Recommendations to protect patients and health care practices from Medicare and Medicaid fraud.

Fraud is defined as knowingly submitting, or causing to be submitted, false claims or making misrepresentations of a fact to obtain a federal health care payment for which no entitlement would otherwise exist. In today's health care environment, Medicare and Medicaid fraud is not uncommon. The negative impact of fraud is vast because it diverts resources meant to care for patients in need to the benefit of fraudsters. Fraud increases the overall costs for vital health care services and can potentially be harmful to Medicare and Medicaid beneficiaries. The objectives of this commentary are to describe the types and trends of Medicare and Medicaid fraud that are committed, and provide recommendations to protect patients and health care practices. Specifically, this article identifies types of Medicare and Medicaid fraud at beneficiary (patient) and provider level, and it can be intentional or unintentional. This article also describes the 3 primary laws that prohibit fraud and gives fraud case examples relevant to each law, including the False Claims Act, Anti-Kickback Statute, and the Stark Law. We also discuss currently trending and emerging areas, including opioid and pharmacogenetic testing; both have experienced heavier and higher-profile instances of fraud in today's health care landscape. Last, the article summarizes detection methods and recommendations for health care providers and patients to protect themselves against fraud. Recommended strategies to combat fraud are discussed at policy, practice, and grassroots levels. Health care practitioners, including pharmacists, can use these strategies to protect themselves and their patients from becoming victims of fraud or unknowingly committing fraud.

The Syntheses and Spectroscopic Properties of the Styryl Quinoline Derivatives.

The simple method of the syntheses of the styryl quinoline derivatives was developed. The intermediate of 2-methylquinoline was synthesized from 10 mmol aniline and 20 mmol (E)-2-Butenal dissolved in 8 mL methylbenzene refluxing at 100 ℃ for 3 hours with 10 mL 6 M hydrochloric acid as catalyst. Eight derivatives were obtained in 15 mL glacial acetic acid using 2-methylquinoline (10 mmol) and aromatic aldehyde (12 mmol) as materials refluxing for 8 hours with a yield of 71%～88%. The method is simple, high yield, easy purification and environment friendly. The structures of all derivatives were confirmed with MS, 1HNMR and IR. The vicinal coupling constant of olefinic carbon hydrogen in 1HNMR is 12～18 Hz, and moderate strength absorption peaks appeared at 960～980 cm-1 in IR indicate that carbon-carbon double bond is transconfiguration. Maximum absorption wavelengths of eight products in CH3OH, DMSO, THF and DMF were measured, and emission wavelengths were measured using maximum absorption wavelengths as excitation wavelengths. It turned out that maximum absorption wavelengths among different solvents were 325～376 nm, and emission wavelengths were 367～477 nm. The molar extinction coefficients were within the range of 1.738×104～4.578×104 L·mol-1·cm-1. The maximum absorption wavelengths and emission wavelengths of styryl quinoline derivatives with methoxyl, hydroxyl and benzyl group are greater than others. Among four solvents, the maximum absorption wavelengths almost unchanged, however, the emission wavelengths varies significantly in the following order DMSO>DMF>CH3OH>THF, which indicates the Stokes shift of one product at aprotic solvent is greater than protic solvent. 2-(3,4,5-trimethoxyphenyl)styryl quinolone (Product Ⅱ) which shows the best fluorescence property and the highest Stokes shift value worth further studying.

Intracuff alkalinized lidocaine to prevent postoperative airway complications: A meta-analysis.

