Practitioner fraud and abuse in medical benefit programs: government regulation and professional white-collar crime

Physicians who defraud and abuse medical benefit programs provide a unique group of lawbreakers for scientific study. They could be considered to epitomize white collar criminals given their exceedingly high socioeconomic status and power as a professional group. Using official reports and documents, as well as interviews with enforcement and program personnel at both state and federal levels, this study examines the problem of physician fraud and abuse in Medicare and Medicaid. Major areas relevant to understanding this phenomenon and its control are presented and policy implications of present knowledge in the area are discussed.     

Medicare and state health care programs and program fraud civil remedies: fraud and abuse; civil money penalties inflation adjustments--Office of Inspector General, HHS. Final rule

In accordance with Federal Civil Monetary Penalty Inflation Adjustment Act of 1990, as amended by the Debt Collection Improvement Act of 1996, this final rule incorporates the penalty inflation adjustments for the civil money penalties for health case fraud and abuse. These inflation adjustment calculations are not applicable to those civil money penalties contained in the Social Security Act, which are exempted from this adjustment.     

Control of fraud and abuse in Medicare and Medicaid.

This Comment explores issues concerning the control of fraud and abuse in health programs financed with public funds, specifically the Medicare and Medicaid programs. It summarizes the nature, scope, and possible causes of what some regard as a fraud and abuse "crisis," and points out the difficulties and obstacles facing those who attempt to develop legislative and executive action aimed at controlling fraud and abuse. Recent federal initiatives in fraud and abuse control are examined, and a brief summary of key provisions of H.R. 3 (the Medicare-Medicaid Anti-fraud and Abuse Amendments, which may prove to be a landmark piece of legislation in this area) is provided. The author emphasizes that more effective control of fraud and abuse is necessary if further expansion of government financing of health programs, including national health insurance, is to occur in the near future. At the same time, caution must be taken not to neglect the appropriate use of other mechanisms necessary for reducing the costs of medical care and improving its quality. In addition, it is likely that efforts to stem fraud and abuse will raise important medicolegal and public policy issues that will require careful interdisciplinary consideration.     

Methodological and ethical issues in child abuse research

The child abuse literature was surveyed but found lacking in analyses of fundamental ethical and procedural issues. The present paper, supported by a review of the relevant research, explores the problems surrounding the definition of physical child abuse, the gender and recruitment of subjects, the use of informed consent and deception, and the problem of maintaining confidentiality in this area. Greater detail in reporting of methods employed by researchers is recommended as an important first step to expanding discussion of these issues.     

Health care programs: fraud and abuse; revisions to the civil money penalty provisions relating to the misuse of certain names, symbols and emblems--HHS. Final rule

In accordance with amendments to section 1140 of the Social Security Act, resulting from the Social Security Independence and Program Improvements Act of 1994, this final rule makes a number of revisions to the civil money penalty authority regulations relating to the misuse of certain symbols, emblems and names. Among other revisions, this rule eliminates the annual cap on penalties, includes the words and letters of the Department and Medicaid under the prohibition, and redefines a violation with regard to mailings. In addition, this final rule serves to remove references to Social Security and the Social Security Administration (SSA) from the HHS/OIG penalty regulations. The penalty regulations addressing the misuse of certain words, letters, symbols and emblems for SSA and its programs are being set forth in a new part of the Code of Federal Regulations published elsewhere in this edition of the Federal Register.     

Medicare and Social Security: fraud and abuse; civil money penalties for misuse of certain terms, symbols and emblems--HHS. Final rule

This final rule implements section 428(a) of Public Law 100-360 which authorizes the imposition of civil money penalties for the use--in advertising, solicitations or other communications--of certain words, letters, symbols or emblems associated with the Department of Health and Human Services' Social Security and Medicare programs in a manner that the user knows, or should know, would convey a false impression that (1) the communicated item was approved, endorsed or authorized by the Department or its programs, or (2) the responsible person or organization has some connection with, or authorization from, the Department or these programs. This rulemaking is designed to assist in protecting citizens from misrepresentations concerning the services offered and programs administered by the Social Security Administration and the Health Care Financing Administration.     

