Adoption of retrospective Medicare maximization billing practices by state Medicaid home care programs

Home care services funded by Medicare and Medicaid grew rapidly throughout most of the 1990s. During this period some state Medicaid programs transferred costs for home care claims to the Medicare program to reduce their liability and increase beneficiary access to Medicare coverage. This article reports the findings of the first national study of these Medicare maximization billing practices for home care services. Primary data were collected to determine which states conduct retrospective Medicare billing practices and the amounts recovered from Medicare. Our analysis indicates that seven states recovered as much as dollar 265 million from Medicare in state and federal dollars during the 1990s. Ratios of recovered expenditures-to-costs incurred for retrospective billing practices conducted in Connecticut, New York, and Massachusetts are between 5:1 and 7:1. While retrospective billing practices may aid states in reducing Medicaid outlays and potentially help dual Medicare beneficiaries gain coverage for their home care claims, they increase Medicare expenditures for home care at a time of concern for the long-term financial viability of Medicare and illustrate the need for reforming our national long-term care financing policy.     

Threats to Perceptions of Fairness in the Termination of Parental Rights

Termination of parental rights (TPR) proceedings are among the most important family court activities. This study contributes to knowledge of the TPR process by illustrating practices employed in TPR proceedings and considering ways that certain practices can hinder perceptions of fairness. TPR court records from one state were analyzed using inductive coding procedures. The analysis identified nine categories of threats to perceptions of fairness in the TPR process. Findings have implications for procedural justice and the legitimacy of child welfare practice.     

The re-occurrence of violations in occupational safety and health administration inspections

How well do firms in the United States maintain compliance with occupational safety and health administration (OSHA) standards after being cited for a violation? How and why does this vary among standards? This paper identifies serious violations of 91 frequently cited standards at manufacturing plants during 1992–2002 and tracks compliance with that standard in later inspections over 10 years. While formal measures of Repeat violations are quite low, we find considerably higher re-violation rates for some standards once we look separately at how often health standards are cited in later health inspections and safety standards cited in later safety inspections. Characteristics of the standards affect re-violation rates, but not always in the expected direction. Standards whose violations are rated as more hazardous or which received higher initial penalties tend to have more re-violations. These findings could reflect inspector behavior, with those standards getting more attention and thus being cited more frequently. When, as in the case of OSHA and other enforcement agencies, we know about violations only when inspectors cite them, we need to consider bureaucratic behavior as well as employers' incentives.     

Projectile Wound to Head from Modified Electronic Cigarette Explosion

One of the dangers of a rapidly growing technology industry is the risk involved in being intimately close to lithium-ion batteries. When exposed to improper conditions, lithium-ion batteries in a variety of devices have been reported to ignite and, in some cases, explode. With the rise of electronic cigarette use and modifications, the lithium-ion batteries in these devices are subject to a higher risk of malfunction. This is a retrograde analysis of a 38-year-old man who experienced fatal penetrating head trauma while using a modified electronic cigarette device. The findings suggest that the trauma from the explosion was caused by the thermal runaway of the lithium-ion battery in the modified e-cigarette.     

Poisson-Based Regression Analysis of Aggregate Crime Rates

This article introduces the use of regression models based on the Poissondistribution as a tool for resolving common problems in analyzing aggregatecrime rates. When the population size of an aggregate unit is small relativeto the offense rate, crime rates must be computed from a small number ofoffenses. Such data are ill-suited to least-squares analysis. Poisson-basedregression models of counts of offenses are preferable because they arebuilt on assumptions about error distributions that are consistent withthe nature of event counts. A simple elaboration transforms the Poissonmodel of offense counts to a model of per capita offense rates. Todemonstrate the use and advantages of this method, this article presentsanalyses of juvenile arrest rates for robbery in 264 nonmetropolitancounties in four states. The negative binomial variant of Poisson regressioneffectively resolved difficulties that arise in ordinary least-squaresanalyses.