BACKGROUND: Post-extubation cough is a common phenomenon in surgical patients undergoing general anesthesia, which can lead to potentially dangerous complications. In this meta-analysis, we evaluated the efficacy and safety of intracuff alkalinized lidocaine in patients with tracheal intubation to prevent cough and other airway complications during the perioperative period. AIM: To perform a systematic review and meta-analysis of intracuff alkalinized lidocaine for the prevention of postoperative airway complications. METHODS: PubMed, Embase, Cochrane, and Web of Science were searched for randomized controlled trials (RCTs) that compared intracuff alkalinized lidocaine to placebo. We used risk-of-bias assessment to assess the RCTs, and the quality of evidence was assessed using the grading of recommendations, assessment, development, and evaluations. RESULTS: Twelve randomized trials (1175 patients) were analyzed. Meta-analysis showed that intracuff alkalinized lidocaine was associated with less cough compared to that produced by placebo [risk ratio (RR): 0.38; 95% confidence interval (CI): 0.23-0.63]. Similarly, intracuff alkalinized lidocaine was more effective than the control in reducing postoperative sore throat at 24 h (RR: 0.19; 95%CI: 0.09-0.41) and postoperative hoarseness (RR: 0.38; 95%CI: 0.21-0.69). CONCLUSION: Intracuff alkalinized lidocaine is an effective adjuvant that can decrease airway complications, such as coughing, hoarseness, and sore throat.

Qualitative exploration of factors influencing the plan selection process by Medicare beneficiaries.

BACKGROUND: Because Medicare plan coverage and costs change annually and older adults, the major beneficiaries of Medicare, are faced with multiple health conditions and changing medical needs, Medicare beneficiaries should evaluate their options during open enrollment every year. However, because of the complexity of plan selection, it may be challenging for Medicare beneficiaries to make an appropriate decision from among competing options. OBJECTIVES: To (a) identify factors that beneficiaries consider having influenced their plan selection decision and (b) describe the decision-making process according to the consumer decision-making model (CDM). The 2 research questions guiding this study included (a) factors Medicare beneficiaries considered having influenced their Medicare plan selection decision and (b) characteristics of decision-making processes employed by Medicare beneficiaries. METHODS: This is a phenomenological qualitative study. Semistructured in-person or telephone interviews with Alabama residents who have Medicare as the sole insurance provider were conducted between June and August 2019. Participant recruitment continued until reaching the saturation point. Each interview session consisted of structured questions identifying characteristics of participants and open-ended questions used to elicit participant Medicare plan decisionmaking process and factors affecting their decision. Data were analyzed using content analysis with a process of qualitative inductive coding. RESULTS: Twenty participants were interviewed. Twenty codes were identified and categorized into 5 themes regarding the factors influencing plan selection decisions by beneficiaries. When making a plan selection, participants were influenced by plan attributes (including cost, coverage, access to doctors, region, quality rating, and transportation); information resources and personal assistance; knowledge about Medicare; status and changes in personal situation; and experience with Medicare. Additionally, we identified 7 codes relating to beneficiary characteristics during decision-making processes, including being proactive, setting priorities, limiting choices, evaluating plans against personal needs, acquiescing to recommendations, sticking to the status quo, and weighing trade-offs. We consulted the CDM and created a conceptual model demonstrating a 5-step Medicare plan selection decision-making process and the factors influencing that process. DISCLOSURES: This study was supported by the Auburn University Undergraduate Research Program. The authors declare no conflicts of interest. CONCLUSIONS: This study created a step-by-step decision flowchart of Medicare plan selection to illustrate the complexity of the plan selection that Medicare beneficiaries must use. We uncovered the plan selection decision-making process among Medicare beneficiaries and factors affecting that process. Drawing from the CDM and the study findings, we developed a conceptual model. Findings will help researchers and community agencies target Medicare beneficiaries with different needs for assistance and design decision-making interventions/tools to help beneficiaries make rational decisions when selecting Medicare plans. These findings suggest that health care professionals should be involved in assistance programs to maximize efficiency of Medicare plan selection and to improve monitoring and consulting mechanisms to ensure the reliability of assistance information and services.

Hydrolyzed seawater pearl tablet modulates the immunity via attenuating Th1/Th2 imbalance in an immunosuppressed mouse model.

