Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.Scientific Misconduct: Intentional falsification of scientific data by presentation of fraudulent or incomplete or uncorroborated findings as scientific fact.Physician Self-Referral: Referral by physicians to testing or treatment facilities in which they have financial interest. The practice is regulated by the Ethics in Patient Referrals Act of 1989.Quackery: The fraudulent misrepresentation of the diagnosis and treatment of disease.Democracy: A system of government in which there is free and equal participation by the people in the political decision-making process.MoscowInsurance, Accident: Insurance providing coverage for physical injury suffered as a result of unavoidable circumstances.Plagiarism: Passing off as one's own the work of another without credit.Retraction of Publication as Topic: Authors' withdrawal or disavowal of their participation in performing research or writing the results of their study.Insurance Claim Reporting: The design, completion, and filing of forms with the insurer.Ethics, Professional: The principles of proper conduct concerning the rights and duties of the professional, relations with patients or consumers and fellow practitioners, as well as actions of the professional and interpersonal relations with patient or consumer families. (From Stedman, 25th ed)
Pious fraud: Pious fraud (Latin: pia fraus) is used to describe fraud in religion or medicine. A pious fraud can be counterfeiting a miracle or falsely attributing a sacred text to a biblical figure due to the belief that the "end justifies the means", in this case the end of increasing faith by whatever means available.Scientific misconduct: Scientific misconduct is the violation of the standard codes of scholarly conduct and ethical behavior in professional scientific research. A Lancet review on Handling of Scientific Misconduct in Scandinavian countries provides the following sample definitions: (reproduced in The COPE report 1999.Quackery: Quackery is the promotion of fraudulent or ignorant medical practices. A "quack" is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess; a charlatan".Howard Phillips (politician)Razvilka, Moscow Oblast: Razvilka () is a rural locality (a settlement) in Leninsky District of Moscow Oblast, Russia, located in the "green forests and parks space" surrounding the city of Moscow, on the Kashira Highway. Population: Postal code: 142717.Labor Standards Bureau: The is a bureau of the Ministry of Health, labour and Welfare responsible for maintaining work standards in Japan. It is tasked with securing and improving working conditions, ensuring the safety and health of workers, and is also responsible for managing Workers' Accident Compensation Insurance.A Tomb for Boris Davidovich: A Tomb for Boris Davidovich (Serbo-Croatian: Grobnica za Borisa Davidoviča / Гробница за Бориса Давидовича) is a collection of seven short stories by Danilo Kiš written in 1976 (translated into English by Duska Mikic-Mitchell in 1978). The stories are based on historical events and deal with themes of political deception, betrayal, and murder in Eastern Europe during the first half of the 20th century (except for "Dogs and Books" which takes place in 14th century France).Outstanding claims reserves: Outstanding claims reserves in general insurance are a type of technical reserve or accounting provision in the financial statements of an insurer. They seek to quantify the outstanding loss liabilities for insurance claims which have been reported and not yet settled
(1/124) Health care programs: fraud and abuse; revised OIG civil money penalties resulting from public law 104-191. Office of Inspector General (OIG), HHS. Final rule.
This final rule revises the OIG's civil money penalty (CMP) authorities, in conjunction with new and revised provisions set forth in the Health Insurance Portability and Accountability Act of 1996. Among other provisions, this final rulemaking codifies new CMPs for excluded individuals retaining ownership or control interest in an entity; upcoding and claims for medically unnecessary services; offering inducements to beneficiaries; and false certification of eligibility for home health services. This rule also codifies a number of technical corrections to the regulations governing OIG's sanction authorities. (+info)
(2/124) Privacy Act; implementation. Office of Inspector General (OIG), HHS. Final rule.
This final rule exempts the new system of records, the Healthcare Integrity and Protection Data Bank (HIPDB), from certain provisions of the Privacy Act (5 U.S.C. 552a). The establishment of the HIPDB is required by section 1128E of the Social Security Act (the Act), as added by section 221(a) of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Section 1128E of the Act directed the Secretary to establish a national health care fraud and abuse data collection program for the reporting and disclosing of certain final adverse actions taken against health care providers, suppliers or practitioners, and to maintain a data base of final adverse actions taken against health care providers, suppliers and practitioners. Regulations implementing the new HIPDB were published in the Federal Register on October 26, 1999 (64 FR 57740). The exemption being set forth in this rule applies to investigative materials compiled for law enforcement purposes. (+info)
(3/124) Unconventional dentistry: Part III. Legal and regulatory issues.
