The Missing Victims of Health Care Fraud

Over the past few decades, combating criminal health care fraud has become one of the highest priorities of federal law enforcement, which views and treats it as a financial crime that causes vast economic losses to the government and private insurers. But the crime also causes, or threatens, physical harms to individual health care patients, a class of victims that the criminal justice system often fails to recognize. This Article is the first to explore how structures and hidden levers of power within the criminal justice bureaucracy lead agents and prosecutors to select—and ignore—particular harms and victims and, more importantly, what drives their selections. The implications extend beyond health care fraud. Questions about this form of prosecutorial discretion are surprisingly absent in the scholarly literature. Through the lens of health care fraud, I show that features of statutory frameworks and sentencing guidelines can have an outsized influence on the selection of harms and victims in complex cases, often in unintended ways that merit greater scrutiny. Internal dynamics within the criminal justice bureaucracy, including those driven by governmental interests as well as the interests of agents and prosecutors themselves, also play a significant role. These factors combine to spur our criminal justice system to treat health care fraud as just another flavor of fraud, devaluing victims and skewing punishments of offenders who exploit patients as a means to enrich themselves

Tuberculous pericarditis: Challenges and controversies in the modern era

Tuberculous pericarditis (TBP) continues to wreak havoc across Sub-Saharan Africa (SSA). Despite more than 5 decades of treatment and research into TBP, we are not much closer to alleviating the suffering and mortality associated with this extrapulmonary manifestation of tuberculosis (TB). In the era of modern cardiology, diseases of the pericardium do not receive the same amount of research attention and investment as what diseases of lifestyle do. Interventional techniques for their diagnosis and management do not extend much further than pericardiocentesis with appropriate laboratory investigations. They also do not provide the potential for the development and use of consumable equipment, or that of expensive drugs and, consequently, fi nancial investment into their research and development is not forthcoming. Diseases of the pericardium do, however, remain important within the discipline that we practice and TBP in particular deserves our continuous efforts and attention. It is unfortunate to acknowledge that we have not made much of an impact on this ancient foe over the last 50 odd years. Despite the World Health Organisation (WHO) declaring TB a global emergency in 1993, more than 20 years later we are not much better off. In 2013 an estimated 9 million people developed the disease and 1.5 million died from it.(1) TBP is predominantly a disease of SSA and it requires a solution from the very region which it torments

Tourism in the post Covid-19 era: An opportunity for expansion of the tourism season; The case of Crete

Tourism worldwide has been affected by Covid-19 and many tourism destinations have been hit hard. The effects of the virus on the tourism sector will be long-lasting and economic losses inevitable. Nonetheless, there is a strong positive correlation between tourism and economic growth. As a result of this, the tourism season expansion can, under specific circumstances, lead to greater economic growth. Global crises can help countries that effectively deal with them, to evolve and effectively expand their seasonality, along with specific measures taken by the local governments to restore tourism and even more to expand it (Beirman, 2003).For Greece, and Crete in particular, that heavily depends on its tourism sector, the economic losses are expected to be devastating. However, based on the development of Covid-19, so far, Greece is presented with a unique opportunity to improve its comparative position and prolong the duration of its tourism season.Crete is the ideal holiday destination to take advantage of the current situation, in order to prolong its season. Crete is an island with a very diverse landscape and a mild climate, all year round. The region of Crete, over the course of the past decade, has put significant effort in promoting its own brand and has already succeeded in extending the islands tourism season by at least one more month, with season starting mid-March and ending early November (Enterprise Greece, 2018). Moreover, in low season, there have been attempts by local Tour Operators and there has been a small but steady flow of Tourists, even in the extremely low season, between November and February. Of course, all initiatives taken by the locals, are important but are not sufficient. Coordinated support is needed by the government and the prefecture of Crete to boost the island and create a viable extent tourism season

An Investigation Into Activated Carbon

The extraction of aurocyanide by activated carbon probably involves the adsorption of neutral ion-pair species [M ^jAuCCN)^. The large hydrophobic aurocyanide anion associates with the cation in order to minimize the disruption of the water structure whereby lowering its free energ

Pericardial effusion with cystic mass

Patient with a 2-month history of exertional dyspnoea and a non-productive cough

Chronic coronary syndromes - time to reassess the evidence

CITATION: Kyriakakis, C. 2018. Chronic coronary syndromes - time to reassess the evidence. SA Heart, 15(2):98-101, doi:10.24170/15-2-3042.The original publication is available at https://www.journals.ac.za/index.php/SAHJNo abstract available.https://www.journals.ac.za/index.php/SAHJ/article/view/3042Publisher's versio

When opportunity knocks

Constrictive pericarditis remains a common medical problem in developing countries where it frequently complicates tuberculous pericarditis. In addition, it is not infrequently seen in the developed world in the context of previous cardiac surgery, chest irradiation and even idiopathic pericarditis.(1) The diagnosis of pericardial constriction is often elusive and delays between the onset of symptoms and final diagnosis is the norm. Given the potential curability of this cause of heart failure and the fact that various features of chronicity in the disease portend a poor prognosis, recognising the disease early is of paramount importance.(1) The haemodynamics of constriction, particularly in more pronounced cases, produces a set of interesting clinical findings that the vigilant physician can elicit. A useful, and often neglected clinical feature, is that of a diastolic precordial or epigastric impulse, the palpable equivalent of an audible diastolic pericardial knock. This short report illustrates this unique clinical finding and explains the haemodynamics responsible for it. We also briefly review other commonly found clinical findings that assist in making the diagnosis of constrictive pericarditis

Dorsal Roots and Associated Ganglia from the First Cervical Spinal Segment in Humans

Pain is a debilitating sensory experience that affects everyone at some point in his or her lives. In the United States alone unrelieved pain results in decreased quality of life, losses in productivity adding up to hundreds of billions of dollars annually, increased hospital stays, increases out patient visits all adding up to hundred of billions of dollars in increased health care costs. One in four Americans over the age of 20 report having had issues with chronic pain. Thirty-four percent of those reported having either severe headaches (15%), neck pain(15%) or facial pain (4%). Despite the tremendous burden on society pain mechanisms are still not completely understood. There is a great deal of knowledge and research devoted to the somatosensory systems, including pain systems, of the head and neck yet there is still much more that remains to be elucidated. For instance, current dogma describes the first cervical nerve (C1) as being purely motor in function. This is the most common description given in medical textbooks and reports and is being taught this way to current health professional students. Despite what is being taught anatomical reports of sensory roots coming off the first spinal segments have been observed (2). We suggest that presence of C1 dorsal roots, and a corresponding dorsal root ganglia, would have significant implications on the distribution of pain sensation in the head. The long-term goal of this project is to investigate the role of sensory roots of the C1 spinal segment in pain sensation of the head and neck