Quackery Research Articles

Cost-based quality measures in subgroup discovery

We consider data where examples are not only labeled in the classical sense (positive or negative), but also have costs associated with them. In this sense, each example has two target attributes, and we aim to find clearly defined subsets of the data where the values of these two targets have an unusual distribution. In other words, we are focusing on a Subgroup Discovery task with a somewhat unusual target concept, and investigate quality measures that take into account both the binary and the cost target. In defining such quality measures, we aim to produce an interpretable valuation of a subgroup, such that data analysts can directly appreciate the findings, and relate these to monetary gains or losses. Our work is particularly relevant in the domain of health care fraud detection. In this domain, the binary target identifies the patients of a specific medical practitioner under investigation, and the cost target specifies the money spent on each patient. When looking for differences in claim behavior, we need to take into account both the `positive' examples (patients of the practitioner) and `negative' examples (other patients), as well as information about costs of all patients. A typical subgroup will list a number of treatments, and the target practitioner's patients behavioral difference in both treatment prevalence and associated costs. An additional angle is the Local Subgroup Discovery task, where subgroups are judged according to the difference with a local reference group instead of the entire dataset. We show how the cost-based analysis of data specifically fits this local focus.

Caring for a patient with unexpected pheochromocytoma complicated by medical fraud.

We report a case of a patient who used multiple aliases as part of a medical fraud scheme. As a consequence, the surgical team was unaware of a left-sided adrenal mass that had been documented for this patient under another name. In the operating room, severe hypertension from the undiagnosed pheochromocytoma led to a ventricular fibrillation cardiac arrest. This case demonstrates the importance of physician awareness of medical identity fraud and its potential consequences.

Corporate Governance - Emerging Economies Fraud and Fraud Prevention

Just as it is impossible to know when a swimming fish will drink water, so it is impossible to find out when a corporate steward is stealing money From Kautilya'sArthashastra (300 B.C) Cadbury (1992) defines corporate governance as the whole system of controls both financial and otherwise by which a company is directed and controlled. In simple words it is all about promoting corporate fairness, transparency and accountability. The opening of the economy has brought growth opportunities with improved competitiveness this has also given rise to cut throat competition in all sectors, which has tempted managers to adopt practices which at times dilute the ethical norms. This competition has put the onus on managers to show improvement in performances quarter by quarter persuading them to tamper with some of the best practices in the rat race for market share growth rate, visibility in securities market. The structure to ensure corporate governance includes the board of directors, top management, shareholders, creditors and all other stakeholders. Frauds in corporate governance According to KPMG fraud survey, organizations are reporting more experiences of fraud than prior years and are taking actions to deal with it. Seventy five percent of companies surveyed reports that they experienced increasing instances of fraud. While employee fraud is the most prevalent type of fraud experienced by organizations, financial reporting fraud and medical insurance fraud are the most costly. During the recent past the financial frauds are almost doubled. Organizations have taken reactive and preventive measures in controlling the corporate frauds like internal audit, internal controls, and notifications by an employee are the three ways of uncovering fraud. The present paper is an exploratory study that focuses on various corporate frauds, genesis of the frauds, people responsible for various frauds and the role of regulatory bodies in overcoming those frauds.

The Reinvigorated Confrontation Clause: A New Basis to Challenge the Admission of Evidence From Nontestifying Forensic Experts in White Collar Prosecutions