OBJECTIVE: To investigate whether Hydrolyzed Seawater Pearl tablet (HSPT) could modulate the Th1/Th2 imbalance in an immunosuppressed mouse model with Th1 to Th2 shift induced by Cyclosporine A (CsA) which can be used in the clinical treatment of Th2 to Th1 shift diseases, and explore the possible mechanism for the adjuvant therapeutic efficacy of HSPT on recurrent respiratory infections (RRI) and acquired immune deficiency syndrome (AIDS). METHODS: The mice were randomly divided into six groups of five animals each, namely normal group, model group, lentinan polysaccharide tablet (LPT) group and three HPST treated groups. HPST treated groups were administered with HPST (0.51, 1.02, 2.04 g/kg) via intragastric gavage (i.g) for 30 consecutive days. LPT used as reference drug for positive control, LPT group was administered with LPT (8.2 mg/kg) for 30 consecutive days. Normal group and model group were received distilled water. The animals in model group, LPT group and HPST treated groups were injected intraperitoneally with CsA (50 mg/kg) to establish the immunosuppressed mice model with Th1 to Th2 shift on the 20th, 22nd and 24th day, one hour after the administration of the respective treatment. Animals were sacrificed one hour after the last administration to collect blood and splenic tissue. The proportion of T cells including CD8+ and CD4+ T cells, Th1 and Th2 in peripheral blood of experimental mice were measured by flow cytometric. The protein level in serum and mRNA level in splenic tissue of experimental mice for interleukin (IL)-2, IL-12, interferon-γ (IFN-γ), IL-4, IL-6, IL-10 and IL-13 were measured by enzyme linked immunosorbent assay and fluorescence quantitative polymerase chain reaction respectively. RESULTS: HSPT elevated the proportion of T cells including both CD8+ and CD4+ T cells, in which the proportion of Th1 and Th2 cells increased, while the ratio of Th1/Th2 cells decreased in peripheral blood of the immunosuppressed mouse model with Th1 to Th2 shift induced by CsA. Furthermore, HSPT elevated both protein and mRNA level of Th1-type cytokines IL-2 and IFN-γ, while had no significant effect on protein and mRNA level of Th1-type cytokine IL-12 and Th2-type cytokines IL-4, IL-6, IL-10, IL- 13 in mouse model. CONCLUSION: Our findings suggest that HSPT can increase proportion of T cells including both CD8+ and CD4+ T cells and induce Th2 to Th1 shift in both cells and cytokines, which probably was the mechanism to account for the adjuvant therapeutic efficacy of HSPT on RRI and AIDS.

[PM2.5 Pollution Characterization and Cause Analysis of a Winter Heavy Pollution Event, Liaocheng City].

Heavy pollution events frequently occur during fall and winter seasons in northern areas. In order to understand the characteristics and chemical composition of PM2.5 during heavy pollution in winter in Liaocheng City, ambient PM2.5 samples were collected between January 7-11,2016. Mass concentration, water-soluble ions, carbonaceous species, and elements were analyzed, as well as the causes of pollution. Results showed that PM2.5 mass concentration was 238.3 µg·m-3 with the trend clearly that of an inverted V; this concentration represents exceedance of the National Ambient Air Quality Standard (GB 3095-2012) by more than 2.2 times. NO3-, SO42-, and NH4+(SNA)were the main water-soluble ions. As pollution increased or decreased, NH4+, SO42-, NO3-, and Cl- exhibited the same trend, which contrasted with that of Ca2+. During the peak of pollution, NH4+, NO3-, and SO42- concentrations were 48.96, 68.45, and 80.55 µg·m-3, with these representing levels 6.29, 7.31, and 7.84 times those of the initial stage, respectively. During the pollution event, OC and EC concentration variation ranges were 20.8-60.2 µg·m-3, and 3.0-7.5 µg·m-3, respectively. The concentration of OC was significantly higher than that of EC and the variation amplitude was significantly larger. During the event, the mass concentrations of 27 inorganic elements on each day were 10.2, 22.4, 16.0, 19.6, and 8.2 µg·m-3, respectively. Enrichment factors (EF) of all elements were less than 10, indicating lack of enrichment and showing that sources were mainly natural. PM2.5 mass concentration reconstruction results showed that organic matter (OM), SO42-, and NO3- were major components, followed by NH4+, crustal material, and other ions. EC and trace element content was relatively low. As PM2.5 pollution worsened, secondary inorganic salt (NH4+, SO42-, NO3-) concentrations and proportions increased, OM concentration increased but its proportion decreased, while crustal material concentration and proportion both decreased, showing that secondary inorganic conversion was the main cause of this pollution event, mainly driven by coal and motor vehicle emissions.