Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Fraud”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed1995

Medicare fraud regulations and the implications for joint ventures: are we working at cross purposes?

The broad language and the broad application of the antifraud and Stark statutes has created uncertainty in the developing trend toward prepaid health plans and other systems (such as joint ventures) which are designed to deliver high quality services at reasonable costs. The motivation behind the statutes and the need for statutes that prosecute exploitation of the federal health care systems are needed. However, a reactive prosecutorial system may be inappropriate. A proactive administrative regulatory system where parties contemplating such ventures can receive quick, reliable approval or disapproval (with an explanation) would reduce the uncertainty in the current system. Such a system can be developed using the Stark reporting requirements and can be based on the model of certificate-of-need applications. Such models are being discussed in national health reform proposals, but in the area of antitrust. These proposals should consider such mechanisms for health care fraud that is of a more subtle nature. A serious longterm drawback is the lack of a preemption provision in the current laws and the proposals for national health reform relating to health care fraud and prohibited referrals. A preemption provision would reduce uncertainty that will develop as health care ventures cross state lines.

Animals↗
PubMed1997

Medicare, Medicaid fraud a billion-dollar art form in the US.

Medicare and Medicaid fraud costs billions of dollars each year in the US. Investigators have shown that fraud is found in all segments of the health care system. Even though the Canadian system has stricter regulations and tighter controls, can regulators here afford to be complacent about believing that such abuse would not happen here? One province has established an antifraud unit to monitor its health insurance scheme; it already has 1 prosecution under its belt.

Canada↗
PubMedDate not supplied

Fraud in the workers' compensation system: origin and magnitude.

Apparently, most investigations of workers' compensation fraud focus on the worker and cost more than the amount of money stolen. Although less is known about the extent of employer fraud, the dollars involved often are in the millions. Therefore, disproportionately policing workers is counterproductive.

Canada↗
PubMed1998

[Billing fraud from the viewpoint of the federal social court].

The intended settlement fraud as it is found in business criminality does not play a role in the social jurisdiction (of Berlin). A physician is endangered to be prosecuted if his treatments become uneconomically as defined by the social law regarding health insurances. These medical procedures are characterized as being excessively extended. The border of settlement fraud may then be reached easily.

Fees, Medical↗
PubMed1995

Fraud and hoaxes in science.

The recent spate of moral condemnation of fraud in science reflects the conservative nature of scientists; fraud, like error, is a normal part of science and cannot be legislated away.

Humans↗
PubMed2000

Fraud and abuse: a pain physician's guide.

The growing burden of regulations and statutes that physicians in the United States must comply with has become an inescapable aspect of the practice of medicine. With the advent of this heightened regulation has also come a new governmental commitment to discover and punish fraud and abuse in the practice of medicine. It is thus incumbent upon pain practitioners to be aware of the basic principles in fraud and abuse law so as to avoid obvious situations of legal liability and to know when to seek expert legal advice in the structuring of business transactions affecting their practice.

Journal Article↗
PubMed2000

Scientific misconduct. Panel finds scores of suspect papers in German fraud probe.

A new report paints a darker picture of what may be the highest profile case of scientific fraud in postwar Germany. After a 2-year investigation of all 347 scientific articles co-authored by former hematologist and cancer researcher Friedhelm Herrmann, a task force jointly sponsored by Germany's main granting agency, the DFG, and the country's largest cancer charity released a report on 19 June indicating that the scope of the fraud--first uncovered 3 years ago--is far more extensive than previously thought. Although Herrmann and a co-author have left their academic posts, the new revelations could place other careers in jeopardy.

Biomedical Research↗
PubMed1992

Scientific fraud: the McBride case.

Scientific fraud has occasionally been reported in Australia. The most recent case involved Dr William McBride, a prominent Sydney obstetrician who became well known in medical research for his part in drawing attention to the teratogenic effects of thalidomide. It is still not clear how much of McBride's later activities were fraud and how much poor quality research. The findings of the Inquiry into the matter (Gibbs et al., 1988) have considerable importance for the conduct of private research organizations, publication procedures of research journals, the role of assistants in research projects, collaboration between laboratories, and methods for inquiring into allegations of malpractice. The present paper is based on the Inquiry report.