Federal and state prosecutors have increasingly resorted to using forensic expert testimony defendants in white collar criminal cases. Forensic accountants testify in cases involving financial fraud, including securities, tax and money laundering violations. In environmental prosecutions, the government engages geologists, chemists, and microscopists to gather and analyze evidence of spills and releases of hazardous pollutants and chemicals. Prosecutors use forensic computer experts to prove a host of computerrelated crimes, such as Internet fraud, unlawful access, and identity theft. They also recover electronic data and testify on spoliation of evidence in obstruction of justice cases. In both white and blue collar cases, however, the prosecution has sought to admit evidence from nontestifying forensic experts through surrogate witnesses, summary witnesses, other experts, and even documents to prevent the defense from cross-examining the experts.Beginning in 2009, the Supreme Court issued a trilogy of opinions examining the reach of the Confrontation Clause of the Sixth Amendment in cases in which the prosecution sought to admit evidence and opinions of nontestifying forensic experts to prove essential elements of the crimes charged. The rulings in two of the cases - Melendez-Diaz v. Massachusetts and Bullcoming v. New Mexico1 - have paved a new path for the defense to challenge the admission of evidence and opinions of nontestifying forensic experts. The third case, Williams v. Illinois,2 resulted in a plurality opinion favoring the prosecution, but has limited precedential impact because a sharply divided Court could agree on the basis for the result. As a result, the ruling in Williams may be limited to bench trials. While the trilogy of cases involved traditional blue collar crimes, white collar practitioners may rely on the holdings of Melendez-Diaz and Bullcoming in cases when the prosecution attempts to admit expert testimony through the back door.This article examines the trilogy of Confrontation Clause cases in detail by discussing similar Confrontation Clause issues that arose in two recent white collar prosecutions and considering how they were addressed at trial. The first case, United States v. W.R. Grace, was a high-profile environmental prosecution charging the company and several Grace executives with violating the knowing endangerment provision of the Clean Air Act and defrauding the United States. The Grace verdict, an across-the-board acquittal of all defendants, occurred less than two months before the Court decided Melendez-Diaz, the first case of the trilogy. The second case, United States v. Ignasiak, was a health care fraud prosecution in which a physician was charged with illegally dispensing controlled substances to patients. The Eleventh Circuit's opinion in Ignasiak, reversing the defendant's convictions, was issued shortly after the Court decided Bullcoming, the second case in the trilogy. Through the framework of these cases, the article provides practical suggestions on how white collar practitioners may rely on the reinvigorated Confrontation Clause to preclude the admission of certain forensic evidence of nontestifying at trial.I. The Supreme Court's Current Formulation of the Confrontation ClauseThe Confrontation Clause of the Sixth Amendment provides that [i]n all criminal prosecutions, the accused shall enjoy the right... to be confronted with the him.3 It guarantees a defendant's right to confront those who bear testimony him.4 This bedrock procedural guarantee applies to federal and state prosecutions.5 While the text of the Confrontation Clause could plausibly be read to apply only to witnesses against the defendant who testify at trial, the Court has rejected that limitation, and held that the Confrontation Clause also applies to certain out-of-court statements offered at trial.6 However, not all hearsay implicates the Sixth Amendment's core concerns. …

Doctoring the Novel: Medicine and Quackery from Shelley to Doyle by Sylvia A. Pamboukian (review)

Doctoring the Novel: Medicine and Quackery from Shelley to Doyle by Sylvia A. Pamboukian (review)

Federal Regulation of Unapproved Chelation Products

Chelation products can be helpful in the treatment of metal poisoning. However, many unapproved products with unproven effectiveness and safety are marketed to consumers, frequently via the internet. This paper describes the primary responsibility of the Health Fraud and Consumer Outreach Branch of the United States Food and Drug Administration to identify and address health fraud products. Efforts to prevent direct and indirect hazards to the population's health through regulatory actions are described.

Fighting Health Care Fraud in Bold and Innovative Ways

Health care fraud remains an enormous problem within the United States. In 1993, health care fraud was identified as the number two crime problem in America after violent crime. Though the social and political landscape of this nation has changed much since 1993, health care fraud remains a top priority because of the large financial implications to taxpayers. In 2010, Americans spent $2.6 trillion on health care. The National Health Care Anti-Fraud Association, a nonprofit collaboration of federal and private health care fraud special investigative units, estimates that between 3% and 10% of health care expenditures are lost to fraud, resulting in approximately $78 to $260 billion stolen from taxpayers on an annual basis. Health care fraud consists of several different methods or schemes. In almost every case, health care fraud is focused on the money. In the past, health care fraud was almost solely perpetrated by medical providers. However, recent trends are showing that health care fraud perpetrators are now more likely to have little to no medical experience and tend to have criminal backgrounds or are part of large pharmaceutical organizations that engage in illegal practices. Last year, GlaxoSmithKline (GSK) admitted to off-label marketing of pharmaceuticals and withholding safety data from the Food and Drug Administration. GSK settled the case with the U.S. Government for $3 billion. In May 2013, Ranbaxy USA pleaded guilty to introducing adulterated drugs into U.S. commerce. Other current schemes include billing for services not rendered, substituting inferior products and billing for more expensive ones, performing unnecessary procedures to gain greater reimbursement, engaging in kickbacks, and prescribing narcotics for money rather than medical necessity. Victims of health care fraud may include the patients, health care workers, insurance companies, and, in the case of federally funded medical benefits plans, the taxpayer. The Military Health System (MHS), funded by the Defense Health Program (DHP) appropriation, is not immune to this growing trend. The MHS supports 9.6 million uniformed service members, their spouses and children, retirees and their families worldwide and is the second largest medical benefits program administered by the government. Within MHS, health benefits are offered to beneficiaries through two methods: direct care through the military treatment facilities (MTFs) and purchased care through the TRICARE program. Total annual costs for the MHS are approximately $50 billion. With such a large program comes great risk for fraud, waste, and abuse within the program. Accordingly, MHS leadership has the responsibility to identify and deter fraud to the maximum extent possible to ensure the proper utilization of the government’s resources. Although the national economic climate remains cloudy and medical expenditures continue to grow, the MHS has developed an exceptional tool to battle against fraud and abuse. Specifically, MHS’ TRICARE Management Activity’s (TMA) Program Integrity (PI) Office uses its worldwide authority to combat fraud, waste and abuse within and against the TRICARE program. The office monitors contractor PI activities, coordinates with the Department of Defense (DoD) and external investigative agencies, and initiates administrative remedies as required. In addition, TMI PI