This is the third in a series of 5 articles providing a contemporary overview and introduction to unconventional dentistry (UD) and its correlation to unconventional medicine (UM). UD presents issues of dental quackery, fraud and malpractice, and it also engenders professional concerns about public protection and professional risks. Case reports illustrate numerous issues. The reader is encouraged to evaluate the cases for problems related to malpractice, fraud, ethics, behaviours and professionalism. A discussion of ethical issues is beyond the scope of this paper. (+info)
(4/124) An on-site audit of the South African trial of high-dose chemotherapy for metastatic breast cancer and associated publications.
PURPOSE: The randomized study reported by Bezwoda et al of high-dose chemotherapy (HDC) for treatment of metastatic breast cancer was audited on site to verify the study results. Additional published studies were reviewed to determine whether they had been subject to the required institutional oversight. PATIENTS AND METHODS: Ninety patients were reported to have been randomized and treated on this trial. A log of the names, hospital numbers, entry dates, and regimen received had been provided by the principal investigator. A search of more than 15,000 sets of medical records available from two Johannesburg hospitals was performed to locate records for as many of these 90 patients as possible. Standard auditing techniques were used. Additional clinical trials published by Bezwoda were compared against the minutes of the University of the Witwatersrand Committee for Research on Human Subjects to verify review and approval. RESULTS: Records for only 61 of the 90 patients could be found. Of these 61, only 27 had sufficient records to verify eligibility for the trial by the published criteria. Of these 27, 18 did not meet one or more eligibility criteria. Only 25 patients appeared to have received their assigned therapy temporally associated with their enrollment date, and all but three of these 25 received HDC. The treatment details of individual patients were at great variance from the published data. Nine other trials reported by Bezwoda were not reviewed or approved by the appropriate institutional committee despite statements to the contrary in the publications. CONCLUSION: The multiple publications of this study do not report verifiable data, and nine other publications coauthored by the principal investigator contain at least one major untrue statement. (+info)
(5/124) Fraud-and-abuse enforcement in Medicare: finding middle ground.
Medicare fraud and abuse cost billions of dollars each year. Yet Congress is considering legislation to hamper enforcement. Providers' anger over enforcement led to a congressional compromise several years ago to limit excesses. If providers and their advocates were to hobble enforcement, this could provoke a backlash. Instead, the existing compromise should be strengthened to accommodate legitimate provider concerns while allowing enforcement against major fraud and abuse. Government should further confine, structure, and check its discretion in applying the False Claims Act. Enhancing the Health Care Financing Administration's capacity to ensure that contractors pay claims properly would remove additional points of friction. (+info)
(6/124) Consumers versus managed care: the new class actions.
The plaintiffs in pending consumer class-action lawsuits against health maintenance organizations (HMOs) should fail in their claims for damages for fraud under federal anti-racketeering legislation. Although HMOs have regularly failed to disclose their business methods and have not strictly honored their contractual coverage promises, the circumstances in which they introduced cost controls into a market sadly lacking them suggest motives not deserving punitive sanctions. Courts could easily find that HMOs violated the Employee Retirement Income Security Act (ERISA), however. Injunctive relief compelling more extensive disclosures and clearer contracts might well legitimize HMOs' methods and generally improve the performance of the health care marketplace. (+info)
(7/124) Medicare program; civil money penalties, assessments, and revised sanction authorities. Final rule with comment period.
This final rule with comment period is a technical rule that updates our civil money penalty (CMP) regulations to add CMP authorities already enacted as part of the Balanced Budget Act of 1997 (BBA) and delegated to us. The rule delineates our authority to assess penalties for: failure to bill outpatient therapy services or comprehensive outpatient rehabilitation services (CORS) on an assignment-related basis, failure to bill ambulance services on an assignment-related basis, failure to provide an itemized statement for Medicare items and services to a Medicare beneficiary upon his/her request, and failure of physicians or nonphysician practitioners to provide diagnostic codes for items or services they furnish or failure to provide this information to the entity furnishing the item or service ordered by the practitioner. The rule also contains technical changes to further conform our current CMP rules to changes in the statute enacted by the BBA. (+info)
(8/124) Providing long-term care benefits in cash: moving to a disability model.
This paper examines the role of a disability approach to the allocation of long-term care benefits. It first highlights the important elements of long-term care that support a disability model. It then reviews the advantages and disadvantages of this approach relative to the traditional indemnity model and summarizes key features of selected domestic and international programs that offer a disability-type benefit. The paper identifies and elaborates on the major implementation challenges and concludes with a recommendation for further examination of the costs and benefits of this approach to the public coffers, the private market, and long-term care consumers. (+info)
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