Healthcare Fraud Data Mining Methods: A Look Back and Look Ahead.

Healthcare fraud is an expensive, white-collar crime in the United States, and it is not a victimless crime. Costs associated with fraud are passed on to the population in the form of increased premiums or serious harm to beneficiaries. There is an intense need for digital healthcare fraud detection systems to evolve in combating this societal threat. Due to the complex, heterogenic data systems and varied health models across the US, implementing digital advancements in healthcare is difficult. The end goal of healthcare fraud detection is to provide leads to the investigators that can then be inspected more closely with the possibility of recoupments, recoveries, or referrals to the appropriate authorities or agencies. In this article, healthcare fraud detection systems and methods found in the literature are described and summarized. A tabulated list of peer-reviewed articles in this research domain listing the main objectives, conclusions, and data characteristics is provided. The potential gaps identified in the implementation of such systems to real-world healthcare data will be discussed. The authors propose several research topics to fill these gaps for future researchers in this domain.

Use of patient assessment skills in advanced pharmacy practice experiences.

INTRODUCTION: Pharmacy programs are required to teach patient assessment (PA) skills. However, pharmacist workforce survey data indicates that limited opportunities exist for students to practice PA skills in real-world settings. The study objectives were to (1) assess how often PA skills are utilized by fourth-year pharmacy (P4) students on advanced pharmacy practice experiences (APPEs), (2) determine perceived competence in performing PA skills, and (3) examine relationships between grade-point average or post-graduation plans and the number of skills performed and between skill use frequency and self-reported competency. METHODS: P4 students completed a questionnaire assessing 13 PA skills. Respondents performing a skill indicated frequency of use and rated their competence using a 5-point scale. Descriptive and bivariate statistics were reported. RESULTS: The response rate was 81%. Measuring blood pressure (BP) (76%) and evaluating metered-dose inhaler (MDI) technique (74%) were most commonly performed. Peak-flow meter evaluation (6%) and lymph node examination (2%) were least commonly performed. Measuring BP and evaluating MDI technique had the highest competency ratings (4.6 + 0.7 for both). Lung (3.4 + 0.7) and heart (2.8 + 1) auscultation had the lowest competency ratings. Positive correlations were found between the frequency of skill use and self-reported competence for assessing MDI technique, peripheral pulses, and peripheral edema. No other findings were significant. CONCLUSIONS: P4 students reported high perceived competency for PA skills performed frequently during APPEs. Preceptor education, requiring skill use, and encouraging students to proactively identify situations to use skills could increase opportunities for use of PA skills.

Characterization of human female breast and abdominal skin elasticity using a bulge test.

Characterization of material properties of human skin is required to develop a physics-based biomechanical model that can predict deformation of female breast after cosmetic and reconstructive surgery. In this paper, we have adopted an experimental approach to characterize the biaxial response of human skin using bulge tests. Skin specimens were harvested from breast and abdominal skin of female subjects who underwent mastectomy and/or reconstruction at The University of Texas MD Anderson Cancer Center and who provided informed consent. The specimens were tested within 2 h of harvest, and after freezing for different time periods but not exceeding 6 months. Our experimental results show that storage in a freezer at -20 °C for up to about 40 days does not lead to changes in the mechanical response of the skin beyond statistical variation. Moreover, displacement at the apex of the bulged specimen versus applied pressure varies significantly between different specimens from the same subject and from different subjects. The bulge test results were used in an inverse optimization procedure in order to calibrate two different constitutive material models - the angular integration model proposed by Lanir (1983) and the generalized structure tensor formulation of Gasser et al. (2006). The material parameters were estimated through a cost function that penalized deviations of the displacement and principal curvatures at the apex. Generally, acceptable fits were obtained with both models, although the angular integration model was able to fit the curvatures slightly better than the Gasser et al. model. The range of the model parameters has been extracted for use in physics-based biomechanical models of the breast.