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The Anti-Kickback Statute was passed by Congress in the 1970s to reduce the overuse of government-reimbursed medical services. It attempts to eliminate fraud, abuse, and waste of medical services by outlawing the incentive of personal gain when referring patients for government-funded services. Although safe harbors were written into the law to maintain transactions beneficial to society, they require strict adherence. Anti-Kickback Statute violations are subject to the whistleblower provision of the False Claims Act, and violations can yield significant civil and criminal penalties., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Medical insurance fraud (MIF) poses a substantial global financial challenge, necessitating effective regulatory strategies, especially in China, where such measures are in a critical developmental phase. This study investigates the effectiveness of various regulatory components in deterring MIF among enrollees and explores preference heterogeneity among individuals with different characteristics, utilizing a discrete choice experiment survey. Grounded in deterrence theory, our conceptual framework incorporates five attributes: intensity of economic penalties, restrictions on medical insurance benefits, deterioration of social reputation, and certainty and celerity of penalties. Employing a D-efficiency design, 24 choice sets were generated and blocked into three versions. A multistage stratified sampling method was adopted to collect data from the basic medical insurance enrollees in Shanghai. The survey was conducted from September to October 2022. The sample representativeness was further improved via the entropy balancing approach. Data from the final sample of 1034 respondents were analyzed using mixed logit models (MIXLs), incorporating interactions with individual characteristics to assess preference heterogeneity. Results reveal that escalating economic penalties, suspending insurance benefits, listing individuals as unfaithful parties, ensuring penalty certainty, and expediting enforcement significantly enhance the deterrent effect. We observed preference heterogeneity across different demographics, including age, gender, education, health status, and employment status. The study underscores the pivotal role of economic penalties in deterring MIF, while also acknowledging the significance of non-economic measures such as enforcement efficiency and social sanctions. These findings offer valuable insights for policymakers to tailor and strengthen regulatory schemes against MIF, contributing to the advancement of more effective and precise healthcare policies., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

After raising more than $700 million, Elizabeth Holmes, the founder and chief executive officer of a healthcare startup once valued at $10 billion, was found guilty on four charges of defrauding investors. Founded in 2003, Theranos Inc. was a privately held corporation that aimed to disrupt the diagnostics industry with rapid, direct-to-consumer laboratory testing using only "a drop of blood" and the company's patented Nanotainer technology. By exploiting gaps in regulatory policy, Theranos brought its panel of laboratory tests to patients without pre-market review or validation from peer-reviewed scientific research. Investigations into Theranos' dubious operations and inaccurate test results exposed the failed venture which had squandered millions of dollars. Theranos affected the lives and health of patients further disrupting an already tenuous relationship between healthcare and the public - the importance of which cannot be understated in the setting of the COVID-19 pandemic. As medical systems address a national public health crisis and pervasive structural inequities, we must align stakeholder incentives between industry and academic biomedical innovation to rebuild trust with our patients., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Since COVID-19 emerged, a plethora of misinformation has undermined the public's ability to identify reliable sources of accurate information. To identify the range of methods governments used to address COVID-19 misinformation, we conducted a content analysis of international media and evaluated government actions in light of international law, which protects freedom of expression and calls on governments to guarantee this fundamental right even during a pandemic or other emergency. We identified five categories of government activities: (1) disseminating and increasing access to accurate information; (2) restricting access to accurate information; (3) disseminating disinformation, false information, and misinformation; (4) addressing commercial fraud; and (5) criminalizing expression. The goal of addressing COVID-19 misinformation is best served by protecting expression, disseminating factual information, ensuring strong protections for whistleblowers, and supporting an independent media environment. Conversely, governments undermine public health when they create a state of uncertainty and violate human rights.

