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Home health agencies: targets of anti-fraud and abuse investigations.

Increased health care fraud and abuse investigations could result in home health agencies, and other targets, becoming politically acceptable casualties of war in the battle to balance the federal budget. To protect themselves, home health agencies would be well advised to conduct internal fraud and abuse audits on an annual basis and to develop corporate compliance plans (see Newsletter, Vol. 9, No. 7, July 1994, at 16, and next month's issue, which will discuss corporate compliance programs as well as the OIG's new voluntary disclosure program). In addition, purchasers of home health agencies should be especially vigilant of fraud and abuse problems during the due diligence phase of the acquisition and, if problems are discovered, should consider whether voluntary disclosure to the OIG and settlement of any resulting claims is an appropriate condition of closing.

Aged↗

Proficiency testing. Its role in a voluntary clinical Laboratory Accreditation Program.

The author's long experience as Chairman of the Laboratory Accreditation Program of the College of American Pathologists provides the background for this article. Laboratory accreditation and proficiency testing have now become an established part of the clinical laboratories in the United States. This article attempts to demonstrate the relationship between proficiency testing and accreditation, and highlights some of the current problems and future challenges facing proficiency testing as pertains to accreditation.

Academies and Institutes↗

Voluntary dental laboratory certification program. Council on Prosthetic Services and Dental Laboratory Relations.

Laboratory certification does not offer concrete guarantees of consistent high quality of products or services. It does, however, identify, for the dental profession, a competency and acceptability factor on which to base a predication of performance by the laboratory. Also, laboratory certification establishes a framework within which the dental laboratory industry can work to continue upgrading its facilities and personnel, demonstrates the concern of certified laboratories for continuing competence, and indicates to government and third-party payers a willingness to develop standards endorsed by the industry.

Certification↗

Legal audits and investigations: a key component of healthcare corporate compliance programs.

In today's complex legal environment, healthcare organizations are increasingly implementing voluntary compliance programs as a means of avoiding severe penalties for violations of the law. The Office of the Inspector General has identified legal audits and investigations as key components of effective compliance programs. The author demonstrates the applicability of legal audits and investigations to healthcare organizations by examining the audit and investigation process from beginning to end. The author also examines the role of attorneys in legal audits and investigations, and explains how information communicated from the healthcare organization to its attorneys can be protected from disclosure. As this Article indicates, the monetary and human resource costs of such compliance audits and investigations are insignificant when compared to the potential costs of defending a legal action or paying monetary penalties.

Confidentiality↗

The planning, development, and implementation of a work-site health promotion program: a case study.

A voluntary health promotion program was introduced at an academic institution with 665 employees. The 239 employees who volunteered to participate in a health risk appraisal were significantly younger and more likely to be female than were nonparticipants. The prevalence rates of the major coronary heart disease risk factors in the participants were as follows: hypercholesterolemia, 25.5%; elevated blood pressure, 15.5%; and current cigarette smoker, 15.1%. In addition, many participants daily consumed food high in cholesterol or fat (54.2%), were obese (44.8%), and led sedentary lifestyles (28.5%). Although a majority of female participants had received physician/nurse breast examinations and had Papanicolaou smears taken during the previous year, only about half this number performed monthly breast self-examinations. A telephone survey of employees revealed the most desired health promotion program components to be stress reduction, nutrition counseling, exercise fitness, and weight reduction. The program is now being monitored for health benefits and program costs.

Adult↗

CMA's proposal for a voluntary, universally available Health Benefits Program. A socio-economic report of the Bureau of Research and Planning, California Medical Association.

The May 4, 1970 issue of the American Medical News contains an article on a report released in April by the British Medical Association following a two-year study of the British National Health Service. Although the BMA study is oriented to the specific program as it has evolved in Great Britain since 1946, its main thrust is in the development of a system of voluntary health insurance which would provide for greater consumer choice, based upon nationally determined guidelines and regulations. BMA's recommendations would have the NHS utilize a combination of tax-supported and voluntary-supported mechanisms in providing medical services to various segments of the population, based upon categories of illness and income levels. Since the BMA proposal as reported in the AMA News parallels in some respects the one approved by the CMA House of Delegates and submitted to the AMA House of Delegates for its consideration, the reader will be interested in seeing the concept for a Voluntary Universally Available Health Benefits Program, independently developed by the California Medical Association. It is interesting to note that the CMA proposal attempts to avoid many of the problems with which the NHS has been identified, and at the same time would establish a single, coherent, integrated approach for development over the next decade, incorporating public programs into a unified system of medical care which utilizes the multiplicity of voluntary health insurance approaches and mechanisms.

California↗

The Pollution Prevention Act of 1990: A Policy Whose Time Has Come or Symbolic Legislation?

/ In 1990, the United States officially entered the era of pollution prevention with passage of the Pollution Prevention Act. This paper analyzes EPA's implementation of the Pollution Prevention Act from its passage in 1990 to the present. It examines the barriers EPA must overcome if it is to effectively integrate pollution prevention into its existing regulatory structure, including impediments created by statutory and organizational structure, the existing relationship between EPA and the groups it regulates, the fragmented implementation scheme of national environmental regulation, the balancing of conflicting demands advanced by powerful interests, industry's economic and technical concerns, and institutional inertia. It also examines issues such as industry commitment, the limits of prevention, and measurement concerns. The findings suggest that EPA's efforts at shifting to a pollution prevention regulatory ethic that holds primacy over pollution control are mixed. Its organizational structure, statutory authority, and incentives system still reflect a single-medium pollution control focus, appropriations for pollution prevention programs and activities are paltry compared to traditional pollution control programs, and participation in the program is voluntary. Yet, the findings also point to some promising programs that are working to institutionalize a pollution prevention regulatory ethic, and many states appear very committed to the concept.KEY WORDS: Pollution prevention; Source reduction; Pollution control; Alternative regulatory design; Barriers to implementation

Journal Article↗

Voluntary counseling, testing, and referral for HIV: new technologies, research findings create dynamic opportunities.

Programs for voluntary counseling and testing (VCT) for HIV play an increasingly important role in comprehensive prevention and care strategies. New technological advancements and behavioral interventions can improve the effectiveness of VCT as a tool for preventing new HIV infections and helping HIV-positive individuals access appropriate care. With growing consensus that early access to HIV therapy increases its effectiveness, and that individuals diagnosed with HIV reduce risk behavior, VCT has become integral to the continuum of HIV primary care. However, federal funding of VCT has declined, with concomitant decreases in numbers of people being tested. An estimated 200,000 people in the United States remain unaware that they are HIV positive, and many at-risk individuals do not seek out standard HIV counseling and testing services. To increase the acceptability and effectiveness of VCT, the authors recommend that VCT programs employ outreach programs offering anonymous testing to reach those at heightened risk of HIV infection, and to make rapid use of new technologies and counseling strategies to improve the reach and efficacy. Given the important role that VCT can play in both prevention and early treatment, the authors recommend significant increases in federal support.

Confidentiality↗