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Health care fraud and abuse enforcement: Relationship scrutiny

July 5, 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.

Minimizing the risk of health care fraud and abuse doesn’t have to be an impossible task. New insights can come from the application of analytics to an organization’s data sets. These insights, in turn, can be used to build a fraud and abuse risk-mitigation program.

This paper examines health care fraud and abuse enforcement drivers and laws, the cyclical trend of relationship scrutiny within the regulatory discussion, and how health care organizations can build a responsive, analytics-based program to address potential fraud and abuse. An effective program will likely enable organizations to identify risks in real time, adjust to mitigate them, communicate their importance, and learn from the regulatory and legislative landscape.

Coercing Pregnancy

July 2, 2015 Comments off

Coercing Pregnancy
Source: William and Mary Journal of Women and the Law

Intimate partners coerce thousands of women in the United States into pregnancy each year through manipulation, threats of violence, or acts that deliberately interfere with the use of, or access to, contraception or abortion. Although many of these pregnancies occur within the context of otherwise abusive relationships, for others, pregnancy serves as a trigger for intimate partner violence. Beyond violence preceding or resulting from pregnancy, women who experience coerced pregnancies often suffer other physical, financial and emotional harms. Despite its correlation to domestic violence, reproductive coercion fits imperfectly, if at all, within our existing laws designed to combat domestic violence or rape. Although the harms of forced sex and, though to a slightly lesser extent, the harms of domestic violence, are well understood and accepted in our culture and our laws, the harm of experiencing a pregnancy through coercive acts remains largely invisible in both spheres, despite the prevalence of coerced pregnancies. This Article begins by filling in the missing narrative of reproductive coercion by exploring the social and legal contours of how women are coerced into pregnancy, the harms that can result, and the deep correlation between such acts and domestic violence. It then explores how our cultural and legal conflation of pregnancy with sex, motherhood and even abortion, limits our ability to isolate and understand the experience of pregnancy coercion. This Article concludes by considering how arming feminists and other advocates with an increased understanding of the interrelatedness between pregnancy, coercion, and intimate partner abuse can help to broaden domestic violence laws and policies, and reconceptualize pregnancy prevention as violence prevention.

Internet Freedom Software Tools Developed by the United States Do Not Facilitate Cybercrime

July 1, 2015 Comments off

Internet Freedom Software Tools Developed by the United States Do Not Facilitate Cybercrime
Source: RAND Corporation

Software tools created by the U.S. State Department to encourage the free flow of information online and on mobile phone networks are not likely to be used by criminals to pursue illegal activities, according to a new RAND Corporation study.

While some technologies supported by the State Department’s efforts have the potential to be used for illicit purposes, there are numerous alternative technologies that are better suited for criminal activity, according to the report.

COPS Office Releases Intervention Guide to Eliminate Drug Markets

June 25, 2015 Comments off

COPS Office Releases Intervention Guide to Eliminate Drug Markets
Source: U.S. Department of Justice, Office of Community-Oriented Policing Services

The U.S. Department of Justice Office of Community Oriented Policing Services (COPS Office) and the National Network for Safe Communities today released Drug Market Intervention: An Implementation Guide to help eliminate overt drug markets. The guide provides practical information intended to assist key community stakeholders prepare and successfully execute drug market intervention programs to ultimately eliminate overt drug markets. The intervention programs help law enforcement, community, and social services partners reduce the use of intrusive policing practices and transform neighborhoods through partnerships, police-community reconciliation, dealer notifications, staging call-ins, maintaining closure of drug markets, and delivering services to dealers.

Psychosocial Maturity and Desistance From Crime in a Sample of Serious Juvenile Offenders

June 23, 2015 Comments off

Psychosocial Maturity and Desistance From Crime in a Sample of Serious Juvenile Offenders (PDF)
Source: Office of Juvenile Justice and Delinquency Prevention

Highlights

The Pathways to Desistance study followed more than 1,300 serious juvenile offenders for 7 years after their conviction. In this bulletin, the authors present key findings on the link between psychosocial maturity and desistance from crime in the males in the Pathways sample as they transition from midadolescence to early adulthood (ages 14–25):

• Recent research indicates that youth experience protracted maturation, into their midtwenties, of brain systems responsible for self-regulation. This has stimulated interest in measuring young offenders’ psychosocial maturity into early adulthood.
• Youth whose antisocial behavior persisted into early adulthood were found to have lower levels of psychosocial maturity in adolescence and deficits in their development of maturity (i.e., arrested development) compared with other antisocial youth.
• The vast majority of juvenile offenders, even those who commit serious crimes, grow out of antisocial activity as they transition to adulthood. Most juvenile offending is, in fact, limited to adolescence.
• This study suggests that the process of maturing out of crime is linked to the process of maturing more generally, including the development of impulse control and future orientation.

U.S. Financial Services Credit Ratings Are Resilient To Cyber Security–For Now

June 17, 2015 Comments off

U.S. Financial Services Credit Ratings Are Resilient To Cyber Security–For Now
Source: Standard & Poor’s

It seems not a week goes by without a high-profile cyber-attack against a major U.S. corporation or government agency. A sampling of past corporate targets includes giant retailers (Home Depot, Target, Sony), banks (JPMorgan Chase, Citibank), and health insurers (Anthem, Premera Blue Cross). Clearly, no entity is safe from a cyber-attack. But what are the credit implications of this onslaught of data breaches? Although the many successful cyber-attacks have not yet resulted in any changes in Standard & Poor’s Ratings Services’ ratings on financial services companies, we view cyber-security as an emerging risk that we believe has the potential to pose a higher credit risk to financial services firms in the future, although we cannot predict the timing. It’s not difficult to envision scenarios in which criminal or state-sponsored cyber-attacks (for credit implications, we don’t differentiate the sources of intrusion) would result in significant economic effects, business interruption, theft, or reputational risk. One key point is that cyber-attacks may not be discovered immediately: It can take weeks or months before an intrusion is discovered.

Cyber-attacks appear random but could be highly correlated thanks to contagion caused by global interconnectivity. Data interconnectivity exists among banks, merchants, data owners (health care providers, telecom companies, etc.), and other sources (vendors, distributors, suppliers). So, hackers have many paths to breaching company data and disrupting business operations. Published reports note that data breaches have been going on long enough for cyber-criminals to have collected substantial data on a large number of individuals.

Overview

  • So far, we have not downgraded any companies because of the damage resulting from a cyber-attack.
  • Although company disclosures about cyber-risks remain limited, we’re starting to explore the issue in the context of management governance and enterprise risk management.
  • Although still too small to draw robust statistical conclusions, our analysis provides insights into how and when cyber-attacks can affect creditworthiness.
  • Our credit opinion takes into account a balanced view including other risk factors concerning the effects of a cyber-attack.

2015 Security Breach Legislation

June 16, 2015 Comments off

2015 Security Breach Legislation
Source: National Conference of State Legislatures

At least 32 states in 2015 introduced or are considering security breach notification bills or resolutions. Many of the bills would amend existing security breach laws to:

  • Require entities to report breaches to attorneys general or another central state agency
  • Expand the definition of “personal information” (e.g., to include medical, insurance or biometric data) in cases of a security breach
  • Require businesses or government entities to implement security plans or various security measures
  • Require educational institutions to notify parents or government entities if a breach occurs.

Only three states–Alabama, New Mexico and South Dakota–do not currently have a law requiring consumer notification of security breaches involving personal information.

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