The Medicare secondary payor provisions: possible rewards and pitfalls

A 1990 report prepared by the Office of Inspector General estimated that as much as $1 billion is lost to the Medicare program annually because (i) secondary payor situations are not detected and (ii) insurance companies often do not pay when they are required to be the primary payors. Office of Inspector General, No. A-09-98-00151, April 1990, Medicare and Medicaid Guide (CCH) [symbol: see text] 39,112, at 25,649. In order to better enforce the MSP provisions, suggestions have been made at the Congressional level to impose sanctions against providers who demonstrate a pattern of inappropriate billing practices such as double billing, repeated failures to screen beneficiaries for other insurance coverage, and the repeated submission to Medicare of bills that should be submitted to another payor. (See the Subcommittee Report on erroneous payments under the MSP program, supra.) Although authority for such sanctions has yet to be adopted, given the fiscal problems currently plaguing the federal government, providers can expect increased enforcement of the MSP provisions as a means of reducing Medicare costs, and should review their screening and billing practices accordingly.     

Family types and communication with parents: A comparison of youth at different identity levels

Recent theory views adolescent behavior as nested in an ongoing system of family relationships. In keeping with this focus, differences in family functioning of high vs. low identity achievement youth were examined and variables to account for differing identity levels were explored. However, the hypothesized relationship (Circumplex Model) between family type and communication was also examined. Subjects were 411 male students, 18–24 years of age, belonging to intact nuclear middle-class homes, who resided with parents in urban areas. Measures used were the Identity Achievement Scale, Family Adaptability and Cohesion Evaluation Scale, and the Parent-Adolescent Communication Scale. Results supported an association between balanced family type and effective communication (p.001). Significant differences in the family types were found (p.001), with high identity subjects belonging to balanced families, experiencing more openness (p.01) and less problems (p.01) in communicating with parents. Openness with father, mother, and problems with father emerged as significant discriminants. There are important implications for counselling and therapy with youth, placing family at the center of the psychosocial milieu influencing their development.Received Ph.D. from H.P. University. Research interests: adolescent psychosocial development, youth, identity, and family influences.Received M.A.; Ph.D. from Boston University; Panjab University. Research interests: family interiors, women studies, life stress, self image (DAP), sexuality, myths, holistic healing, and tribal women.     

Behavior of animal blood in blood typing systems. Isoelectric focusing of erythrocyte acid phosphatase and phosphoglucomutase

Isoenzyme band patterns of animal blood erythrocyte acid phosphatase (EAP) and phosphoglucomutase-1 (PGM) were studied by isoelectric focusing on ultrathin polyacrylamide gels. For blood from all animals tested (dog, cat, cow, sheep, and goat), the overall band patterns for both isoenzymes were different from those of the most common human types of these enzymes, although some animal EAP and PGM bands appeared in the human band areas. When mixtures of human and animal red blood cells were studied, it was found that misinterpretation of human types was possible only if the overall band pattern of the mixtures was ignored. For the animal blood tested, the strong PGM bands appearing outside the human band areas could be used as "markers" for the possible presence of animal blood in the samples tested.     

The cutaneous ink sign: a tipoff to suicide or suicide notes

The presence of smeared or unsmeared ink on the skin resulting from the writing process has been observed in a number of suicide victims who have left suicide notes. The authors report a case of a palmar "cutaneous ink sign" and discuss its forensic science import.     

Deaths allegedly caused by the use of "choke holds" (shime-waza)

Shime-waza or the "choke hold", when properly applied, should not cause death; therefore, its primary purpose should be to subdue violent suspects. When properly applied, the choke hold causes unconsciousness in 10 to 20 s. No fatalities as a result of shime-waza have been reported in the sport of judo since its inception in 1882. Among the methods of "control holds" taught to law enforcement officers is the choke hold similar or identical to shime-waza used in judo. Using the choke hold, officers may afford themselves maximum safety while subjecting the suspect to a minimum possibility of injury. The author has reviewed 14 fatalities with autopsy findings where death was allegedly caused by the use of choke holds.