Investigating Healthcare Fraud: Its Scope, Applicable Laws, and Regulations

Healthcare costs are not only an enormous strain on the U.S. economy but are expected to increase in the foreseeable future. Not surprisingly, clever fraudsters view the healthcare industry as a lucrative and attractive hotspot for illegal activity. Although federal and state governments have increased their funding and prosecution efforts relating to healthcare fraud, this fraud continues to be a major threat to the U.S. economy and every patient and consumer. The impact of healthcare fraud is substantial and far-reaching. Healthcare fraud in the U.S. affects not only the government, but also insurance companies, patients, healthcare providers, and consumers. This Article examines the types of healthcare fraud and the major federal laws used to combat this type of fraud

#35 - Enamel isotopes reveal late Pleistocene ecosystem dynamics in southeastern North America

The end of the late Pleistocene (~10,000 years ago) witnessed the extinction of over seventy percent of North America’s megafaunal genera. Although this pattern has been extensively investigated, its causal mechanisms remain elusive. Much of this difficulty is related to the spatial and temporal discontinuity of sites dating to the period leading up to the extinctions. Due to its removal from glacial conditions, southeastern North America provides a unique window into ecosystem dynamics just prior to human arrival in the region. In this study, we present new stable carbon and oxygen isotope data from Mammuthus columbiand Bison latifronsteeth collected from a well-dated Last Glacial Maximum (~20,000 rcybp) locality called Clark Quarry in coastal Georgia, USA. We compare these data to those from similarly aged (middle and late Rancholabrean) localities from Florida and demonstrate the presence of a vegetation gradient with elevated levels of C3vegetation at higher latitudes. We hypothesize that this pattern may have contributed to previously described migratory patterns of mastodon (Mammut) populations in southeastern North America. Serially-sampled δ13C and δ18O values suggest that Clark Quarry Mammuthus and Bison changed their diet seasonally with the incorporation of elevated quantities of C4vegetation during warmer periods. Our data indicate more exaggerated seasonal dietary variability in these taxa at Clark Quarry relative to those collected from the interglacial locality of Waccasassa River in Florida, providing additional evidence for the significant influence of glacial dynamics in structuring North American ecosystems

Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out. Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.; Patients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.; Of the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52-2.70, p < 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63-0.76). After adjusting for age > 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26-2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test < 0.001). Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.; Copeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.; Study Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov

Comprehensive Molecular Characterization of Pheochromocytoma and Paraganglioma

SummaryWe report a comprehensive molecular characterization of pheochromocytomas and paragangliomas (PCCs/PGLs), a rare tumor type. Multi-platform integration revealed that PCCs/PGLs are driven by diverse alterations affecting multiple genes and pathways. Pathogenic germline mutations occurred in eight PCC/PGL susceptibility genes. We identified CSDE1 as a somatically mutated driver gene, complementing four known drivers (HRAS, RET, EPAS1, and NF1). We also discovered fusion genes in PCCs/PGLs, involving MAML3, BRAF, NGFR, and NF1. Integrated analysis classified PCCs/PGLs into four molecularly defined groups: a kinase signaling subtype, a pseudohypoxia subtype, a Wnt-altered subtype, driven by MAML3 and CSDE1, and a cortical admixture subtype. Correlates of metastatic PCCs/PGLs included the MAML3 fusion gene. This integrated molecular characterization provides a comprehensive foundation for developing PCC/PGL precision medicine

Investigating Healthcare Fraud: Its Scope, Applicable Laws, and Regulations

Healthcare costs are not only an enormous strain on the U.S. economy but are expected to increase in the foreseeable future. Not surprisingly, clever fraudsters view the healthcare industry as a lucrative and attractive hotspot for illegal activity. Although federal and state governments have increased their funding and prosecution efforts relating to healthcare fraud, this fraud continues to be a major threat to the U.S. economy and every patient and consumer. The impact of healthcare fraud is substantial and far-reaching. Healthcare fraud in the U.S. affects not only the government, but also insurance companies, patients, healthcare providers, and consumers. This Article examines the types of healthcare fraud and the major federal laws used to combat this type of fraud