Abnormalities, Drug-Induced↗
PubMed2005

Did Kettlewell commit fraud? Re-examining the evidence.

H.B.D. Kettlewell is famous for several investigations conducted in the early 1950s on the phenomenon of industrial melanism, which are widely regarded as the classic demonstration of natural selection. In a recent (2002) book-length popularization of this episode in the history of the science, science writer Judith Hooper draws attention to what she interprets as discrepancies in the results reported by Kettlewell in his first scientific papers on the subject. On the basis of correspondence among Kettlewell and his associates, a survey of scientific publications that mention outstanding questions surrounding the phenomenon, as well as interviews with his son, surviving colleagues, and scientists who have worked on industrial melanims, Hooper all but explicitly concludes that Kettlewell committed fraud. The following essay critically examines her evidence in support of this allegation, including her discussion of his character, the alleged motives, and whether fraud was even committed. None of Hooper's arguments is found to withstand careful scrutiny. The concluding section draws several conclusions about how history of science should be depicted to the public.

Animals↗
PubMed2005

[The biggest fraud of the century: light cigarettes].

"The biggest fraud of the century: 'light' cigarettes" exposes one of the largest scams companies have exerted on their consummers. Exploiting the dreams of smokers to find cigarettes which would not harm them as much, tobacco manufacturers duped and lurred millions of people by making them believe such a product existed and encouraged them to take up "light" cigarettes, while they knew internally that these products were by no means less dangerous. Tobacco manufacturers also lurred public authorities by neglecting to share vital information on the way smokers do not behave like measuring machines and would compensate by drawing on their cigarettes according to their nicotine intake needs. Thus smoking machines utilised to measure tar and nicotine intake could never reflect the reality and would render the content information printed on packs of cigarette meaningless. Very few countries have banned the misleading descriptors such as "light". It is hoped that the FCTC which includes a provision on the use of descriptors will prevent the fraud being repeated in the rest of the world and especially in the countries of Africa.

Deception↗
PubMed1997

[Research fraud].

In this article problems of research fraud are discussed. Academic courses of teaching scientific integrity and the impact of clinical trial fraud on good clinical research practice are mentioned.

Ethics, Medical↗
PubMed2005

The effects of fraud on the evaluation of health care.

Studies on health care practices, financing, and organization increasingly rely on Medicare and other expanded data sets. These studies are of critical importance for public policy and for the development of strategies to contain escalating health care costs, but they often use data that have been corrupted by fraud and abuse. Mistaken conclusions, as to the effectiveness of policy and procedures, are likely being reached in studies that have used corrupted data. Researchers need to consider the suspect nature of results obtained from the corrupted data, and determine methods for making the data more valid.

Data Collection↗
PubMed2004

Fraud, errors and gamesmanship in experimental toxicology.

We expect moral behaviour from scientists. Morality implies being a good person and being good at one's profession. The general view appears to be that the vast majority of scientists aim to achieve these high standards. Science prides itself on the 'self-correcting' mechanism in the scientific method, namely the requirement to reproduce findings before they are taken seriously. However, when findings are related to the adverse effects of chemicals there are several features that make this less effective than in some other fields of science. First, is the perception that everyone is exposed to chemicals and observations about chemical danger are immediately applicable to many people. Second, it is often easy to summarize adverse findings in attention-getting headlines seen by the lay public before the slow process of replication and interpretation has time to work. Third, most regulatory toxicology studies on a particular compound are only done once to minimise cost and the use of animals. Finally, the question posed about chemicals--are they safe?--is easy to ask but more difficult to test with appropriate studies. Fabrication of data in regulatory studies was found to occur in several contract laboratories in the 1960s and this lead directly to the introduction of Good Laboratory Practice regulations. Now studies submitted for regulatory purposes must comply with GLP regulations and this has virtually eliminated flawed studies due to fraudulent or careless behaviour. It is possible to discern different ways in which the expected standards have not been met. The first is in the intention of the work. Thus reports that the Roodeplaats Research Laboratory in South Africa was seeking to identify toxins that would kill without trace is an example where the intention is unacceptable. The second is in the conduct of the studies. Here the examples of William McBride and Michael Briggs who falsified data are pertinent. The example of the retraction of reports on the toxicity of ecstasy because the wrong compound had been administered indicates a degree of carelessness in the conduct of the study. The third is in the design and interpretation of studies. The report that genetic modification per se could render potatoes toxic has been criticised because of the inappropriate design and interpretation of the studies. Finally, that the reports of studies are biased because of conflicts of interest. Journals often require a declaration that the author has no financial conflict of interest. However, there are many other conflicts of interest with just as large an impact on the author's impartiality which are omitted from consideration. Gamesmanship has also entered the practice of toxicology, for example where strong assertions about conflict of interest are used to justify particular points of view. The main casualty from fraud, errors and gamesmanship is the perceived status of science itself. It is only gamesmanship that is on the increase. The remedies for these activities are explored.

