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At least 19 recordsLinked to original sources
PubMed1977

Control of fraud and abuse in Medicare and Medicaid.

This Comment explores issues concerning the control of fraud and abuse in health programs financed with public funds, specifically the Medicare and Medicaid programs. It summarizes the nature, scope, and possible causes of what some regard as a fraud and abuse "crisis," and points out the difficulties and obstacles facing those who attempt to develop legislative and executive action aimed at controlling fraud and abuse. Recent federal initiatives in fraud and abuse control are examined, and a brief summary of key provisions of H.R. 3 (the Medicare-Medicaid Anti-fraud and Abuse Amendments, which may prove to be a landmark piece of legislation in this area) is provided. The author emphasizes that more effective control of fraud and abuse is necessary if further expansion of government financing of health programs, including national health insurance, is to occur in the near future. At the same time, caution must be taken not to neglect the appropriate use of other mechanisms necessary for reducing the costs of medical care and improving its quality. In addition, it is likely that efforts to stem fraud and abuse will raise important medicolegal and public policy issues that will require careful interdisciplinary consideration.

Crime↗
PubMedDate not supplied

Scientific fraud: definitions, policies, and implications for nursing research.

Scientific research typically has been founded on high ethical standards established by researchers in academia and health care research institutions. Scientific fraud, an act of deception or misrepresentation of one's own work, violates these ethical standards. It can take the form of plagiarism, falsification of data, and irresponsible authorship. Scientific fraud has been attributed to misdirected attempts to attain high levels of personal and professional success. Researchers so prone commit scientific fraud in a search for promotion, status, tenure, and the obtaining of research grants. To divert scientific fraud, three recommendations are suggested: (1) socialize prospective nurse researchers into an atmosphere where intellectual and professional integrity prevail; (2) have established nurse researchers serve as role models and mentors who can educate the neophyte researcher about the ethics of research, including scientific fraud; and (3) emphasize and reward quality in research and publications, rather than quantity.

Ethics, Professional↗
PubMed1978

Fraud and abuse in psychiatric practice.

A consensus has not yet been reached on definitions of fraud and abuse, particularly the latter. Further, the terms tend to be linked routinely by federal agencies, although abuse is generally understood to relate to inappropriate and fraud to illegal practices. These definitional problems make it difficult to determine what constitutes fraudulent or abusive practice in psychiatry. The authors provide hypothetical examples relevant to psychiatry, noting that in many cases it is still impossible to determine at what point a practice becomes inappropriate or illegal. Criteria must be developed by claims review systems, ethics committees, and PSROs; all those in the mental health field should devote serious attention to these issues.

Crime↗
PubMed1990

Detecting health fraud in the field of learning disabilities.

Quackery is currently a widespread problem that pervades all aspects of healthcare, including the treatment of learning disorders. A discussion of the nature of modern health fraud in special education is presented. The psychopathology of health fraud, the standards by which pseudoscience and health quackery are defined, and the complexities of learning disorders are discussed. A Therapy Rating Scale to determine if an alternative therapy is reasonable is presented. Several popular therapies are used as examples.

Child↗
PubMed1992

Is new OIG physician fraud alert precursor to enforcement action?

A recent fraud alert published by the OIG listing "suspect hospital incentive arrangements" in physician recruitment practices is compelling hospital executives to review their recruitment strategies. "What is new about this fraud alert," says an attorney, "is that the OIG has put them into one document as an indication of its enforcement priorities."

Fraud↗
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↗
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↗
PubMed1991

Fraud by physicians against Medicaid.

The inauguration of the Medicaid program in the mid 1960s ultimately led to the appearance of a wide range of new forms of illegal behavior by physicians. The fact that government authorities, instead of individual patients, were responsible for payments undoubtedly encouraged the large number of violations. A review of the background of sanctioned physicians shows an overrepresentation of psychiatrists and foreign medical graduates as well as minority-group physicians. Interviews with physicians sanctioned for Medicaid fraud and abuse indicated that they routinely placed the blame for their violations on the program, their employees, patients, or others. In particular, they find program guidelines confusing and irrational and insist that they intrude on what ought to be independent medical judgments. The enforcers, for their part, maintain that the convicted physicians are merely rationalizing self-serving and greedy behavior.

Attitude of Health Personnel↗
PubMed1990

Fraud and abuse rules: enforcement questions persist.

Attorneys disagree on how the yet-to-be-published fraud and abuse regulations will be enforced. Some interpret them as "guidelines," others as the "letter of the law." In addition, officials in the Office of the Inspector General say that they are not sure how the regulations will be enforced. Then there's the question of how the Secretary of Health and Human Services will use his official sanction. Is everything perfectly clear?

Commerce↗
PubMed1989

The campaign against health fraud.

Deficiencies in the law, and persuasive fraudsters preying on real and imagined health fears, continue to cause great concern to victims, the professions and society as a whole. The Campaign Against Health Fraud has been formed to address this thriving and malignant relic of more desperate times.

Crime↗
PubMed1989

Civil monetary penalties--weapon against fraud or instrument of health policy?

Most physicians are aware of the highly publicized aspects of government health care regulation, including attempts at mandatory physician assignment and recoupment of services deemed medically unnecessary. There is less awareness of the potential pitfalls of civil monetary penalties, as many physicians believe they are primarily applicable to false claim allegations. However, the use of civil monetary penalties is increasing as Congress creates new bases of liability. This development leads to the question: Are civil monetary penalties a weapon against fraud or an instrument of federal policy?

Crime↗