CAN ANCIENT FELIDS AND CANIDS BE DISTINGUISHED BASED UPON THEIR TOOTH MARKS? A CASE STUDY ON MODERN BONES

Predator-prey relationships are vital for structuring modern ecosystems but have been especially challenging to investigate in the fossil record. Although there is abundant evidence of carnivore presence in ancient ecosystems in the form of behavioral traces (e.g., tooth marks), their fossils are rare relative to the animals they ingest. In this study, we use a large sample (n = 33) of modern Bos taurus (cow) tibia that have been processed by Canis lupus (wolf) and Panthera leo (lion) to assess whether morphology and location of tooth marks can be used to distinguish canids and felids in the fossil record. The tibia were divided into three sections (proximal, middle, distal) based upon their total length. Based upon previously published studies and our own observations, a new categorization scheme was developed for this study to characterize each tooth mark within these three regions. Our preliminary results indicate that the overall size and position of tooth marks can be used to distinguish wolf and lion behavioral traces. In particular, we find that lions and wolves differ in the manner by which they process the proximal end of cow tibia. These results could infer that lions prefer areas with higher flesh to bone ratios, which is consistent with interpretations based upon dental morphology. This study indicates that behavioral traces on fossils could be the key to unlocking predator-prey relationships in the fossil record

23. Lion and wolf tooth mark frequency and morphology as a model for ancient carnivore bone damage

Predator-prey relationships are vital for structuring modern ecosystems, but have been especially challenging to investigate in the fossil record. Although there is abundant evidence of carnivore presence in ancient ecosystems in the form of behavioral traces (e.g., tooth marks), their fossils are rare relative to the animals they ingest. In this study, we use a large sample (n = 33) of modern Bos taurus (cow) tibia that have been processed by Canis lupus (wolf) and Panthera leo (lion) to assess whether morphology and location of tooth marks can be used to distinguish canids and felids in the fossil record. The tibia were divided into three sections (i.e., proximal, middle, distal) based upon their overall length. We developed a new categorization scheme (based upon published literature and our own observations) to characterize each tooth mark within these three regions. Our preliminary results indicate that the overall size and position of tooth marks can be used to distinguish wolf and lion behavioral traces. In particular, we find that lion and wolf differ in the manner by which they process the proximal end of cow tibia. This could indicate that lions prefer areas with higher flesh to bone ratios, which is consistent with interpretations based upon dental morphology. This study indicates that behavioral traces on fossils could be the key to unlocking predator-prey relationships in the fossil record

Enamel isotopes reveal late Pleistocene ecosystem dynamics in southeastern North America

The end of the late Pleistocene (∼10,000 years ago) witnessed the extinction of over seventy percent of North America\u27s megafaunal genera. Although this pattern has been extensively investigated, its causal mechanisms remain elusive. Much of this difficulty is related to the spatial and temporal discontinuity of sites dating to the period leading up to the extinctions. In this study, we present new stable carbon and oxygen isotope data from Mammuthus columbi and Bison latifrons teeth collected from a well-dated Last Glacial Maximum (∼20,000 rcybp) locality called Clark Quarry in coastal Georgia, USA. This site lies in direct proximity to where Sir Charles Lyell collected the type specimen of M. columbi in 1846 and therefore is of added historical significance. We compare these data to those from similarly aged (Sangamonian interglacial and Wisconsin glacial intervals) localities from Florida and demonstrate the presence of a vegetation gradient with elevated levels of C3 vegetation at higher latitudes. Serially-sampled δ13C and δ18O values suggest that Clark Quarry Mammuthus and Bison changed their diet seasonally with the incorporation of elevated quantities of C4 vegetation during warmer periods. Our data indicate more exaggerated seasonal dietary variability in these taxa at Clark Quarry relative to those collected from the Sangamonian interglacial locality of Waccasassa River in Florida, providing additional evidence for the significant influence of glacial dynamics in structuring North American ecosystems. These high-resolution ecological patterns should be incorporated into hypotheses focused on extinction dynamics in southeastern North America and more broadly