Health care fraud and abuse data collection program: technical revisions to Healthcare Integrity and Protection Data Bank data collection activities. Final rule

The rule finalizes technical changes to the Healthcare Integrity and Protection Data Bank (HIPDB) data collection reporting requirements by clarifying the types of personal numeric identifiers that may be reported to the data bank in connection with adverse actions. The rule clarifies that in lieu of a Social Security Number (SSN), an individual taxpayer identification number (ITIN) may be reported to the data bank when, in those limited situations, an individual does not have an SSN.     

A tale of two cultures: examining patient-centered care in a forensic mental health hospital

Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers' perceptions of safety is needed.     

A fragmented organizational approach to fraud in a European context

He runs the Unit for the Study of White Collar Crime.     

Two faces of patient safety and care quality: a Franco-American comparison

Patient safety, and more broadly the quality of care, is typically discussed with reference to the reduction of preventable adverse events within hospitals and adherence to practice guidelines on care processes. We call it the 'care-centered approach' and recognize that the United States is a leader in the field. Another face of patient safety and care quality may be defined as the 'system-centered approach'. It focuses on access to a timely and effective continuum of health-care services--clinical prevention, primary care and appropriate referral to and receipt of specialty care. Although France's efforts to pursue a care-centered approach to patient safety are limited, its system-centered approach yields some benefits. Based on the evidence we have reviewed for access to primary care (hospital discharges for avoidable hospital conditions), mortality amenable to medical intervention and consumer satisfaction, in the United States and France, there appear to be good grounds for bolstering the system-centered approach in the United States.     

Medicare and State health care programs: fraud and abuse; OIG anti-kickback provisions--HHS. Final rule

This final rule implements section 14 of Public Law 100-93, the Medicare and Medicaid Patient and Program Protection Act of 1987, by specifying various payment practices which, although potentially capable of inducing referrals of business under Medicare or a State health care program, will be protected from criminal prosecution or civil sanctions under the anti-kickback provisions of the statute.     

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.     

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.     

Improving health care safety and quality: reluctant regulators

The Penal Code is the main of source of criminal law and criminal offences in Malawi. Unfortunately, as the results of a survey show, many people in Malawi do not understand the provisions of the Penal Code. This article examines aspects of the language of the Penal Code which impede people’s understanding of the provisions. The article recommends that the Penal Code be amended and redrafted in a language which the audience can understand.     

Improving legal quality—a knowledge engineering approach

Many legislation drafting departments at the different ministries have their own quality insurance techniques. Furthermore in many cases the Ministry of Justice has a special role because it is usually responsible for the overall legal quality of a country. Despite all the effort that has been spent on improving legal quality using traditional measurements, such as co‐reading (peer reviewing etc.) many anomalies can still be found in recently drafted legislation. The situation is even worse in situations when existing legislation is adapted. This paper will show how a systematic approach that has its origins in knowledge engineering can help to improve legal quality. This approach was developed in the Dutch Tax and Customs Administration (DTCA) (in Dutch: Belastingdienst) and offers both a method and supporting tools that support a systematic translation of (new) legislation into the administrations' processes. This method—called the POWER‐method—not only helps to improve the quality of (new) legislation. It also supports codification of the legal knowledge into procedures, computer programs and other designs. One of the advantages thereof is the reduction of the time‐to‐market of the implementation of legislation and its increased transparency (which will lead to reduced maintenance costs). Focus will be placed on legal quality improvement and knowledge representation techniques that are used to enable this will be explained. In contrast to other knowledge modeling approaches, the POWER‐approach is focused on modeling legal sources rather than expert knowledge. Expert knowledge of course is indispensable to find the correct interpretations and also for efficiency reasons. Starting with representing the (legal) experts' knowledge (using scenarios) helps to find the adequate scope (the legal sources to be analyzed). Confronting the expert with differences between the models built out of the experts' knowledge and the conceptual models constructed of the other knowledge sources (specifically the law) causes the legal experts to see things in a different light and has often led to changes in the law.