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https://www.readbyqxmd.com/read/28210864/pharmacy-benefit-management-companies-do-they-create-value-in-the-us-healthcare-system
#1
Alan Lyles
Pharmacy benefit management companies (PBMs) perform functions in the US market-based healthcare system that may be performed by public agencies or quasi-public institutions in other nations. By aggregating lives covered under their many individual contracts with payers, PBMs have formidable negotiating power. They influence pharmaceutical insurance coverage, design the terms of coverage in a plan's drug benefit, and create competition among providers for inclusion in a plan's network. PBMs have, through intermediation, the potential to secure lower drug prices and to improve rational prescribing...
February 16, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28202567/stopping-the-slide-to-research-fraud
#2
Miriam Shuchman
No abstract text is available yet for this article.
February 13, 2017: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/28178913/training-us-health-care-professionals-on-human-trafficking-where-do-we-go-from-here
#3
Clydette Powell, Kirsten Dickins, Hanni Stoklosa
: Some 21 million adults and children are labor-trafficked or sex-trafficked through force, fraud, or coercion. In recognition of the interface between trafficking victims and the healthcare setting, over the last 10 years there has been a notable increase in training of health care professionals (HCPs) on human trafficking (HT) and its health implications. Many organizations have developed curricula and offered training in various clinical settings. However, methods and content of this education on trafficking vary widely, and there is little evaluation of the impact of the training...
2017: Medical Education Online
https://www.readbyqxmd.com/read/28166773/reducing-medical-claims-cost-to-ghana-s-national-health-insurance-scheme-a-cross-sectional-comparative-assessment-of-the-paper-and-electronic-based-claims-reviews
#4
Eric Nsiah-Boateng, Francis Asenso-Boadi, Lydia Dsane-Selby, Francis-Xavier Andoh-Adjei, Nathaniel Otoo, Patricia Akweongo, Moses Aikins
BACKGROUND: A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana. METHODS: The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed...
February 6, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28157116/detection-of-concealed-cars-in-complex-cargo-x-ray-imagery-using-deep-learning
#5
Nicolas Jaccard, Thomas W Rogers, Edward J Morton, Lewis D Griffin
BACKGROUND: Non-intrusive inspection systems based on X-ray radiography techniques are routinely used at transport hubs to ensure the conformity of cargo content with the supplied shipping manifest. As trade volumes increase and regulations become more stringent, manual inspection by trained operators is less and less viable due to low throughput. Machine vision techniques can assist operators in their task by automating parts of the inspection workflow. Since cars are routinely involved in trafficking, export fraud, and tax evasion schemes, they represent an attractive target for automated detection and flagging for subsequent inspection by operators...
January 31, 2017: Journal of X-ray Science and Technology
https://www.readbyqxmd.com/read/28134037/destiny-rides-again-the-reappearance-of-silicone-gel-filled-breast-implant-toxicity
#6
A E Brawer
Background Twenty-five years ago attorneys representing ailing women in class action litigation against silicone breast implant manufacturers made the procedural error of defining silicone-induced toxicity in the courtroom before it was properly studied in the exam room. This aberrant methodology perverted the proper research process, rendered verification of any real disease elusive, and cemented the groundwork for a repeat public health crisis potentially affecting two million women in the USA who possess new silicone gel devices inserted over the past 10 years...
January 1, 2017: Lupus
https://www.readbyqxmd.com/read/28102981/health-care-programs-fraud-and-abuse-revisions-to-the-office-of-inspector-general-s-exclusion-authorities-final-rule
#7
(no author information available yet)
This final rule amends the regulations relating to exclusion authorities under the authority of the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS or the Department). The final rule incorporates statutory changes, early reinstatement provisions, and policy changes, and clarifies existing regulatory provisions.
January 12, 2017: Federal Register
https://www.readbyqxmd.com/read/28095345/forensic-assignment-to-geographic-origin-a-useful-tool-in-seafood-fraud-control
#8
J L Horreo, G Machado-Schiaffino, E García-Vázquez
Seafood fraud is an economically motivated and widely spread problem encompassing drastic consequences in both public health and species conservation. In Northern Spain, only the first Atlantic salmon (Salmo salar) catch of the angling season (named Campanu) can be sold. In the year 2011, an angler denounced it on regional Court claiming that the Campanu (which was sold in 6000€) was fraudulent because it had been caught from another river than the fisherman ("the seller") stated. Here, we report the first judicial case of application of geographical genetic assignment in a fish species in Spain...