Publication of OIG Special Fraud Alerts: home health fraud, and fraud and abuse in the provision of medical supplies to nursing facilities--HHS. Notice

This Federal Register notice sets forth two recently issued OIG Special Fraud Alerts concerning fraud and abuse practices in the home health industry and in the provision of medical supplies to nursing facilities. For the most part, the OIG Special Fraud Alerts address national trends in health care fraud, including potential violations of the Medicare anti-kickback statute. These two Special Fraud Alerts, issued directly to the health care provider community and now being reprinted in this issue of the Federal Register, specifically address fraud and abuse in the provision of (1) home health services and (2) medical supplies to nursing facilities, including the submission of false claims and anti-kickback violations.     

The need for a regulatory response to diagnosis fraud in mesothelioma cases

Australian courts and tribunals allow claimants with pleural plaques to "piggy back" compensation claims for mental health problems. This article contends that Australia is open to an era of diagnosis fraud by psychologists similar to that which has been experienced in the United States with radiologists. The courts will continue to reflect Australia's "compensation culture" unless legislation squarely addresses the compensability of pleural plaques and clarifies when, if at all, the courts should allow mental health claims for asymptomatic "marker" conditions such as pleural plaques.     

死亡时间在继承案件中的应用

继承是指公民（自然人）死亡后，依法将其合法所有财产转归给他人所有的一项法律制度。我国继承法规定，继承从被继承人死亡时开始。有相互继承关系的当事人，在某次事件（如交通事故、地震等）中突然死亡，为了合理、合法地处理他们的遗产，必须先确定有相互继承关系的当事人谁先死，此类事件在国外已较普遍，而在国内尚属罕见。现介绍一例：1995年10月5日14时，本局接到某派出所报案，称该所辖区某镇居民朱某某、倪某某夫妻俩双双死在家中，性质难以确定，要求派员侦查。接报后本局迅速组织刑技人员赴现场。经查，朱某某，男28岁，浙江上…     

死亡时间在继承案件中的应用

继承是指公民(自然人)死亡后,依法将其合法所有财产转归给他人所有的一项法律制度.我国继承法规定,继承从被继承人死亡时开始.     

Health care programs: fraud and abuse; revisions to the PRO sanctions process--HHS. Final rule

This final rule revises and updates the procedures governing the imposition and adjudication of program sanctions predicted on recommendations of State Utilization and Quality Control Peer Review Organizations (PROs). These changes are being made as a result of statutory revisions designed to address health care fraud and abuse issues and the OIG sanctions process. In addition, this final rule sets forth new appeal and reinstatement procedures for practitioners and other persons excluded by the OIG based on a PRO recommendation.     

Health care programs: fraud and abuse; revisions to the PRO sanctions process-HHS. Correction to final regulations

This document corrects a technical error that appeared in 42 CFR part 1004 of the final rule published in the Federal Register on December 12, 1995 (60 FR 63634). The final rule was designed to revise and update the procedures governing the imposition and adjudication of program sanctions predicated on recommendations of State Utilization and Quality Control Peer Review Organizations. Specifically, this correction notice sets forth the corrected text for section 1004.110(f) which contained a typographical error in subparagraph (2).     

Medicare and state health care programs: fraud and abuse, civil money penalties and intermediate sanctions for certain violations by health maintenance organizations and competitive medical plans--HHS. Correction to final regulations

This document corrects technical errors that appeared in 42 CFR part 1003 of the final rule published in the Federal Register on July 15, 1994 (59 FR 36072). Specifically, the final rule set forth the Secretary's authority to impose sanctions and civil money penalties on health maintenance organizations, competitive medical plans and other prepaid health plans contracting under Medicare and Medicaid. This correction notice sets forth the corrected text for sections 1003.100, 1003.103 and 1003.106, some of which was inadvertently omitted or amended.