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Health care fraud and abuse enforcement: Relationship scrutiny

July 17, 2015 Comments off

Health care fraud and abuse enforcement: Relationship scrutiny
Source: Deloitte

Where is fraud and abuse enforcement headed in health care? One emerging area of interest is relationship scrutiny. Relationships can be complex in the business of health care: tracking and analyzing them is an important part of minimizing the fraud and abuse that may result from questionable relationships and improper influence.

Many organizations depend on analytics to understand their own performance. Insights and patterns within the data are often used to inform strategy and decision making. Researchers can apply analytics to identify external trends and factors that may impact businesses. To that end, Deloitte researchers used analytics techniques to examine the text of tens of thousands of federal regulations and identify emerging trends in health care fraud and abuse enforcement. The results are telling: Federal health care regulators are emphasizing relationship scrutiny in their fraud and abuse enforcement efforts. Also, discussion of health care fraud and abuse topics – including relationship scrutiny – is recurring, as evidenced by the cyclical rise and fall in frequency and relevance of keyword groups related to “enforcement,” “value-based care,” and “fraud and abuse.” The bottom line: discussion of these topics is present; relationship scrutiny is likely here to stay.

HHS OIG — Ensuring the Integrity of Medicare Part D

July 16, 2015 Comments off

Ensuring the Integrity of Medicare Part D
Source: U.S. Department of Health and Human Services, Office of Inspector General

In the 9 years since Part D began, OIG has produced a wide range of investigations, audits, evaluations, and legal guidance related to Part D program integrity. This work has resulted in the prosecution of individuals accused of defrauding Part D, as well as the identification of systemic program vulnerabilities that raise concerns related to both inappropriate payments and quality of care. OIG has made recommendations to strengthen Part D program integrity, and progress has been made. However, Part D remains vulnerable to fraud, as evidenced by ongoing investigations. OIG has prepared this portfolio to document key progress in addressing Part D program vulnerabilities and to highlight issues that need improvement.

See also: Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D

Legal Responses to Health Emergencies

July 15, 2015 Comments off

Legal Responses to Health Emergencies
Source: Law Library of Congress

This report contains discussions of the regulations addressing health emergencies in 25 jurisdictions, including countries from six continents, the European Union, and the World Health Organization. All surveys included in this report review government structures tasked with delivering public health protection, relevant legislative frameworks for addressing health emergencies, and the powers of government institutions in times of health crises and their ability to mitigate the consequences of such crises. Analyses of the regulation of such issues as disease surveillance and notification systems are also provided.

Do Private Prisons Distort Justice? Evidence on Time Served and Recidivism

July 15, 2015 Comments off

Do Private Prisons Distort Justice? Evidence on Time Served and Recidivism
Source: Social Science Research Network

I contribute new evidence on the impact of private prisons on prisoner time served and recidivism by exploiting the staggered entry and exit of private prisons in Mississippi between 1996 and 2004. Little is known about this topic, even though burgeoning prison populations and an effort to cut costs have caused a substantial level of private contracting since the 1980s. The empirical challenge is that prison assignment may be based on traits unobservable to the researcher, such as body tattoos indicating a proclivity for violent behavior. My first result is that private prisons increase a prisoner’s fraction of sentence served by an average of 4 to 7 percent, which equals 60 to 90 days; this distortion directly erodes the cost savings offered by privatization. My second result is that prisoners in private facilities are 15 percent more likely to receive an infraction (conduct violation) over the course of their sentences, revealing a key mechanism by which private prisons delay release. Conditional on receiving an infraction, prisoners in private prison receive twice as many. My final result is that there is no reduction in recidivism for prisoners in private prison despite the additional time they serve, suggesting that either the marginal returns to incarceration are low, or private prisons increase recidivism risk. These results are consistent with a model in which the private prison operator chooses whether to distort release policies, i.e., extend prisoner time served beyond the public norm, based on the typical government contract that pays a diem for each occupied bed and is imperfectly enforced.

Sovereign Immunity for Public Airport Operations

July 15, 2015 Comments off

Sovereign Immunity for Public Airport Operations
Source: Transportation Research Board

TRB’s Airport Cooperative Research Program (ACRP) Legal Research Digest 24: Sovereign Immunity for Public Airport Operations examines sovereign immunity as it applies to public airports that are owned and operated by units of local government or regional governmental authorities. This report summarizes the extent of sovereign immunity granted to airports from state to state. Appendix A provides a table of cases, and Appendix B contains a chart of authorities.

Auto Franchise Laws Restrict Consumer Choice and Increase Prices

July 14, 2015 Comments off

Auto Franchise Laws Restrict Consumer Choice and Increase Prices
Source: Mercatus Center

Arizona, Michigan, New Jersey, and Texas recently received the 2014 Luddite Award from the Information Technology and Innovation Foundation for preventing automaker Tesla from selling cars directly to consumers. These states’ efforts to ban direct sales are reminiscent of the Luddites, nineteenth-century English workers employed in the textile industry who both rejected technological development and actively worked to prevent its use through its destruction. State legislatures, rather than destroying physical plant and equipment like the Luddites, actively impede alternative distribution models, reducing consumer choice.

Auto franchise laws often include three major restrictions: mandatory dealership licensing requirements, onerous terms for terminating dealerships, and the creation of exclusive territories for incumbent dealers. Each rule carries a potential cost for consumers.

The coverage of these laws has expanded significantly during the past 30 years.

Liability Aspects of Pedestrian Facilities

July 11, 2015 Comments off

Liability Aspects of Pedestrian Facilities
Source: Transportation Research Board

TRB’s National Cooperative Highway Research Program (NCHRP) Legal Research Digest 65: Liability Aspects of Pedestrian Facilities addresses legal claims that relate to pedestrian facilities, such as sidewalks and crosswalks, and focuses on allegations of violations of the Americans with Disabilities Act (ADA) and lawsuits alleging that a government agency has been negligent in maintaining its facilities.

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