Introduction to Fraud and Abuse Law

2020 ◽  
Author(s):  
Tracey A. Elliott ◽  
Joan H. Krause
Keyword(s):  
United States ◽  
The United States ◽  
Healthcare Systems ◽  
Federal Level ◽  
Ethical Content ◽  
Definitional Problem ◽  
Operational Issues

This chapter focuses on healthcare fraud and the range of legal solutions provided to address fraud in the United States and Europe on a federal level. It provides key examples of the range of approaches to healthcare fraud that are adopted within Europe. It also analyzes the manner in which healthcare systems in the United States and Europe are funded and organized, considering that fraud is dynamic and dependent on the mechanisms for funding in the relevant system. This chapter reviews the issue of what qualifies as healthcare fraud, and it considers both the definitional problem and the interplay between the moral and ethical content of fraud and legal definitions of fraudulent conduct. It discusses operational issues in the identification, prevention, and punishment of healthcare fraud in the United States and Europe.

Sold—to the Highest Bidder in Japan: Operational Challenges and Culture

2015 ◽  
pp. 1-5
Author(s):  
Gerry Yemen ◽  
Kristin J. Behfar ◽  
Allison Elias
Keyword(s):  
United States ◽  
The United States ◽  
Japanese Firm ◽  
Cultural Norms ◽  
Exit Strategy ◽  
Cross Border ◽  
Start Up ◽  
Financial Benefits ◽  
Operational Issues ◽  
The U.S

Most talented executives can recognize when an acquisition has strategic or financial benefits, and in this case, the decision to be acquired was an appropriate exit strategy for a successful start-up. Peter Street’s start-up had been growing quickly and was building a reputation for reliability in a booming industry when a Japanese firm offered to pay a premium for the U.S. firm. Having done business in Japan (and extensively with the acquiring company) before the sale of his company, Street entered the acquisition with enthusiasm. As part of the deal, Street’s former company would continue to operate in the United States as a division of its parent company and Street would remain as CEO. A few months into the transition, however, Street discovered a huge difference between working with and working for the Japanese firm. Cultural norms for confronting seemingly small problems quickly became bigger operational issues, and Street experienced a growing dichotomy between corporate (in Japan) and his division (in the United States). This case focuses on the challenges of implementing a cross-border acquisition.

Regional and Community Health Information Exchange in the United States

2011 ◽  
pp. 198-218 ◽  
Author(s):  
Adi V. Gundlapalli ◽  
Jonathan H. Reid ◽  
Jan Root ◽  
Wu Xu
Keyword(s):  
United States ◽  
Patient Care ◽  
Community Health ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Business Case ◽  
The United States ◽  
Healthcare Systems ◽  
Secure Information

A fundamental premise of continuity in patient care and safety suggests timely sharing of health information among different providers at the point of care and after the visit. In most healthcare systems, this is achieved through exchange of written medical information, phone calls and conversations. In an ideal world, this exchange of health information between disparate providers, healthcare systems, laboratories, pharmacies and payers would be achieved electronically and seamlessly. The potential benefits of electronic health exchange are improved patient care, increased efficiency of the healthcare system and decreased costs. The reality is that health information is electronically exchanged only to a limited extent within local communities and regions, much less nationally and internationally. One main challenge has been the inability of health information exchange organizations to develop a solid business case. Other challenges have been socio-political in that data ownership and stewardship have not been clearly resolved. Technological improvements over the past 20 years have provided significant advances towards safe and secure information exchange. This chapter provides a general overview of community health information exchange in the United States of America, its history and details of challenges faced by stakeholders. The lessons learned from successes and failures, research and knowledge gaps and future prospects are also discussed. Current and future technologies to facilitate and invigorate health information exchange are highlighted. Two examples of successful regional health information exchanges in the US states of Utah and Indiana are highlighted.