Conflict of Interest↗
PubMedDate not supplied

Avoiding the fraud and abuse pitfalls.

In the current medical environment, long-standing and appropriate referral patterns among medical care providers may be scrutinized for possible violation of a technical provision of Medicare, the "anti-fraud and abuse statute." The physician can avoid misunderstanding by preparing and implementing a compliance program.

Fraud↗
PubMed2002

The rules of fraud and abuse.

It appears that the government is taking a no-holds-barred type approach to combating fraud and abuse of government programs by enacting new and by expanding existing statutes designed for this purpose. It is clear now, more than ever, that due to the abuse suffered by federal health care programs, the government, by and through its respective agencies, is using every resource available to track, identify, and prosecute those who defraud and attempt to defraud these programs. It is therefore imperative that hospitals and health care professionals take the necessary precautions to ensure that inadvertent violations of these statutes do not occur.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

The health fraud battle. Education is the best defense.

Despite the regulatory and educational efforts of the Food and Drug Administration and other agencies and organizations, large numbers of American consumers continue to be fooled by unsubstantiated "miracle cure" claims made by manufacturers of fraudulent medical products. Physicians who are familiar with the language of health fraud advertising and product labels may be able to help patients avoid unnecessary expense, false hope, and physical and emotional harm.

Advertising↗
PubMed1995

Estimating possible fraud in coal mine operators' samples of respirable dust.

Coal mine operators are required to sample miners' exposure to respirable dust on a regular basis. A method has been developed for screening all operator samples for detecting possible instances of fraud. This method relies on the occurrence of very low concentration (VLC = 0.1 mg/m3) samples more frequently than expected. The number of underground mine sections from which 50% or more of all samples for FY 1990 were VLC (VLC-50 sections) was compared to the expected number, which was estimated by assuming that the occurrence of VLC samples could be described with a binomial probability distribution. Out of 1983 continuous mining sections, there were 147 VLC-50 sections vs. 7.3 expected (O/E = 20.1). Moreover, these 147 sections occurred more frequently than expected among small as opposed to large mines. For sections using conventional mining methods, 19 of 175 were VLC-50 vs. 0.9 expected (O/E = 20.8). There was one VLC-50 longwall section vs. 0.003 expected. For 99 bituminous and anthracite hand-loading sections the observed number of VLC-50 sections was 65 vs. 78 expected (O/E = 0.8). It is suggested that, except for hand-loading and longwall sections, sampling programs should be investigated at mines with VLC-50 sections.

Coal↗
PubMed2001

Avoiding Medicare fraud. Part 1.

In 1997, Congress authorized payments to nurse practitioners (NPs) for Medicare-provided services. NP services are now reimbursed at 85% of the physician fee schedule. As this source of reimbursement was realized, so was a new area of liability for NPs. Failure to follow billing rules can result in payment denial, repayment of fees already paid, mandated educational activities, fines, fraud prosecution, loss of Medicare-billing ability, and loss of employment. Appropriate billing entails adhering to guidelines for selecting procedure codes and proper medical documentation. This article identifies high-risk areas for NPs who bill Medicare and provides resources for accessing additional information.

Forms and Records Control↗