No abstract available.
Medical Identity Theft

BACKGROUND: The aim of our study was to review the findings of health insurance fraud investigations and to evaluate their impacts on medical costs for target and non-target organizations. An interrupted time series study design using generalized estimation equations was used to evaluate changes in cost following fraud investigations. METHODS: We used National Health Insurance claims data from 2009 to 2015, which included 20,625 medical institutions (1,614 target organizations and 19,011 non-target organizations). Outcome variable included cost change after fraud investigation. RESULTS: Following the initiation of fraud investigations, we found statistically significant reductions in cost level for target organizations (−1.40%, p < 0.001). In addition, a reduction in cost trend change per month was found for both target organizations and non-target organizations after fraud investigation (target organizations, −0.33%; non-target organizations of same region, −0.19%; non-target organizations of other regions, −0.17%). CONCLUSION: This study suggested that fraud investigations are associated with cost reduction in target organization. We also found similar effects of fraud investigations on health expenditure for non-target organizations located in the same region and in different regions. Our finding suggests that fraud investigations are important in controlling the growth of health expenditure. To maximize the effects of fraud investigation on the growth of health expenditure, more organizations needed to be considered as target organizations.
Cost Savings ; Delivery of Health Care ; Fraud ; Health Expenditures ; Health Policy ; Insurance, Health ; Interrupted Time Series Analysis ; Korea ; National Health Programs

Integrity of authorship and peer review practices are important considerations for ethical publishing. Criteria for authorship, as delineated in the guidelines by the International Committee of Medical Journal Editors (ICMJE), have undergone evolution over the decades, and now require fulfillment of four criteria, including the need to be able to take responsibility for all aspects of the manuscript in question. Although such updated authorship criteria were published nearly five years ago, still, many major medical and specialist journals have yet to revise their author instructions to conform to this. Inappropriate authorship practices may include gift, guest or ghost authorship. Existing literature suggests that such practices are still widely prevalent, especially in non-English speaking countries. Another emerging problem is that of peer review fraud, mostly by authors, but also rarely by handling editors. There is literature to suggest that a proportion of such fake peer review may be driven by the support of some unscrupulous external editing agencies. Such inappropriate practices with authorship malpractices or disagreement, or peer review fraud, have resulted in more than 600 retractions each, as identified on the retractions database of Retractionwatch.com. There is a need to generate greater awareness, especially in authors from non-English speaking regions of the world, about inappropriate authorship and unethical practices in peer review. Also, support of any external editing agency should be clearly disclosed by authors at the time of submission of a manuscript.
Authorship* ; Fraud ; Peer Review* ; Specialization

This article explains the relationship between open-access publications and pseudo-journals, and explores their characteristics including predatory journals and journal hijackers. Pseudo-journals and pseudo-conferences cause the disruption of academic development by spreading low quality information as well as the violation of research ethics by abusing research funds. Finally, preventive measures are described from the perspective of journal authors/researchers, institutions/funding organizations, and journal editors.
Ethics, Research ; Financial Management ; Fraud ; Open Access Publishing ; Periodicals as Topic

PURPOSE: Recently a controversy has arisen about so-called “ghost surgery” practices, and people have voiced their opinions for legal sanction against such practices, which clearly undermine the foundation of medical ethics. However, there has been a lack of legal basis for punishing those actions. The present study aims to examine which pre-existing legal provisions could be applied to regulate ghost surgery. METHODS: The Korean Medical Service Act has a provision relating to informed consent to inhibit ghost surgery but does not include penalty provisions prohibiting ghost surgery itself. Also, the Korean Supreme Court precedents on this issue have not been settled as of yet. Therefore, this study referred to U.S precedents, law books, and related papers. RESULTS: With respect to ghost surgery, we expect the charges of bodily harm, assault and battery, and fraud could be applied under Korean law, in addition to charges regarding the violation of medical law, such as the omission of entries or false entries in medical records. A patient provides consent to bodily harm prior to surgery, and only the person who is entrusted with such permission can become the operating surgeon in the operating room. CONCLUSION: In other words, even if other medical professionals are present in the operating room, the operating surgeon who received consent must take overall responsibility for the whole process of the surgery. A surgeon should bear in mind that a violation of such duty can constitute a criminal offense.
Criminals ; Ethics, Medical ; Fraud ; Humans ; Informed Consent ; Jurisprudence ; Korea* ; Medical Records ; Operating Rooms ; Punishment* ; Surgical Procedures, Operative

