the nature and frequency of medicare/medicaid fraud and neutralization techniques among speech,occupational, and physical therapists

ABSTRACT

The current study examines the nature and frequency of Medicare/Medicaid fraud and the techniques of neutralization utilized by a purposeful sample of speech, occupational, and physical therapists working within the context of hospitals, nursing homes, and with home health agencies, in a southern state. Participant observations, surveys, and in-depth interviews were utilized to obtain data for this study. We identified two main fraudulent practices, cutting sessions short while charging for the entire session and charging individual session rates for group therapy sessions. We also identified three techniques of neutralization utilized by the therapists in our study, including: (1) everyone else does it, (2) denial of responsibility, and (3) denial of injury. The implications of our findings are discussed.     

Cognición ambiental

Resumen

Esta investigación revisa el conocimiento espacial humano en los ambientes cotidianos y reales. Los estudios relativos a mapas cognitivos se organizan en cinco categorías empíricas: edad, familiaridad, sexo, clase-cultura y componentes físicos del ambiente. Se discuten las cuestiones metodológicas y conceptuales en los trabajos sobre el conocimiento ambiental, enfatizando los problemas con las metodologías que utilizan el dibujo de mapas cognitivos. En particular se observa una falta de integración entre la investigación cognitiva pertinente y los trabajos de la psicología ambiental sobre mapas cognitivos. Finalmente se discute la aplicación potencial de los trabajos de conocimiento ambiental a la arquitectura, el diseño urbanístico y la educación.     

BEING DRIVEN MAD: TOWARDS UNDERSTANDING BORDERLINE AND OTHER DISTURBED STATES OF MIND THROUGH THE USE OF THE COUNTER‐TRANSFERENCE

In this paper material is presented from supervision groups run for nurses and other mental health professionals. The patients presented to the group came from different mental health settings with a diagnosis that included borderline features and/or other disturbed states of mind. All of the patients described caused strong counter‐transference feelings of sympathy, confusion, anger, hopelessness and guilt. Although these views were not expressed in formal ward rounds or recorded in clinical notes, evidence of their influence could be seen in the staff's attitude toward these patients. In supervision groups staff would either say that the patients were victims of mistreatment or they adopted a rather moralistic tone saying, ‘the patient is attention‐seeking’, ‘manipulative’ or ‘not mentally ill’. Psychoanalytic supervision which puts the transference and counter‐transference relationship at the centre of practice can help staff to think about their feelings and digest them in a way that makes use of them as evidence rather than discarding them as purely subjective. It also helps to reduce the toxic effects of the patient's projections upon the clinician's mind and this in turn helps to reduce retaliatory or manic clinical decisions. In this paper I argue that staff teams need time to reflect on their practice in handovers and clinical meetings and that psychoanalytic supervision can offer a particularly valuable clinical perspective on patients with Borderline features. This sort of support should be seen as an essential part of the work of nurses and other mental health professionals rather than an unaffordable luxury.     

MAKING ROOM FOR MADNESS IN MENTAL HEALTH: THE IMPORTANCE OF ANALYTICALLY‐INFORMED SUPERVISION OF NURSES AND OTHER MENTAL HEALTH PROFESSIONALS

In this paper, I discuss the importance of psychoanalytically informed supervision and training of nurses and other professionals in mental health settings. Using examples from supervision groups I will illustrate how a psychoanalytic approach to mental health can complement other ways of thinking about practice and management. Psychoanalysis provides a framework for understanding the relationship between the internal world of the patients, the therapeutic relationship and the social system. I will also argue that this understanding helps to develop and maintain therapeutic factors while reducing the risk of damaging behaviour and beliefs.     

Adapting Motivation,Control, and Compensation Research to A New Environment

The authors discuss the need to adapt research in three substantively related but paradigmatically diverse research domains (salesperson motivation, control systems, and compensation) in light of the evolving selling environment. A key objective is to suggest the desirability of integrating these literatures, which, ultimately, all seek to inform management regarding how salespeople and sales organizations can be encouraged to become more productive. The authors maintain that specification of the right goals and metrics constitutes a fundamental common denominator across the three literatures.     

Two-Year-Olds' Object Retrieval Based on Television: Testing a Perceptual Account

Two-year-olds frequently fail to use information provided by video to find objects hidden in an adjacent room. Schmitt and Anderson (2002) hypothesized that they fail to map the 2-dimensional (2D) video image onto the 3D layout of the search space. Two experiments tested whether 2-year-olds can successfully use information from video when the search space is 2D or when the information is provided verbally (by telling the child where the toy is hidden). In both experiments, children performed poorly in the video conditions but performed well in direct live experience comparison conditions, contradicting Schmitt and Anderson's hypothesis. Performance was above chance on the first trial in the video conditions, suggesting that 2-year-olds do have a memory of the hiding location, albeit one that is easily disrupted by perseverative errors on subsequent trials. Overall, the results are most consistent with the hypothesis that very young children give priority to direct experience over mediated information.     

Problem-solving Strategies and Expertise in Engineering Design

A study is reported which focused on the problem-solving strategies employed by expert electronics engineers pursuing a real-world task: integrated-circuit design. Verbal protocol data were analysed so as to reveal aspects of the organisation and sequencing of ongoing design activity. These analyses indicated that the designers were implementing a highly systematic solution-development strategy which deviated only a small degree from a normatively optimal top-down and breadth-first method. Although some of the observed deviation could be described as opportunistic in nature, much of it reflected the rapid depth-first exploration of tentative solution ideas. We argue that switches from a predominantly breadth-first mode of problem solving to depth-first or opportunistic modes may be an important aspect of the expert's strategic knowledge about how to conduct the design process effectively when faced with difficulties, uncertainties, and design impasses.