Ethical Issues and Practical Challenges Raised by Internal Investigations in the Life Sciences Industry

OVER THE LAST four years, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint effort between the Department of Health and Human Services (HHS) and the U.S. Department of Justice, has recovered over $13.9 billion in healthcare fraud settlements, many involving pharmaceutical companies charged with the off-label (1) of drugs to healthcare providers. (2) As an effort to change corporate culture, each of these settlements has included a corporate integrity agreement (CIA) with the Office of Inspector General (OIG) for HHS. Yet the deterrent effect of CIA's and deferred prosecution agreements (DPAs) is uncertain, (3) and even OIG has acknowledged that billion dollar settlements are not sufficient to change corporate culture in pharmaceutical companies. (4) Some companies may even view paying these fines as merely the cost of doing business, and several companies (5) that previously settled with the government for significant amounts have come repeated scrutiny for unlawful promotion violations. (6) One reason for the lack of deterrence is that companies may believe they are too big to be excluded (7) by OIG because of the risk it would pose to the welfare of government healthcare beneficiaries. While some alternatives been offered, (8) OIG has responded by indicating its intent to exclude executives in the life sciences industry from federal healthcare programs under a broader range of circumstances, (9) including the responsible corporate officer (RCO) doctrine. (10) In fact, OIG has recently excluded several life science executives (11) and the Department of Justice (DOJ) and the Food and Drug Administration (FDA) collectively expressed their intent to pursue future cases against executives as well as mid-level managers and officers. (12) The mounting number of government inquiries into corporate practices, coupled with the increased focus agencies are placing on charging corporate executives and managers, has caused growing uncertainty for in-house and outside counsel with respect to ethical issues relating to internal investigations, representation of the corporation (including counsel's relationship with the corporation's constituents), conflicts of interest, and the attorney-client privilege. Among these, internal investigations for life science companies present unique challenges. The nature and complexity of interactions life science companies with private and government entities and individuals, and the tremendous frequency with which these interactions occur, create countless opportunities for fraudulent conduct to occur that may implicate the company and its executives. Such interactions may take place in numerous countries, which may implicate the Foreign Corrupt Practices Act (FCPA) or other foreign bribery or kickback laws. Internal investigations may reveal legal obligations and liabilities outside of traditional healthcare fraud concerns, such as shareholder, product liability and consumer protection litigation, and parallel but separate actions by State prosecutors and agencies. This article analyzes the special factors and circumstances FDA and healthcare attorneys must consider when conducting an internal investigation. This article first provides an overview of internal investigations, including Upjohn warnings, in the life sciences industry. This article then provides a detailed overview of the principles the Department of Justice considers when charging corporations and the various factors and circumstances the agency may consider when resolving investigations. This article also offers practical advice for counsel to consider in carrying out internal investigations and concludes with observations and predictions for future trends in the life sciences industry. I. Internal Investigations An internal investigation is an inquiry performed by a company or its agent after the company is made aware of a serious and reasonably plausible allegation of corporate misconduct. …

Namibia healthcare services use fingerprint tech to counter fraud

Healthcare schemes in Namibia are to use biometric technology to address issues of fraud. This comes as researchers have found that the healthcare biometrics market is expected to see considerable growth across the globe due to a rising need to address increasing healthcare fraud, as well as to provide improved patient care and protect patent privacy, according to a report recently released by Transparency Market Research.