Crackdown

2020 ◽  
pp. 88-109
Author(s):  
Russell Crandall
Keyword(s):  
United States ◽  
Legal System ◽  
The United States ◽  
Pharmaceutical Market ◽  
Drug Control ◽  
Freedom Of Choice ◽  
Drug Laws ◽  
Federal Level ◽  
American Legal System ◽  
The U.S

This chapter recounts how the United States in the nineteenth century permitted considerable personal freedom of choice regarding drugs, citing the idiosyncrasies of the U.S. Constitution that helped ensure potent forms of opium, cocaine, and cannabis remained widely available nationwide. It talks about how the American legal system made states responsible for regulating drugs, particularly opium and cannabis, on their own turf. It also discusses how most states and several major cities by 1910 had anti-drug laws wherein ritual police raids were a hallmark of the states' haphazard enforcement schemes. The chapter recounts the first efforts at drug control at the federal level, which were designed not to break up underground dealer networks but to regulate the runaway pharmaceutical market. It refers to the Pure Food and Drug Act in 1906, which simply mandated that certain active ingredients meet standardized purity requirements and forced drug makers to label in a clear way any of ten ingredients considered unsafe.

Success Stories (DRAFT)

2018 ◽  
Author(s):  
Boaz Ronen ◽  
Joseph S Pliskin ◽  
Shimeon Pass
Keyword(s):  
United States ◽  
Emergency Department ◽  
United Kingdom ◽  
Emergency Room ◽  
The United States ◽  
Healthcare Systems ◽  
Theory Of Constraints ◽  
Wait Times ◽  
Success Stories ◽  
Specific Contribution

This chapter describes some success stories that show how the tools, methods, and philosophies were used in a variety of healthcare systems. The cases presented here include successful implementations in the United States, United Kingdom, and Israel. Each story highlights the objectives and the results of the organization. Objectives include reducing emergency room wait times, reducing delayed admissions, improving emergency department and operating room throughput, improving quality and customer satisfaction. Although the cases use a variety of methods, approaches include eliminating dummy constraints, using specific contribution for prioritization, and working with complete kits, focusing on the theory of constraints, and reducing work in progress.

Dangerous Excursions: The Case against Expanding Forensic DNA Databases to Innocent Persons

2006 ◽  
Vol 34 (2) ◽  
pp. 390-397 ◽  
Author(s):  
Tania Simoncelli
Keyword(s):  
United States ◽  
Law Enforcement ◽  
Juvenile Offenders ◽  
Sexual Offenders ◽  
The United States ◽  
Forensic Dna ◽  
State Laws ◽  
Federal Level ◽  
The Past ◽  
And Storage

Over the past fifteen years, the United States has witnessed an extraordinary expansion in the banking and mining of DNA for law enforcement purposes. While the earliest state laws governing forensic DNA limited collection and retention of DNA samples to sexual offenders – on the theory that these persons were especially prone to recidivism and most likely to leave behind biological evidence – today forty-three states collect DNA from all felons, twenty-eight from juvenile offenders, and thirty-eight from those who commit certain categories of misdemeanors.A few states have expanded their databases beyond convicted criminals. Virginia, Louisiana, Texas, and California have authorized DNA retention from persons merely arrested for various offenses, although to date only Virginia has implemented such a program. At the federal level, an ill-considered statute that allows for the seizure and storage of DNA from anyone arrested and from non-U.S. citizens detained under federal authorities was recently signed into law.

scholarly journals From Liability Shields to Democratic Theory: What We Need from Tort Theory Now

2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Heidi Li Feldman
Keyword(s):  
United States ◽  
Democratic Theory ◽  
Tort Law ◽  
The United States ◽  
Tort Liability ◽  
Federal Level ◽  
American Conservatism

Abstract In the United States, one startling response to COVID-19 has been a push for so-called “liability shields,” laws modifying tort doctrine so as to largely eliminate tort liability for negligently causing COVID-19. Though not enacted at the federal level, such changes have been adopted in numerous states. This article excavates and articulates the tort theory that lies behind this puzzlingly response to a pandemic. I call the theory “tort deflationism.” Grounded in modern American conservatism and with a doctrinal pedigree dating back to the 1970s, tort deflationism explains and justifies only minimal tort liability, out of deference to non-governmental actors – especially family, church, and business—and suspicion of government competence and power. Other tort theories should reckon with tort deflationism, and I discuss some challenges of doing so. The contest between tort deflationism and other theories speaks to ongoing debates about the legitimacy of law in pluralist democracies. I urge tort theorists to enter these debates and to consider their implications for tort law itself.

scholarly journals Support for Paid Family Leave among Small Employers Increases during the COVID-19 Pandemic

