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Child Abuse 2E: Quick Reference for Healthcare, Social Service, and Law Enforcement Professionals

Child Abuse 2E: Quick Reference for Healthcare, Social Service, and Law Enforcement Professionals

Child Abuse Quick Reference, Second Edition is completely updated, new chapters and images make this required reading for anyone who is involved in identifying, interpreting, and reporting child abuse cases. Medical professionals, social workers, attorneys, law enforcement personnel, and others will find that this quick reference is unquestionably the best field reference available on child maltreatment and abuse. This widely popular, convenient, and comprehensive field guide contains the latest research and information on the subject of child maltreatment. Approaching the wide range of issues from a multidisciplinary perspective, this pocket-sized reference is perfect for professionals who face cases of abuse beyond their office walls. With the guidance of the step-by-step procedures included in this publication, frontline professionals can quickly access the information they need to properly identify, interpret, document, and report children who are at-risk or have suffered abuse. Explicit instructions are provided for performing thorough examinations, assessing lab and radiological studies, conducting effective interviews, and writing competent reports that will survive courtroom scrutiny. Every topic is designed to equip professionals with the tools needed to effectively handle the complexities of today s child abuse cases.

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Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview

Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview

A number of federal statutes aim to combat fraud and abuse in federally funded health care programs such as Medicare and Medicaid. Using these statutes, the federal government has been able to recover billions of dollars lost due to fraudulent activities. In March 2010, Congress enacted comprehensive health care reform legislation. One focus of this legislation, the Patient Protection and Affordable Care Act (PPACA) as amended, is improved health care fraud and abuse enforcement. PPACA, among other things, creates new health care fraud enforcement tools and expands upon the types of prohibited conduct. This report provides an overview of some of the more commonly used statutes used to fight health care fraud and abuse and discusses some of the changes made to these statutes by PPACA.

Title XI of the Social Security Act contains Medicare and Medicaid program-related anti-fraud provisions, which impose civil penalties, criminal penalties, as well as exclusions from federal health care programs on persons who engage in certain types of misconduct. PPACA amends these administrative sanctions and authorizes the imposition of several new civil monetary penalties and exclusions.

Under the federal anti-kickback statute, it is a felony for a person to knowingly and willfully offer, pay, solicit, or receive anything of value (i.e., “remuneration”) in return for a referral or to induce generation of business reimbursable under a federal health care program.The statute prohibits both the offer or payment of remuneration for patient referrals, as well as the offer or payment of anything of value in return for purchasing, leasing, ordering, or arranging for, or recommending the purchase, lease, or ordering of any item or service that is reimbursable by a federal health care program. PPACA revises the evidentiary standard under the anti-kickback statute and eliminates the requirement of actual knowledge of, or specific intent to commit a violation of the statute. This amendment may make it easier for the government to prove its case.

The Stark law and its implementing regulations prohibit physician self-referrals for certain health services that may be paid for by Medicare or Medicaid. Under the Stark law, if (1) a physician (or an immediate family member of a physician) has a “financial relationship” with an entity, the physician may not make a referral to the entity for the furnishing of these health services for which payment may be made under Medicare or Medicaid, and (2) the entity may not bill the federal health care program or any individual or entity for services furnished pursuant to a prohibited referral. PPACA limits certain exceptions to the Stark law.

The federal False Claims Act (FCA) imposes civil liability on persons who knowingly submit a false or fraudulent claim or engage in various types of misconduct involving federal government money or property. Health care program false claims often arise in billing, including billing for services not rendered, billing for unnecessary medical services, double billing for the same service or equipment, or billing for services at a higher rate than provided (“upcoding”). Civil actions may be brought in federal district court under the FCA by the Attorney General or by a person known as a relator (i.e., a “whistleblower”), for the person and for the U.S. Government, in what is termed a qui tam action. PPACA appears to make it easier for certain relators to bring qui tam actions, thus potentially allowing some FCA actions to proceed that would have been dismissed under prior law.

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ObamaCare Is Winning the Fight on Fraud and Abuse
Thanks to provisions in the Affordable Care Act (ACA/ObamaCare) and to an unprecedented effort by the Obama Administration, more progress has been made in the past three years to combat health care fraud and abuse than ever before. …
Read more on Boston.com

Health care cloudy in New Year
Gross said Monro is looking at higher costs if the Patient Protection and Affordable Care Act passed by Congress in 2010 is fully implemented. But much of 2012 may pass before employers know if that's what will happen. The centerpieces of the law are a …
Read more on Rochester Democrat and Chronicle

Preventive care: It's free, or not
Associated Press Associated Press medical writer » Call your insurance plan — the 800-number on the back of your insurance card — to find out whether the plan must comply with the Affordable Care Act. If your plan is "grandfathered," it's exempt from …
Read more on Appleton Post Crescent

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Drug companies are working to develop a pure, more powerful version of a highly abused medicine, which has addiction experts worried that it could spur a new wave of abuse.

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U.S. authorities arrested 22 people in Florida on Friday, including pharmacists and doctors, in a crackdown against prescription drug abuse that officials say is the nation’s fastest growing drug problem.

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Prescription drug abuse by elderly and disabled beneficiaries of Medicare cost the U.S. program nearly $ 150 million in 2008, highlighting an area where the government can seek to save health costs.




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Prescription drug abuse by elderly and disabled beneficiaries of Medicare cost the U.S. program nearly $ 150 million in 2008, highlighting an area where the government can seek to save health costs.




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A pharmacist counts pills in a pharmacy in this January 31, 2008 file photo. REUTERS/Mark Blinch/FilesAccess to rogue online pharmacies may be driving a rapid increase in the abuse in the United States of prescription drugs like powerful painkillers Percocet and Oxycontin, a new study shows.


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Lisa Roberts, a public health nurse at the Portsmouth City Health Department, stands in front of a storefront display in Portsmouth, Ohio. Nearly one in 10 babies were born addicted to drugs last year in southern Ohio's Scioto County. Admissions for prescription painkiller overdoses were five times the national average.Nearly one in 10 babies were born addicted to drugs last year in southern Ohio’s Scioto County. Admissions for prescription painkiller overdoses were five times the national average.



msnbc.com: Health care

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Drugmaker Alkermes Inc. says it has received U.S. approval to market its addiction medication for use in patients addicted to narcotics like heroin and morphine.

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