Unraveling Medicare and Medicaid Prescription Drug Fraud and Abuse

2011 ◽  
Vol 43 (6) ◽  
pp. 339-345 ◽  
Author(s):  
Myranda Toothman ◽  
Ken Moore ◽  
Doohee Lee

With government spending on Medicare and Medicaid programs skyrocketing, their futures are questionable. Many politicians and political pundits are calling for intense oversight of these agencies to reduce fraud and abuse in the system and, consequently, rein in costs. Many medical providers’ fraudulent behaviors, which cost the medical community billions of dollars, stem from prescribing of pharmaceutical drugs to treat an illness or injury. Although this is part of the job of providers, some allow kickbacks from pharmaceutical companies or patient requests to cloud their clinical judgment. This article identifies several options for increased enforcement of laws concerning Medicaid and Medicare fraud and abuse of drug benefits, with great emphasis placed on the Integrated Data Repository currently under development by the federal government.

2020 ◽  
Vol 01 ◽  
Author(s):  
Aaron Han

: Social media is increasingly used as a platform by medical providers. The positive contribution is also balanced by risks and governed by codes of professionalism by the medical community. The values of medical professionalism include universal tenets and also those unique to the Arab world and the United Arab Emirates. We propose that institutional guidelines and self governance in the medical community is important, as well as further dialogue on this important subject.


PEDIATRICS ◽  
1991 ◽  
Vol 88 (6) ◽  
pp. 1233-1237
Author(s):  
Lewis H. Margolis

How physicians respond to the promotional activities of the pharmaceutical industry is the subject of ongoing debate and controversy. This paper postulates that the acceptance of gifts in virtually any form violates fundamental duties of the physician of nonmaleficence, fidelity, justice, and self-improvement. The medical community must articulate this position clearly, and it should act accordingly.


2013 ◽  
Vol 12 (4) ◽  
pp. 346-356 ◽  
Author(s):  
M Fakruddin ◽  
A Chowdhury

Introduction: Pharmacogenomics (PGx) is the study of the genetic basis of variability among individuals in response to drugs. It is the newest discipline of medicine and is becoming a very active area of research, with the pharmaceutical industry gaining experience applying it, integrating it into the drug development process, and also learning to better manage the expectations of the medical community. Methodology: A comprehensive review of the literature on the principles, applications, challenges and prospects of pharmacogenomics was performed. Results: Pharmacogenomics tailors therapies to the genetic makeup of an individual and can therefore offer treatments that are more efficacious and have fewer side effects. Despite these benefits, personalized medicine has not been embraced by large pharmaceutical companies. It is expected that the first wave of successful pharmacogenomics products will be used in acute treatments for which current therapies have and severe side effects. These products should also be good candidates for premium pricing. Personalized medicine (PM), based on the genetic makeup of a patient, may result in not only an improved therapeutic response but also a clinically important reduction in adverse drug reactions. The experience to date is mixed, with a few successes but many frustrations. Conclusion: However, for pharmacogenomics to be truly embraced, the benefits of this technology must become more widely accepted in terms of economic, public, regulatory and ethical issues. DOI: http://dx.doi.org/10.3329/bjms.v12i4.11041 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 346-356


2000 ◽  
Vol 31 (3) ◽  
pp. 91-98 ◽  
Author(s):  
Russell Abratt ◽  
Julie Lanteigne

This study examines the factors influencing general practitioners' prescription behaviour. It differs from previous studies in that the subject is homeopathic medicines and not pharmaceutical drugs. The literature indicates very particular behaviour patterns of doctors prescription behaviour. The present study provides evidence which contradicts the previous studies. There is thus evidence that what applies to the prescription of ethical pharmaceutical drugs does not apply to the prescription of alternative homeopathic medicines. It follows that marketing practices for alternative medicines should differ from those used by pharmaceutical companies.


2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Atsushi Hakura ◽  
Takumi Awogi ◽  
Toshiyuki Shiragiku ◽  
Atsushi Ohigashi ◽  
Mika Yamamoto ◽  
...  

Abstract Background Ames test is used worldwide for detecting the bacterial mutagenicity of chemicals. In silico analyses of bacterial mutagenicity have recently gained acceptance by regulatory agencies; however, current in silico models for prediction remain to be improved. The Japan Pharmaceutical Manufacturers Association (JPMA) organized a task force in 2017 in which eight Japanese pharmaceutical companies had participated. The purpose of this task force was to disclose a piece of pharmaceutical companies’ proprietary Ames test data. Results Ames test data for 99 chemicals of various chemical classes were collected for disclosure in this study. These chemicals are related to the manufacturing process of pharmaceutical drugs, including reagents, synthetic intermediates, and drug substances. The structure-activity (mutagenicity) relationships are discussed in relation to structural alerts for each chemical class. In addition, in silico analyses of these chemicals were conducted using a knowledge-based model of Derek Nexus (Derek) and a statistics-based model (GT1_BMUT module) of CASE Ultra. To calculate the effectiveness of these models, 89 chemicals for Derek and 54 chemicals for CASE Ultra were selected; major exclusions were the salt form of four chemicals that were tested both in the salt and free forms for both models, and 35 chemicals called “known” positives or negatives for CASE Ultra. For Derek, the sensitivity, specificity, and accuracy were 65% (15/23), 71% (47/66), and 70% (62/89), respectively. The sensitivity, specificity, and accuracy were 50% (6/12), 60% (25/42), and 57% (31/54) for CASE Ultra, respectively. The ratio of overall disagreement between the CASE Ultra “known” positives/negatives and the actual test results was 11% (4/35). In this study, 19 out of 28 mutagens (68%) were detected with TA100 and/or TA98, and 9 out of 28 mutagens (32%) were detected with either TA1535, TA1537, WP2uvrA, or their combination. Conclusion The Ames test data presented here will help avoid duplicated Ames testing in some cases, support duplicate testing in other cases, improve in silico models, and enhance our understanding of the mechanisms of mutagenesis.


