Medicare and state health care programs: fraud and abuse; safe harbors for certain electronic prescribing and electronic health records arrangements under the anti-kickback statute. Final rule.
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As required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Public Law 108-173, this final rule establishes a new safe harbor under the Federal anti-kickback statute for certain arrangements involving the provision of electronic prescribing technology. Specifically, the safe harbor would protect certain arrangements involving hospitals, group practices, and prescription drug plan (PDP) sponsors and Medicare Advantage (MA) organizations that provide to specified recipients certain nonmonetary remuneration in the form of hardware, software, or information technology and training services necessary and used solely to receive and transmit electronic prescription information. In addition, in accordance with section 1128B(b)(3)(E) of the Social Security Act (the Act), this final rule creates a separate new safe harbor for certain arrangements involving the provision of nonmonetary remuneration in the form of electronic health records software or information technology and training services necessary and used predominantly to create, maintain, transmit, or receive electronic health records. (+info)
Getting by on credit: how district health managers in Ghana cope with the untimely release of funds.
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BACKGROUND: District health systems in Africa depend largely on public funding. In many countries, not only are these funds insufficient, but they are also released in an untimely fashion, thereby creating serious cash flow problems for district health managers. This paper examines how the untimely release of public sector health funds in Ghana affects district health activities and the way district managers cope with the situation. METHODS: A qualitative approach using semi-structured interviews was adopted. Two regions (Northern and Ashanti) covering the northern and southern sectors of Ghana were strategically selected. Sixteen managers (eight directors of health services and eight district health accountants) were interviewed between 2003/2004. Data generated were analysed for themes and patterns. RESULTS: The results showed that untimely release of funds disrupts the implementation of health activities and demoralises district health staff. However, based on their prior knowledge of when funds are likely to be released, district health managers adopt a range of informal mechanisms to cope with the situation. These include obtaining supplies on credit, borrowing cash internally, pre-purchasing materials, and conserving part of the fourth quarter donor-pooled funds for the first quarter of the next year. While these informal mechanisms have kept the district health system in Ghana running in the face of persistent delays in funding, some of them are open to abuse and could be a potential source of corruption in the health system. CONCLUSION: Official recognition of some of these informal managerial strategies will contribute to eliminating potential risks of corruption in the Ghanaian health system and also serve as an acknowledgement of the efforts being made by local managers to keep the district health system functioning in the face of budgetary constraints and funding delays. It may boost the confidence of the managers and even enhance service delivery. (+info)
Representative payment policies and administrative procedure for imposing penalties for false or misleading statements or withholding of information. Final rules.
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We are amending our regulations on representative payment and on the administrative procedure for imposing penalties for false or misleading statements or withholding of information to reflect and implement certain provisions of the Social Security Protection Act of 2004 (SSPA). The SSPA amends representative payment policies by providing additional safeguards for Social Security, Special Veterans and Supplemental Security Income beneficiaries served by representative payees. These changes include additional disqualifying factors for representative payee applicants, additional requirements for non-governmental fee-for-service payees, authority to redirect delivery of benefit payments when a representative payee fails to provide required accountings, and authority to treat misused benefits as an overpayment to the representative payee. In addition, we are amending our rules to explain financial requirements for representative payees, and we have made minor clarifying plain language changes. The SSPA also allows us to impose a penalty on any person who knowingly withholds information that is material for use in determining any right to, or the amount of, monthly benefits under titles II or XVI. The penalty is nonpayment for a specified number of months of benefits under title II that would otherwise be payable and ineligibility for the same period of time for payments under title XVI (including State supplementary payments). (+info)
Rules for the issuance of work report receipts, payment of benefits for trial work period service months after a fraud conviction, changes to the student earned income exclusion, and expansion of the reentitlement period for childhood disability benefits. Final rules.
