW presents management challenges because of its complexity and the potential for controversy over its responsibilities. Califano discusses management reforms he implemented to identify fraud, establish concrete goals, translate confusing regulations into plain English, require more competitive bidding, and cut inflation in hospital costs. He focuses his discussion on student loan programs, but also mentions Medicaid fraud.