January 10, 2017: Forensic Science International
https://www.readbyqxmd.com/read/28094000/molecular-tracing-of-the-origin-of-six-different-plant-species-in-bee-honey-using-real-time-pcr
#9
Yajun Wu, Yange Yang, Mingchang Liu, Bin Wang, Meige Li, Ying Chen
The quality of honey is significantly influencedby floral origin. Mislabeling floral species occursfrequently in beehoney products. To protectconsumers from economic fraud and maintain afair market environment, methods to identify floralspecies in honey are necessary. In our study, realtimePCRs were established, targeting six honeytypes mainly produced in China (canola, Chinesemilkvetch, Chinese chaste tree, locust tree, litchi,and longan). Sensitivity testing on DNA from planttissues exhibited LODs of about 0...
January 16, 2017: Journal of AOAC International
https://www.readbyqxmd.com/read/28088897/multiplex-pcr-as-a-rapid-and-sensitive-method-for-identification-of-meat-species-in-halal-meat-products
#10
Mahsa Alikord, Javad Keramat, Mahdi Kadivar, Hassan Momtaz, Mohammad Naghi Eshtiaghi, Aziz Homayouni Rad
BACKGROUND: Species identification and authentication in meat products are important subjects for ensuring the health of consumers. The multiplex-PCR amplification and species-specific primer set were used for identification of horse, donkey, pig and other ruminants in raw and processed meat products. METHODS: Oligonucleotid primers were designed for amplification of species-specific mitochondrial DNA sequences of each species and samples were prepared from binary meat mixtures...
January 13, 2017: Recent Patents on Food, Nutrition & Agriculture
https://www.readbyqxmd.com/read/28088859/determination-of-the-geographical-origin-of-all-commercial-hake-species-by-stable-isotope-ratio-sir-analysis
#11
Mónica Carrera, José M Gallardo
The determination of the geographical origin of food products is relevant to comply with the legal regulations of traceability, to avoid food fraud, and to guarantee food quality and safety to the consumers. For these reasons, stable isotope ratio (SIR) analysis using an isotope ratio mass spectrometry (IRMS) instrument is one of the most useful techniques for evaluating food traceability and authenticity. The present study was aimed to determine, for the first time, the geographical origin for all commercial fish species belonging to the Merlucciidae family using SIR analysis of carbon (δ(13)C) and nitrogen (δ(15)N)...
January 30, 2017: Journal of Agricultural and Food Chemistry
https://www.readbyqxmd.com/read/28079490/paris-vs-prague-a-suspicion-of-fraud-ernst-mach-argues-over-photographs-and-epistemological-prerequisites
#12
Christoph Hoffmann
Argument In spring 1888, an anonymous critic raised severe doubts about Ernst Mach's and Peter Salcher's studies, published one year before, on the processes in the air caused by very rapid projectiles. Paraphrasing the experiments for the French popular science magazine La Nature, the critic insinuated that the photographs upon which Mach and Salcher's argument were ostensibly based must have been of such low quality that they did not allow any well-founded conclusion. The critic did not deny the phenomena Mach and Salcher had presented in their article; he denied that the photographs taken in the course of the experiments could permit any observation of the phenomena...
December 2016: Science in Context
https://www.readbyqxmd.com/read/28075039/using-dna-barcoding-to-track-seafood-mislabeling-in-los-angeles-restaurants
#13
Demian A Willette, Sara E Simmonds, Samantha H Cheng, Sofia Esteves, Tonya L Kane, Hayley Nuetzel, Nicholas Pilaud, Rita Rachmawati, Paul H Barber
Seafood mislabeling is common in both domestic and international markets. Previous studies on seafood fraud often report high rates of mislabeling (e.g. >70%), but these studies have been limited to a single sampling year, making it difficult to assess the impact of stricter governmental truth-in-labeling regulations. This study uses DNA barcoding to assess seafood mislabeling in Los Angeles over a four-year period. Sushi restaurants had a consistently high percentage of mislabeling (47%) from 2012 to 2015, yet mislabeling was not homogenous across species...