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We are revising our rules to reflect and implement sections 202, 208, 420A, and 432 of the Social Security Protection Act of 2004 (the SSPA). Section 202 of the SSPA requires us to issue a receipt each time you or your representative report a change in your work activity or give us documentation of a change in your earnings if you receive benefits based on disability under title II or title XVI of the Social Security Act (the Act). Section 208 changes the way we pay benefits during the trial work period if you are convicted by a Federal court of fraudulently concealing your work activity. Section 420A changed the law to allow you to become reentitled to childhood disability benefits under title II at any time if your previous entitlement to childhood disability benefits was terminated because of the performance of substantial gainful activity. Section 432 changes the way we decide if you are eligible for the student earned income exclusion. We will also apply the student earned income exclusion when determining the countable income of an ineligible spouse or ineligible parent. We are also changing the SSI student policy to include home schooling as a form of regular school attendance. (+info)
Characteristics, prevalence, attitudes, and perceptions of academic dishonesty among pharmacy students.
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OBJECTIVES: To ascertain background factors that influence pharmacy students' willingness to cheat, describe attitudes regarding methods of cheating, assess prevalence of cheating and determine atmospheres that may aid in preventing academic dishonesty. METHODS: Third-professional year PharmD students at 4 institutions participated in a survey administered by a class representative. RESULTS: Of the 296 students who completed survey instruments, 16.3% admitted to cheating during pharmacy school. Approximately 74% admitted that either they or their classmates had worked on an individual assignment with a friend. Students who cheated during high school or in a prepharmacy program were more likely to cheat during pharmacy school (p < 0.0001). Those who possessed a bachelor of science (BS) degree prior to pharmacy school were less likely to cheat (p < 0.0001). CONCLUSIONS: Academic dishonesty is prevalent among pharmacy students. While few respondents directly admitted to cheating, many admitted to activities traditionally defined as dishonest. (+info)
The Objective Structured Clinical Examination and student collusion: marks do not tell the whole truth.
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OBJECTIVE: To determine whether the marks in the third year Objective Structured Clinical Examination (OSCE) were affected by the collusion reported by the students themselves on an electronic discussion board. DESIGN: A review of the student discussion, examiners' feedback and a comparison of the marks obtained on the 2 days of the OSCE. PARTICIPANTS: 255 third year medical students. SETTING: An OSCE consisting of 15 stations, administered on three sites over 2 days at a UK medical school. RESULTS: 40 students contributed to the discussion on the electronic discussion board. The main points raised were perceived inequity between students who did, or did not, have prior knowledge of the station content, and the lack of honesty and professionalism of their peers. Most contributors claimed to have received, or knew of others receiving, prior knowledge, but none confessed to passing on information. No significant difference (p = 0.16) was observed in the overall mark for the OSCE on day 1 (mean 390 (SD 37)) and day 2 (mean 397 (38)). On day 2, marks were considerably greater for four stations and markedly lower for three stations. It was not obvious why collusion should affect these station marks. A clear indication of the effects of collusion could only be obtained from a single subsection of an individual station (pathology) where 82 students on day 2 incorrectly gave the diagnosis from day 1. CONCLUSION: Marks do not provide a sound inference of student collusion in an OSCE and may mask the aspects of professional development of students. (+info)
Knights, knaves, pawns and queens: attitudes to behaviour in postwar Britain.
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The choice agenda is currently one of the most prominent in public policy. One of its main architects, Julian Le Grand, has used the metaphors of knights, knaves, pawns and queens to characterise changing attitudes to questions of motivation and behaviour among public servants and service users. He has said, for example, that, in the immediate postwar period, public servants were perceived as public-spirited altruists (or knights), whereas service users were seen as passive (or pawns). It was only in the mid-1980s that public servants came to be seen as essentially self-interested (knaves) and service users came to be regarded as consumers (queens). However, this highly influential model has undergone remarkably little critical scrutiny to date. This article explores the debate over transmitted deprivation in the 1970s to provide a historically grounded piece of analysis to explore the accuracy and utility of these metaphors. It challenges Le Grand's arguments in three respects. Firstly, a concern with behaviour and agency went much broader than social security fraud. Secondly, the metaphor of pawns is inadequate for characterising attitudes towards the poor and service users. Finally, Le Grand's periodisation of the postwar era also has serious flaws. (+info)
Automated coding software: development and use to enhance anti-fraud activities.
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This descriptive research project identified characteristics of automated coding systems that have the potential to detect improper coding and to minimize improper or fraudulent coding practices in the setting of automated coding used with the electronic health record (EHR). Recommendations were also developed for software developers and users of coding products to maximize anti-fraud practices. (+info)