Objectives: The goal of this study was to investigate the perception of financial exploitation and its causes and consequences by older adults who have firsthand experience of being exploited., Method: Thirty-one cognitively healthy older adult participants aged 50 or older were drawn from the Finance, Cognition, and Health in Elders Study. In-depth, one-on-one interviews were conducted. Interview transcripts were analyzed using an iterative, data-driven, thematic coding scheme and emergent themes were summarized., Results: Categories of financial exploitation included (a) investment fraud, (b) wage theft/money owed, (c) consumer fraud, (d) imposter schemes, and (e) manipulation by a trusted person. Themes emerged around perceived causes: (a) element of trust, (b) promise of financial security, (c) lack of experience or awareness, (d) decision-making, and (e) interpersonal dynamics. Perceived consequences included negative and positive impacts around (a) finances, (b) financial/consumer behaviors (c) relationships and trust, (d) emotional impact, and (e) future outlook., Discussion: These narratives provide important insights into perceived financial exploitation experiences., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Quackery and fraud in dental practice, seen in many countries, is also rampant in Nepal, and they are unethical practices. There is a growing need for strict enforcement of government policy measures to eliminate quackery and fraudulent dental practice in Nepal. The government should mobilize all dental workforce (dental specialists, dentists, and dental auxiliaries) and aware of their responsibilities and limitations. This article presents a brief review showing some cases of malpractice in dentistry in Nepal.

The present study investigated perceptions of plea bargains in elder financial abuse. Approximately 78-90% of felony convictions are the result of plea bargains, yet very little work examines the public's perceptions of it. Additionally, elders lose an estimated $2.6-36.5 billion dollars each year to financial abuse and exploitation. Participants were recruited from Mturk ( N = 74) and completed a mixed-factors 2 (Amount of Money Stolen: $5,000 vs. $50,000) x 2 (Relationship of Victim and Perpetrator: son vs. caretaker) x 2 (Type of Sentence: reduced jail sentence vs. probation) x 2 (Participant Gender) design. Amount, relationship, and sentence were within-participant factors, while gender was between-participant. It was found that there were main effects of amount, sentence, and relationship between victim and defendant such that participants showed a preference for plea bargains when the amount in question was lower ($5,000 vs. $50,000), when the sentence given was harsher (a reduced jail sentence vs. probation), and when the defendant was the victim's son (vs. a caretaker).

Scientific misconduct (fabrication, falsification, and plagiarism) and detrimental research practices (selective reporting of data, inappropriate citation practice, ghostwriting) are admitted respectively by 2 % and 33 % of researchers. The consequences of scientific misconduct and detrimental research practices are disastrous, both for the doctors, who are the most affected researchers in view of the number of retracted articles, and for the patients, victims of false information that may have health consequences. In order to fight against the causes (promotion of doctors and allocation of resources to clinical wards and laboratories on purely quantitative research criteria, lack of training in scientific integrity in medical studies, heterogenous quality of reviewing, legal impunity), there are legislative, academic, technological and editorial solutions, but radical and urgent cultural change is needed first., (Copyright © 2020 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Objectives: As reported in other high-income countries, around the 2008 Great Recession the Spanish banking sector engaged abusive practices that satisfy the definition of fraud. Our objective is to examine the association between self-reported bank fraud and physical health, using a gender perspective., Methods: With data from the 2017 Madrid Health Survey, we examined the association between the economic impact of fraud and poor self-rated health (SRH), comorbidity and pain (N = 4425). Interactions of time since fraud and sex with economic impact were tested by Poisson regression models with robust variance., Results: In total, 11% of adults in Madrid reported bank fraud since 2006. Among men, those who experienced frauds with severe economic impact were more likely to report adverse health than those who did not experience fraud (PR comorbidity: 1.46; PR pain conditions: 2.17). Among men time elapsed since fraud strengthened the association between severe economic impact and poor SRH (p = 0.022; p = 0.006, respectively). Among women, associations did not reach statistical significance., Conclusions: Bank frauds are an emerging phenomenon which is likely to damage public health. Stricter regulation to protect people from fraudulent bank practices is needed.

