Corporate compliance programs: risk management for the future

The Department of Justice has estimated that the government loses $100 billion annually in health care fraud. Consequently, the government's health care fraud enforcement activities with respect to all health care providers and suppliers continue to grow. Last year alone, the government collected more than $8 billion in settlements, fines, and penalties involving health care fraud. Recent settlements with the government have begun to include corporate compliance programs that require continued government oversight of the health care organization as an essential part of the settlement. The first section of this article describes the legal significance of health care companies' having corporate compliance programs. The second section provides a sample list of topics that should be included in any corporate compliance program. Finally, we describe various issues related to the creation and implementation of corporate compliance programs.     

A hospital protocol to resolve complaints against staff physicians

Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time-consuming, and potentially damaging litigation.     

A comparison of quality and utilization problems in large and small group practices

Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.     

“Consumer Confidence” Indexes as social indicators

Consumer Confidence Indexes can be sensibly used in economic and social research conducted in theoretical and methodological framework of social indicators research. They are good predictors of other attitudes, such as voting preferences. Voting preferences are determined much more strongly by expectations of changes in economic conditions than by evaluations of present situation. On the other hand, Consumer Sentiment Indexes — irrespective whether they concern future or present times — are correlated more strongly with leading than with coincident indexes of economic cycles. That proves very important role of predictions, expectations and hopes in attitude formation.     

Nondictatorially independent pairs

Suppose that social welfare function f satisfies the Pareto condition and has complete and transitive values. On a domain satisfying the free quadruple property, if the outcome set X has m< outcomes, then the set of pairs of distinct alternatives on which f satisfies both independence and nondictatorship contains at most the fraction 2/m of all pairs. On a domain satisfying the free six-tuple property, if X is a subset of Euclidean space then the set of pairs on which f satisfies both independence and nondictatorship has Lebesgue measure zero.Campbell's research was financed by the National Science Foundation, grant SES 9209039.     

Economic integration and labor flows: stage migration in farm labor markets in Mexico and the United States

"This article examines the probable effects of the North American Free Trade Agreement (NAFTA) on migration from Mexico to the United States, disputing the view that expansion of jobs in Mexico could rapidly reduce undocumented migration. To the extent that NAFTA causes Mexican export agriculture to expand, migration to the United States will increase rather than decrease in the short run. Data collected in both California and the Mexican State of Baja California show that indigenous migrants from southern Mexico typically first undertake internal migration, which lowers the costs and risks of U.S. migration. Two features of employment in export agriculture were found to be specially significant in lowering the costs of U.S. migration: first, working in export agriculture exposes migrants to more diverse social networks and information about U.S. migration; second, agro-export employment in northern Mexico provides stable employment, albeit low-wage employment, for some members of the family close to the border (especially women and children) while allowing other members of the family to assume the risks of U.S. migration."     

"SECRET BALLOTS" AND SELF-REPORTS IN AN EXIT-POLL EXPERIMENT

A controlled exit-poll experiment on Election Day (November3, 1992) shows that refusals to answer questions and other evasiveforms of responding were significantly lower when respondentswere given a self-administered "secret-ballot" questionnairethan when they were interviewed face-to-face. While there weresome suggestive interactions of this mode-of-data collectioneffect with age and sex, and with the partisan atmosphere ofthe precinct in which the interviews were conducted, they wereborderline in significance, inconsistent in pattern, or difficuitto interpret. More important, comparisons with official electionreturns (the truth) indicated that the secret-ballot techniquewas more accurate than were face-to-face interviews in estimatingthe final outcome on the most socially sensitive of three self-reportedvotes: a vote for or against a tax levy for elderly services.Using a genuine secret ballot in the tradition of the olderGallup preelection polls can thus increase the validity of self-reportsin exit polls today.     

An evaluation of population projection errors for census tracts

"In this article we evaluate the accuracy and bias of projections of total population and population by age group for census tracts in three counties in Florida. We use [U.S. census] data from 1970 and 1980 and several simple extrapolation techniques to produce projections for 1990; we then compare these projections with 1990 census counts and evaluate the differences. For the total sample, we find mean absolute errors of 17%-20% for the three most accurate techniques for projecting total population and find no indication of overall bias. For individual age groups, mean absolute errors range from 20%-29%." This is a revised version of a paper presented at the 1993 Annual Meeting of the Population Association of America.     

A simple,automatic and adaptive bivariate density estimator based on conditional densities

The standard approach to non-parametric bivariate density estimation is to use a kernel density estimator. Practical performance of this estimator is hindered by the fact that the estimator is not adaptive (in the sense that the level of smoothing is not sensitive to local properties of the density). In this paper a simple, automatic and adaptive bivariate density estimator is proposed based on the estimation of marginal and conditional densities. Asymptotic properties of the estimator are examined, and guidance to practical application of the method is given. Application to two examples illustrates the usefulness of the estimator as an exploratory tool, particularly in situations where the local behaviour of the density varies widely. The proposed estimator is also appropriate for use as a pilot estimate for an adaptive kernel estimate, since it is relatively inexpensive to calculate.     

Home,work and community: skilled international migration and expatriate women in Singapore

While skilled labour migration across international borders is a phenomenon of increasing significance in the age of globalization and an important component in the production of global cities, it has not been given sufficient attention in traditional migration analyses.
Recent research has focused on institutional mechanisms regulating the patterns of skill transfer rather than the individual experience of being part of the international labour circuit. Women, in particular, have usually been relegated to the role of "trailing spouses" and are generally invisible in the migration process.
Using a questionnaire survey and in-depth interviews, this article attempts to reinstate the importance of women's roles by portraying them as active agents who adopt a range of strategies in negotiating the move and coming to terms with the transformations wrought by the move in the domains of home, work and community. It argues that skilled labour migration is a strongly gendered process, producing different sets of experiences for the men and women involved in it.
While international circulation often represents "career moves" for expatriate men, their spouses often experience a devalorization of their productive functions and a relegation to the domestic sphere. As an adaptive strategy, expatriate women often turn to the social and community sphere to reach for grounding in their lives.
The article also points to the diversity of "expatriate experiences": while "western" expatriates tend to recreate a more exclusive world by drawing on strong institutional support, "Asian" expatriates find that they have to navigate much finer social and cultural divides between themselves and the host society.