The Fevered Novel from Balzac to Bernanos: Frenetic Catholicism in Crisis, Delirium and Revolution

This monograph is an important and compelling account of a novelistic tradition that stretches from Georges Bernanos back to Balzac, by way of Léon Bloy, Joris-Karl Huysmans, and Barbey d'Aurevilly. Depending on a master plot that evokes Maistrean themes of blood, sacrifice, and redemption, working in a feverish female body, this canon combines Romantic freneticism and anti-Enlightenment religion to create a compound that Francesco Manzini calls ‘frenetic Catholicism’. The theme of fever, Manzini tells us, was commented on by Huysmans in writing about Barbey d'Aurevilly. When André Gide read Bernanos's Sous le soleil de Satan, he dismissed it as a rehash of Bloy and Barbey. In this present work Manzini aims to make us aware once more of the gradually intensifying themacity of fever in writings more usually classed in theologo-literary categories. His analysis encompasses (though is not restricted to) Balzac's Ursule Mirouët, Barbey d'Aurevilly's Un prêtre marié, Huysmans's En rade, Bloy's Le Désespéré and La Femme pauvre, and Bernanos's Nouvelle histoire de Mouchette. Thus, as Manzini argues in his conclusion, between the freneticism of the Romantics and that of the surrealists this corpus represents an intermediary wave of freneticism, foregrounding fever, hyperconsciousness, dreamlike episodes, and female automatism. Manzini's knowledge of, and ease amidst, the sources is constantly impressive. Much like Richard Griffiths before him (The Reactionary Revolution: The Catholic Revival in French Literature, 1870–1914 (London: Constable, 1966)), he has read both the bad novels and the good ones. For that we are in his debt. His commentary thrives on the oddities of his subjects. He points quite rightly to the peculiar hubris of writers whose contempt for the secular excesses of scientism leads them down a cul-de-sac of primitive medical quackery. Likewise, he underlines how Zola's attempt to unwrite Barbey — exorcising the former's anti-Romantic animus, as much as scratching his anticlerical itch — leads him to recapitulate Barbey's religious authoritarianism in the secular vernacular of patriarchy. Les espèces qui se rapprochent se mangent, to paraphrase Bernanos (Les Grands Cimetières sous la lune). In spite of all Manzini's tightly organized analysis, however, this reader wonders whether the fevered novel ‘best allowed contemporaries — and now […] literary critics and historians — to imagine the issues at stake in the amorphous scientistic, religious, and political debates’ of the period (p. 17). Below the ideological clashes of nineteenth-century science and religion, the two contending dynamics of anthropocentrism and theocentrism are attested and, it can be argued, even more perfectly dramatized in other Catholic literature (Charles Péguy's poetry, for example). In these terms, what distinguishes the Catholic frenetics from their Romantic or surrealist counterparts is that their fevered subject represents an attempt to build a road out of what Canadian philosopher Charles Taylor calls ‘buffered’ individuality, and back towards the theocentric porous subject who is open to divine influence. By way of minor corrections, nuns do not take holy orders (p. 94) but make religious profession by taking vows. Also, the last Eucharistic host is not extreme unction (p. 119) but viaticum.

CUSTOMER SEGMENTATION IN PRIVATE BANKING SECTOR USING MACHINE LEARNING TECHNIQUES

Machine learning techniques have proven good performance in classification matters of all kinds: medical diagnosis, character recognition, credit default and fraud prediction, and also foreign exchange market prognosis. Customer segmentation in private banking sector is an important step for profitable business development, enabling financial institutions to address their products and services to homogeneous classes of customers. This paper approaches two of the most popular machine learning techniques, Neural Networks and Support Vector Machines, and describes how each of these perform in a segmentation process.

Samuel Holden Parsons Lee (1772–1863): American physician, entrepreneur and selfless fighter of the 1798 Yellow Fever epidemic of New London, Connecticut

Samuel Holden Parsons Lee practised medicine at a time when the germ theory of disease had not yet been proposed and antibiotics remained undiscovered. In 1798 he served selflessly as the only physician in town who was willing to battle the Yellow Fever outbreak of New London, Connecticut. Because he practised at the dawn of the age of patent medicine, unfortunately his name also came to be associated with medical quackery. We argue that his contributions have been grossly underestimated. He compounded and vended medications - including bilious pills and bitters - that were gold standards of the day. Moreover, one preparation for treatment of kidney stones led to his sub-specialization in this field and was met with such success that its sale continued for nearly 100 years after his death. While a talented medical man, Lee also had a knack for business, finding success in trading, whaling and real estate.

A Security based Framework for Interoperability of Healthcare Systems

The healthcare domain requires the seamless, secured and meaningful exchange of health related information for effective and efficient patient care. These information are highly sensitive and they are meant to be highly confidential. However, health related information are usually distributed across several heterogeneous and autonomous healthcare systems which makes the interoperability process prone to abuse, medical fraud, inappropriate disclosure of patients’ information for secondary purposes by unauthorized persons and misuse. The effects of inadequate security and privacy in healthcare include monetary penalties, loss of revenue, damage to the healthcare system reputation, risk of receiving less information for optimum care, decreased quality of patients’ care as well as threat to patients’ lives. Consequently, effective information protection within the healthcare domain is highly significant. Hence, this paper examines the security and privacy policies that safeguard sensitive and confidential information in healthcare systems during the exchange and use of vital health information. The paper also proposes a security based framework that seeks to mitigate security risks in healthcare, and thus protect the integrity, confidentiality, and access to health related information.