2020 ◽  
Vol 9 (12) ◽  
pp. 3811 ◽  
Author(s):  
Gaby N. Moawad ◽  
Jad Elkhalil ◽  
Jordan S. Klebanoff ◽  
Sara Rahman ◽  
Nassir Habib ◽  
...  

Technology has been integrated into every facet of human life, and whether it is completely advantageous remains unknown, but one thing is for sure; we are dependent on technology. Medical advances from the integration of artificial intelligence, machine learning, and augmented realities are widespread and have helped countless patients. Much of the advanced technology utilized by medical providers today has been borrowed and extrapolated from other industries. There remains no great collaboration between providers and engineers, which may be why medicine is only in its infancy of innovation with regards to advanced technologic integration. The purpose of this narrative review is to highlight the different technologies currently being utilized in a variety of medical specialties. Furthermore, we hope that by bringing attention to one shortcoming of the medical community, we may inspire future innovators to seek collaboration outside of the purely medical community for the betterment of all patients seeking care.


2020 ◽  
Vol 11 ◽  
pp. 215013272092295
Author(s):  
Zach Sartor ◽  
Burritt Hess

The novel coronavirus (SARS-CoV-2), which is the cause of coronavirus disease (COVID-19 formally 2019-nCoV), has received widespread attention from the medical community. Despite the rapid publication of research on the virus and the disease it causes, there is a lack of concise and relevant material to help busy medical providers navigate recognition and management of the disease in the ambulatory setting. This review article aims to bridge this gap by briefly reviewing the key points of the evaluation and treatment of patients with COVID-19 in the ambulatory clinic environment.


Author(s):  
Mohit ◽  
Aakash Deep ◽  
Gaurav Khurana ◽  
Jagdeep Kumar ◽  
Akshay Monga

Background: The product registration in rest of the world is a challenging task because they are not harmonized. ASEAN and GCC regions come under semi-regulated market. These regions have somewhat harmonized their regulatory organization. The significance of an emerging market is increasing globally. It is important for pharmaceutical companies to be up-to-date with the latest regulatory development. ASEAN used ACTD format and GCC used ICH CTD format for drug product Registration. ASEAN includes a group of countries like Singapore, Philippines etc. Whereas GCC includes Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and UAE. Conclusion: This review article focuses on general regulatory requirements of registration of pharmaceuticals in ASEAN and GCC region.


Author(s):  
Sergio Sismondo

When a knowledge system importantly loses integrity, ceasing to provide the kinds of trusted knowledge expected of it, we can label this epistemic corruption. Epistemic corruption often occurs because the system has been co-opted for interests at odds with some of the central goals thought to lie behind it. There is now abundant evidence that the involvement of pharmaceutical companies corrupts medical science. Within the medical community, this is generally assumed to be the result of conflicts of interest. However, some important ways that the industry corrupts are not captured well by standard analyses in terms of conflicts of interest. It is not just that there is a body of medical science perverted by industry largesse. Instead, much of the corruption of medical science via the pharmaceutical industry happens through grafting activities: Pharmaceutical companies do their own research and smoothly integrate it with medical science, taking advantage of the legitimacy of the latter.


Author(s):  
Arun Kumar S ◽  
Ankita Wadhwa ◽  
Amol Gramle

Internet has become essential to everyone during the Covid-19 pandemic lockdown as everything went to virtual. This has made the interactions between Pharmaceutical companies and Health Care Professionals (HCPs) explore digital channels as Medical Representatives (MRs) were not able to efficiently reach the HCPs. This pioneering study was conducted to evaluate the scope of digital channels and uncover insights into the digital behavioral landscape of HCPs to reach them effectively. A proctored, PAN India survey was conducted for health care professionals across diverse specialties and the responses were collected through in-clinic visits, mobile phones (via WhatsApp & SMS) and e-mails. 407 HCPs had actively participated in this survey from across the country. Descriptive statistics were used to analyze the outcomes of this research which will help to develop programs directed at the HCPs in India to enhance their knowledge, medicine practice, HCP – patient & HCP – Pharmaceutical company interactions, engagement with the medical community and highlight the areas that they face challenges while accessing information online to better fit in this fast-growing digital landscape of the health sector. This will also cover insights to bridge both physical and digital interactions as ‘Phygital interactions’ that could be followed in the hopeful Post – Covid-19 scenario.


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