2021 ◽  
Vol 7 ◽  
pp. 237802312110619
Author(s):  
Ann P. Bartel ◽  
Maya Rossin-Slater ◽  
Christopher J. Ruhm ◽  
Meredith Slopen ◽  
Jane Waldfogel
Keyword(s):  
United States ◽  
New York ◽  
The United States ◽  
Family Leave ◽  
Limited Data ◽  
Federal Level ◽  
Paid Family Leave ◽  
Negative Impacts ◽  
Small Employers ◽  
High Support

The United States is one of the few countries that does not guarantee paid family leave (PFL) to workers. Proposals for PFL legislation are often met with opposition from employer organizations, which fear disruptions to business, especially among small employers. But there are limited data on employers’ views. The authors surveyed firms with 10 to 99 employees in New York and New Jersey on their attitudes toward PFL programs before and during the coronavirus disease 2019 (COVID-19) pandemic. There was high support for state PFL programs in 2019 that rose substantially over the course of the pandemic: by the fall of 2020, almost 70 percent of firms were supportive. Increases in support were larger among firms that had employees using PFL, suggesting that experience with PFL led to employers becoming more supportive. Thus, concerns about negative impacts on small employers should not impede efforts to expand PFL at the state or federal level.

scholarly journals Impact of COVID-19 Second Wave on Healthcare Networks in the United States

2020 ◽  
Author(s):  
Emad M. Hassan ◽  
Hussam Mahmoud
Keyword(s):  
United States ◽  
Healthcare System ◽  
The United States ◽  
Healthcare Systems ◽  
Mitigation Strategies ◽  
County Level ◽  
Protective Measures ◽  
The Impact ◽  
Second Wave ◽  
The U.S

The risk of overwhelming healthcare systems from a second wave of COVID-19 is yet to be quantified. Here, we investigate the impact of different reopening scenarios of states around the U.S. on COVID-19 hospitalized cases and the risk of overwhelming the healthcare system while considering resources at the county level. We show that the second wave might involve an unprecedented impact on the healthcare system if an increasing number of the population becomes susceptible and/or if the various protective measures are discontinued. Furthermore, we explore the ability of different mitigation strategies in providing considerable relief to the healthcare system. The results can aid healthcare planners, policymakers, and state officials in making decisions on additional resources required and on when to return to normalcy.

scholarly journals 784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S280-S281
Author(s):  
Khalid M Dousa ◽  
Rafael Ponce-Terashima ◽  
Daniel Van Aartsen ◽  
Alejandro De La Hoz ◽  
John L Johnson
Keyword(s):  
United States ◽  
Risk Factors ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
The United States ◽  
Healthcare Systems ◽  
Electronic Health Record Data ◽  
Integrated Healthcare ◽  
Record Data ◽  
Necrosis Factor

Abstract Background The epidemiology of disseminated Mycobacterium avium complex (DMAC) infection in the United States is changing. Previously most DMAC occurred in adults with advanced AIDS. Since the development of effective antiretroviral therapy, the incidence of DMAC in AIDS has fallen more than 10-fold. Malignancy, immunosuppression, and tumor necrosis factor inhibitors are known risk factors for DMAC. We sought to describe the epidemiology of DMAC disease in HIV seronegative patients in the United States. Methods We performed a retrospective analysis of a commercial database (Explorys Inc., Cleveland, OH). This database contains an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999 to present. Explorys contains de-identified information from over 50 million patients, 360 hospitals, and over 317,000 providers. We identified a total of 571 persons diagnosed with DMAC, based on Systemized Nomenclature of Medicine-Clinical Terms. We excluded 80 HIV-infected and identified association of the infection with known risk factors. Results Of 570 patients, 491 HIV-uninfected patients with DMAC were studied. Underlying structural pulmonary diseases were COPD and bronchiectasis (51% and 47%, respectively). Two hundred ten patients had concomitant malignancy of which lung cancer was the most frequent (43%). Seventy-nine percent were receiving corticosteroids and 10 patients (2%) were on TNF inhibitors (2%). Conclusion In this study, majority of patients with DMAC are HIV-uninfected. Larger studies should focus on identifying the prevalence and risk factors of DMAC in the post-AIDS era. Disclosures All authors: No reported disclosures.

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