Kickbacks, Self-Referrals, and False Claims: The Hazy Boundaries of Health-care Fraud

The fraud and abuse laws that govern conduct related to the federal health-care programs, such as Medicare and Medicaid, impose broad and complex limitations on billing practices and financial relationships among providers. Given the potential consequences of engaging in fraudulent behavior, it is crucial that physicians appreciate the types of activities that may run afoul of these laws. This article summarizes the major aspects of the fraud laws that are most likely to have a daily impact on physician practice: the Civil False Claims Act, the Medicare and Medicaid Anti-Kickback Statute, and the so-called Stark Law prohibition on physician self-referrals.

Expanding Physician Education in Health Care Fraud and Program Integrity

Program integrity (PI) spans the entire spectrum of improper payments from fraud to abuse, errors, and waste in the health care system. Few physicians will perpetrate fraud or abuse during their careers, but nearly all will contribute to the remaining spectrum of improper payments, making preventive education in this area vital. Despite the enormous impact that PI issues have on government-sponsored and private insurance programs, physicians receive little formal education in this area. Physicians' lack of awareness of PI issues not only makes them more likely to submit inappropriate claims, generate orders that other providers and suppliers will use to submit inappropriate claims, and document improperly in the medical record but also more likely to become victims of fraud schemes themselves.In this article, the authors provide an overview of the current state of PI issues in general, and fraud in particular, as well as a description of the state of formal education for practicing physicians, residents, and fellows. Building on the lessons from pilot programs conducted by the Centers for Medicare and Medicaid Services and partner organizations, the authors then propose a model PI education curriculum to be implemented nationwide for physicians at all levels. They recommend that various stakeholder organizations take part in the development and implementation process to ensure that all perspectives are included. Educating physicians is an essential step in establishing a broader culture of compliance and improved integrity in the health care system, extending beyond Medicare and Medicaid.

Quack medicine: a history of combating health fraud in twentieth-century America

Quack medicine: a history of combating health fraud in twentieth-century America

How big pharma and regulators fail clinicians

Generalists daily make poor evidence-based decisions because regulatory and ethics committees fail them and drug companies habitually misrepresent products. The pervasiveness of this perversion – at least overseas – is best illustrated by the equivalent of R131.4 billion in healthcare fraud settlements made by pharmaceutical corporates in the USA over the last 10 years, with the most recent individual company fines breaking all records.

Implementation of Data Mining in Medical Fraud Detection

With the enormous amount of data stored in files, databases, and other repositories, it is increasingly important, to develop powerful means to analyze and extract interesting knowledge from data. Fraudulent healthcare claims increase the burden on the society. The healthcare fraud detection requires compilation of potentially huge data, involving complex computation and sorting operations. Once such frauds have been detected and classified, data cleaning is applied to it which helps to remove the noise and inconsistencies in the data thereby enhancing its quality. This technique can be used to detect the sale of potentially dangerous medicine by pharmacists thereby preventing such medical fraud.

PHS75 - Health care fraud 2006 to 2011

PHS75 - Health care fraud 2006 to 2011

'Just a quack who can cure cancer': John Braund, and regulating cancer treatment in New South Wales, Australia.

In 1948 the New South Wales government instituted an inquiry into the claims of John Braund – a 78-year-old self-described ‘quack’ – that his secret treatment had cured 317 cancer sufferers. The ‘Braund controversy’, as it became known, was one of Australia’s most prominent cases of medical fraud. This paper examines that controversy and its effects on cancer philanthropy, medical research, and especially on legislation regulating treatment providers up to the present. With the Braund controversy in mind, the New South Wales (NSW) parliament struggled to develop legislation that would protect patients and punish quacks but also allow for serendipitous, unorthodox discoveries. Recent decades saw new elements added to this calculus – allowing a wide-ranging health marketplace, and allowing patients to choose their therapies. This paper argues that the particular body of law legislatures used in regulating cancer treatment and how regulations were framed reflected the changing context of healthcare and illustrates the calculus legislatures have undertaken in regulating the health marketplace, variously factoring in public safety, serendipitous discovery, the authority of orthodox medicine, patient choice, and economic opportunity.