January 11, 2017: Conservation Biology: the Journal of the Society for Conservation Biology
https://www.readbyqxmd.com/read/28059749/evading-cancer-drugs-by-identity-fraud
#14
EDITORIAL
Paula A Kiberstis
No abstract text is available yet for this article.
January 6, 2017: Science
https://www.readbyqxmd.com/read/27995445/promoting-virtue-or-punishing-fraud-mapping-contrasts-in-the-language-of-scientific-integrity
#15
S P J M Horbach, W Halffman
Even though integrity is widely considered to be an essential aspect of research, there is an ongoing debate on what actually constitutes research integrity. The understanding of integrity ranges from the minimal, only considering falsification, fabrication and plagiarism, to the maximum, blending into science ethics. Underneath these obvious contrasts, there are more subtle differences that are not as immediately evident. The debate about integrity is usually presented as a single, universal discussion, with shared concerns for researchers, policymakers and 'the public'...
December 19, 2016: Science and Engineering Ethics
https://www.readbyqxmd.com/read/27992158/medicare-and-state-health-care-programs-fraud-and-abuse-revisions-to-the-safe-harbors-under-the-anti-kickback-statute-and-civil-monetary-penalty-rules-regarding-beneficiary-inducements-final-rule
#16
(no author information available yet)
In this final rule, OIG amends the safe harbors to the anti-kickback statute by adding new safe harbors that protect certain payment practices and business arrangements from sanctions under the anti-kickback statute. The OIG also amends the civil monetary penalty (CMP) rules by codifying revisions to the definition of "remuneration," added by the Balanced Budget Act (BBA) of 1997 and the Patient Protection and Affordable Care Act, Public Law 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010 (ACA)...
7, 2016: Federal Register
https://www.readbyqxmd.com/read/27992157/medicare-and-state-health-care-programs-fraud-and-abuse-revisions-to-the-office-of-inspector-general-s-civil-monetary-penalty-rules-final-rule
#17
(no author information available yet)
This final rule amends the civil monetary penalty (CMP or penalty) rules of the Office of Inspector General to incorporate new CMP authorities, clarify existing authorities, and reorganize regulations on civil money penalties, assessments, and exclusions to improve readability and clarity.
7, 2016: Federal Register
https://www.readbyqxmd.com/read/27965065/recurrent-themes-in-the-history-of-the-home-use-of-electrical-stimulation-transcranial-direct-current-stimulation-tdcs-and-the-medical-battery-1870-1920
#18
REVIEW
Anna Wexler
BACKGROUND: In recent years, neuroscientists and ethicists have warned of the dangers of the unsupervised home use of transcranial direct current stimulation (tDCS), in which individuals stimulate their own brains with low levels of electricity for self-improvement purposes. Although the home use of tDCS is often referred to as a novel phenomenon, in reality the late nineteenth and early twentieth century saw a proliferation of electrical stimulation devices for home use. In particular, the use of an object known as the medical battery bears a number of striking similarities to the modern-day use of tDCS...
November 29, 2016: Brain Stimulation
https://www.readbyqxmd.com/read/27931442/policy-on-third-party-payor-audits-abuse-and-fraud
#19
(no author information available yet)
No abstract text is available yet for this article.
October 2016: Pediatric Dentistry
https://www.readbyqxmd.com/read/27893382/a-new-framework-for-quality-assessment-of-high-resolution-fingerprint-images
#20
Raoni Teixeira, Neucimar Leite
The quality assessment of sets of features extracted from patterns of epidermal ridges on our fingers is a biometric challenge problem with implications on questions concerning security, privacy and identity fraud. In this work, we introduced a new methodology to analyze the quality of high-resolution fingerprint images containing sets of fingerprint pores. Our approach takes into account the spatial interrelationship between the considered features and some basic transformations involving point process and anisotropic analysis...
November 22, 2016: IEEE Transactions on Pattern Analysis and Machine Intelligence
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