OBJECTIVES: There exists only a limited number of studies on the people's perception of criminality of people with mental illness. People's fear of the dangerousness of people with mental illness may have been exaggerated, and yet there are few studies exploring whether people's view of the crime rates of mentally ill people are correct or not. METHODS: A total of 363 college students participated in the present study. The present study first compared the official statistics of the crime rates of the mentally ill with the public perception. In addition, the rates of mentally ill offenders with previous convictions across crime types are compared with people's perception. RESULTS: Compared to the official crime statistics, people's estimates of crime rates of mentally ill offenders were grossly exaggerated across crime types, including fraud, assault, rape, robbery, theft, homicide, and arson. Furthermore, the rates of mentally ill offenders with previous convictions across all crime types on the official crime statistics were actually higher than people's estimates. CONCLUSION: The present findings reveal that people's view of the crime rates of mentally ill people is considerably distorted. There is an urgent need to clarify these prejudices in order to help people with mentally illness adjust to society and to prevent them from committing crime.
Crime* ; Criminals ; Dangerous Behavior ; Firesetting Behavior ; Fraud ; Homicide ; Humans ; Mentally Ill Persons ; Prejudice ; Rape ; Theft

This paper aims to investigate whether good governance of a recipient country is a necessary condition and what combinations of factors including governance factor are sufficient for low prevalence of HIV/AIDS in HIV/AIDS aid recipient countries during the period of 2002-2010. For this, Fuzzy-set Qualitative Comparative Analysis (QCA) was used. Nine potential attributes for a causal configuration for low HIV/AIDS prevalence were identified through a review of previous studies. For each factor, full membership, full non-membership, and crossover point were specified using both author's knowledge and statistical information of the variables. Calibration and conversion to a fuzzy-set score were conducted using Fs/QCA 2.0 and probabilistic tests for necessary and sufficiency were performed by STATA 11. The result suggested that governance is the necessary condition for low prevalence of HIV/AIDS in a recipient country. From sufficiency test, two pathways were resulted. The low level of governance can lead to low level of HIV/AIDS prevalence when it is combined with other favorable factors, especially, low economic inequality, high economic development and high health expenditure. However, strengthening governance is a more practical measure to keep low prevalence of HIV/AIDS because it is hard to achieve both economic development and economic quality. This study highlights that a comprehensive policy measure is the key for achieving low prevalence of HIV/AIDS in recipient country.
Acquired Immunodeficiency Syndrome/*epidemiology/prevention & control ; Computer Simulation ; Developing Countries/*economics/statistics & numerical data ; Economic Development/statistics & numerical data ; Fraud/economics/*statistics & numerical data ; Fuzzy Logic ; HIV Infections/*epidemiology/prevention & control ; Humans ; Models, Statistical ; Prevalence ; Risk Factors ; Socioeconomic Factors

Publishing scholarly articles in traditional and newly-launched journals is a responsible task, requiring diligence from authors, reviewers, editors, and publishers. The current generation of scientific authors has ample opportunities for publicizing their research. However, they have to selectively target journals and publish in compliance with the established norms of publishing ethics. Over the past few years, numerous illegitimate or predatory journals have emerged in most fields of science. By exploiting gold Open Access publishing, these journals paved the way for low-quality articles that threatened to change the landscape of evidence-based science. Authors, reviewers, editors, established publishers, and learned associations should be informed about predatory publishing practices and contribute to the trustworthiness of scholarly publications. In line with this, there have been several attempts to distinguish legitimate and illegitimate journals by blacklisting unethical journals (the Jeffrey Beall's list), issuing a statement on transparency and best publishing practices (the Open Access Scholarly Publishers Association's and other global organizations' draft document), and tightening the indexing criteria by the Directory of Open Access Journals. None of these measures alone turned to be sufficient. All stakeholders of science communication should be aware of multiple facets of unethical practices and publish well-checked and evidence-based articles.
Communication ; Disclosure/*ethics ; *Ethics, Research ; Fraud/*ethics ; Information Dissemination/*ethics ; Medical Writing ; Periodicals as Topic/ethics ; Publishing/*ethics ; Science/*ethics

There exists numerous indices for quality evaluation and control in Chinese medicinal materials. However, most of these indices are qualitative and non-interrelated each other, as well as having little relationship with safety and efficiency. In this article, we first establish a comprehensive evaluating index--Dao-Di index (DDI) based on five factors: relative history of producing areas, ecological suitability of producing areas, commercial specification and grade, golden rate of main components, and biopotency/ toxic potency. This DDI can be used to guarantee the quality of Chinese medicinal materials more comprehensively, objectively and effectively, promoting the integration of 'species-quality-property-effect-usage', and it will provide significant references and revelation for taking a world leading role of quality control standard for tranditional medicines.
Fraud ; prevention & control ; Humans ; Medicine, Chinese Traditional ; standards ; Quality Control

Systematic and effective means for promoting and protecting the welfare of the disabled requires reliable criteria that accurately demonstrate the presence and measure the severity of the disability. Given the same disability, however, the degree of that disability may measure differently according to the particular criteria used in Korea. In addition to inconsistency, the varying set of criteria has resulted in significant diagnostic errors, fraud, and malingers, leading to overall distrust and dissatisfaction. Accurate disability evaluation is the key for the welfare for the disabled. Evaluation of the physical impairment is possible only by the medical doctors. Doctors should know the concept, purpose, and methods of disability evaluation.
Diagnostic Errors ; Disability Evaluation ; Fraud ; Korea ; Public Health ; Social Welfare ; Workers' Compensation