Artificial intelligence (AI) research and regulation seek to balance the benefits of innovation against any potential harms and disruption. However, one unintended consequence of the recent surge in AI research is the potential re-orientation of AI technologies to facilitate criminal acts, term in this article AI-Crime (AIC). AIC is theoretically feasible thanks to published experiments in automating fraud targeted at social media users, as well as demonstrations of AI-driven manipulation of simulated markets. However, because AIC is still a relatively young and inherently interdisciplinary area-spanning socio-legal studies to formal science-there is little certainty of what an AIC future might look like. This article offers the first systematic, interdisciplinary literature analysis of the foreseeable threats of AIC, providing ethicists, policy-makers, and law enforcement organisations with a synthesis of the current problems, and a possible solution space.

Federal agents raided a number of genetic testing laboratories in September 2019, resulting in 35 people being charged with fraudulent genetic testing associated with an estimated $2.1 billion in losses to federal healthcare insurance programs. The scams work in several ways. In some cases, an older adult is contacted by a customer service representative of the testing laboratory and told that Medicare pays for the genetic testing ordered, based on a simple cheek swab sample. This occurs when representatives of the testing laboratory have "arrangements" with providers who order the tests, often without the provider examining the patient. These providers may receive financial payment or other gifts for their efforts.

Transparency in healthcare has been demanded and promoted for years. The aim of such transparency is disclosure of relationships and interests, so that patients can draw their own conclusions regarding the economic relations of their treating physician. Furthermore, transparency measures aim to prevent illegitimate payments. Overall, transparency should keep healthcare free from non-medical considerations, which may stand in contrast to the patient's wellbeing. Part of this strategy is the legislation aimed at fighting corruption in healthcare passed 13 April 2016, the so-called Anticorruption Act.

Richard Griffith , Senior Lecturer in Health Law at Swansea University, outlines what constitutes fraud and the measures taken by the NHS to counter fraudulent activity.

Richard Griffith , Senior Lecturer in Health Law at Swansea University, outlines what constitutes fraud and the measures taken by the NHS to counter fraudulent activity.

The food industry is advancing at a rapid pace and consumer sensitivity to food safety scares and food fraud scandals is further amplified by rapid communication such as by social media. Academia, regulators, and industry practitioners alike struggle with an evolving issue regarding new terms and definitions including food fraud, food authenticity, food integrity, food protection, economically motivated adulteration, food crime, food security, contaminant, adulterant, and others. This research addressed some of the global need for clarification and harmonization of commonly used terminology. The 150 survey responses were received from various food-related workgroups or committee members, communication with recognized experts, and announcements to the food industry in general. Overall food fraud was identified as a "food safety" issue (86%). The food quality and manufacturing respondents focused mainly on incoming goods and adulterant-substances (<50%) rather than the other illegal activities such as counterfeiting, theft, gray market/diversion, and smuggling. Of the terms included to represent "intentional deception for economic gain" the respondents generally agreed with food fraud as the preferred term. Overall, the preference was 50% "food fraud," 15% "economically motivated adulteration" EMA, 9% "food protection," 7% "food integrity," 5% "food authenticity," and 2% "food crime." It appears that "food protection" and "food integrity" are terms that cover broader concepts such as all types of intentional acts and even possibly food safety or food quality. "Food authenticity" was defined with the phrase "to ensure" so seemed to be identified as an "attribute" that helped define fraudulent acts. PRACTICAL APPLICATION: Food Fraud-illegal deception for economic gain using food-is a rapidly evolving research topic and is facing confusion due to the use of different terms and definitions. This research survey presented common definitions and publication details to gain insight that could help provide clarity. The insight from this report provides guidance for others who are harmonizing terminology and setting the overall strategic direction., (© 2019 Institute of Food Technologists®.)

Competing Interests: Der Autor gibt an, dass kein Interessenkonflikt besteht.

Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of awareness of existence of self-inflicted arm fractures for insurance fraud could help community health workers to report these injuries to the competent authorities. In this article, authors have recognised an unusual but consistent pattern of upper and lower limb fractures whose incidence does not coincide in numerical terms with what is reported in literature. The aim of the present study is to describe fracture patterns observed over the past 2 years. Further, authors describe clinical presentations of these fractures and attempt to define a possible mechanism of these types of injuries.

Objective: Document the use of ultraviolet watermark in counterfeit joint New York City/New York State cigarette tax stamps to assess the scale at which distributors of illegal cigarettes adapt to measures protecting the integrity of the system of tobacco tax collection., Methods: In 2016, we collected 2357 empty discarded cigarette packs along a stratified random sample of block groups in New York City (n=114) and analysed 449 joint New York City/New York State tax stamps using long wave ultraviolet irradiation, light microscopy and taggant testers developed by the tax stamp manufacturer, Meyercord Revenue, to determine whether the tax stamps were counterfeit and how they differed from their genuine equivalent., Findings: 23% (n=102) of the joint NYC/NYS tax stamps examined were counterfeit. Subsequent investigation revealed that almost two-thirds (n=58) of the counterfeit sample bore ultraviolet watermark that closely resembled genuine tax stamps in terms of fluorescence, watermark colour and wording. However, microscopic findings revealed that counterfeit tax stamps mismatched the genuine ultraviolet watermark in regards to font style and word orientation., Conclusion: Counterfeiters are using ultraviolet watermarks which makes it difficult to differentiate counterfeit joint New York City/New York State tax stamps from their genuine equivalent when UV irradiation is used as the sole screening tool. Innovations in counterfeiting technology may be the result of fluorescent ink being available for purchase in the mainstream market. Independent monitoring of trends in the illicit market for tobacco products is advised to keep apace of counterfeiting methods., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

For the better part of a decade, Americans have had a front-row seat to a fervent and turbulent debate over the future of their health care system. The passage of the Patient Protection and Affordable Care Act of 2010 (ACA), the most comprehensive health reform effort since the mid-1960s, ushered in a new era in health law and policy, granting millions of Americans access to health care. After multiple legal challenges and congressional efforts that ultimately failed to slay the law, the ACA had become entrenched by the end of the Obama administration, even though pieces of the law had failed to work exactly as planned. Now, with the surprising election of President Donald Trump, reenergized Republicans are targeting the law once more, and it suddenly appears more vulnerable than ever. Dynamic uncertainty again permeates the national debate. Although most powerful protections of the ACA may evaporate--no small event, to be sure--the value-based era which it unleashed seems here to stay. Indeed, this era--focused on efficiency, standardization, and quality within American medicine--has just begun to bear fruit. Illustrated prominently by recent changes to Medicare that alter how the program pays its doctors for services they provide to its beneficiaries, America is moving away from the old strictures of fee-for-service medicine. At the same time, traditional legal tools, and particularly the federal government’s most prominent anti-fraud tool, the civil federal False Claims Act (FCA), seem to be facing new limits. This has been recently evident in medical necessity-based fraud cases, and particularly highly publicized fights that have targeted the burgeoning industry of hospice care. This Article tracks this development, ultimately arguing that the move to "reimbursement-based regulation" may be a positive step in finally reining in the worst excesses of American health care. But it also cautions against the deceptive simplicity of allowing medical heterogeneity and clinical complexity to prevent application of America’s most powerful anti-fraud tools to its medical industry. Just because reimbursement policy has shifted to shoulder some of the regulatory burden of overtreatment does not mean that health care fraud--like fee-for-service medicine--should be confined to the past. In the end--and regardless of whatever legislation the national debate surrounding American health care produces--American medicine must adequately address its susceptibility to overtreatment, its incentives toward financial excess and waste, and its inability to push providers and entities into adopting more efficient practices. Medicare is finally moving quickly to bring about effective changes, and the program is seeking clarity in the midst of a period of tremendous uncertainty for American health care.

Medical practices are a ripe target for embezzlement.