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Written By: Jeffrey L. Cohen Date: April 22nd, 2013. Topic: Behavioral Health.
Many business people involved in some aspect of the recovery business world (e.g. IOPs, PHPs, Detox) are not aware of the punishing laws that apply to their marketing arrangements. Simply paying someone commission-based sales compensation without fully appreciating the applicable laws is dangerous and costly.
The big federal law involved in the issue, the Anti Kickback Statute (?AKS?) (42 CFR 1320a-7b(b)) basically forbids paying anyone for referring patients whose care is compensated in any way by any state or federal healthcare program (e.g. Medicare, Medicaid, CHAMPUS or TriCare). The law enforcement arm of that law, the Department of Health and Human Services Office of the Inspector General (OIG), has been clear that such commission-based sales arrangements implicate the AKS and has identified some core suspect indicators, including:
Compensation set on a percentage-of-sales basis
Direct billing of any federal healthcare program by the seller for an item sold by the contractor
A direct contract between the contractor and a physician in a position to order or refer
A direct contract between the contractor and federal healthcare program beneficiaries
The AKS has both criminal and civil monetary consequences and is one of the government?s favorite tools. Recovery service providers are well advised to become familiar with not only the AKS, but also the law?s exceptions, so called ?Safe Harbors,? which describe arrangements that don?t violate the AKS. The ?personal services arrangement? Safe Harbor has particular application in the area of marketing, as does the AKS exception for ?bona fide employment arrangements,? which apply to W-2 employees, but not independent contractor relationships. Though the AKS arguably applies to just about every arrangement, at least these are some good examples of what?s OK.
Many recovery service providers do not interact with federal or state healthcare programs of any kind. That?s great. For them, the AKS may not seem to be an issue, since the law only applies when services are reimbursable by a state or federal healthcare program. But states are equally unkind in enacting laws that essentially require providers to comply with the AKS even when no state or federal healthcare program dollars are involved. For instance, Florida?s Patient Brokering Act (?PBA?) mirrors the AKS in many ways and carries with it criminal consequences. Even more damaging is the fact that many insurers use the PBA to deny payment for claims.
Recovery service providers have to be careful about how federal and state laws apply to marketing arrangements. Though doing so is a little like playing Whack a Mole, it?s totally doable with the right guidance.
Apr. 23, 2013 ? An international team of scientists has shed new light on a fundamental area of physics which could have important implications for future electronic devices and the transfer of information at the quantum level.
The electrical currents currently used to power electronic devices are generated by a flow of charges. However, emerging quantum technologies such as spin-electronics, make use of both charge and another intrinsic property of electrons ? their spin ? to transfer and process signals and information.??
The experimental and theoretical work, carried out by researchers from York?s Department of Physics, the Institute of Nanoscience in Paris and the University of Missouri-Columbia, USA, could have important implications for spintronics and quantum information technologies.
The team looked at semiconductors? structures ? the base of current electronic devices and of many spintronic device proposals - and the problems created by internal fields known as spin-orbit fields. In general, these tend to act differently on each electronic spin, causing a phenomenon referred to as ?spin-decoherence?. This means that the electronic spins will behave in a way which cannot be completely controlled or predicted, which has important implications for device functionalities.
To address this problem, the scientists looked at semiconductor structures called ?quantum wells? where the spins can be excited in a collective, coherent way by using lasers and light scattering. ?????
They demonstrated that these collective spin excitations possess a macroscopic spin of quantum nature. In other words, the electrons and their spins act as a single entity making them less susceptible to spin orbit fields, so decoherence is highly suppressed.
The theoretical work was led by Dr Irene D?Amico from York?s Department of Physics, and Carsten Ullrich, an Associate Professor from Missouri-Columbia?s Department of Physics. The project began with their prediction about the effect of spin Coulomb drag on collective spin excitations, and developed into a much larger international project spanning over three years, which was funded in the UK by a Royal Society grant, with additional funding from the Engineering and Physical Sciences Research Council (EPSRC).
Dr D?Amico said: ?This work has developed into a strong international collaboration which has greatly improved our understanding at fundamental level of the role of many-body interactions on the behaviour of electron spins.
?By combining experimental and theoretical work, we were able to demonstrate that through many-body interactions, a macroscopic collection of spins can behave as a single entity with a single macroscopic quantum spin, making this much less susceptible to decoherence. In the future, it may be possible to use these excitations as signals to transport or elaborate information at the quantum level.?
After reporting their results in the journal Physical Review Letters last year, the team of scientists confirmed and extended the results by considering different materials and type of excitation. The second set of experiments, were recently reported in Physical Review B (Rapid Communication) and highlighted by the Journal as an ?Editor?s Suggestion?.
Dr Florent Perez, who led the experimental work with Florent Baboux, at the CNRS/Universit? Paris VI, says the results strongly suggest that the quantum nature of the macroscopic spin is universal to collective spin excitations in conductive systems.
He said: ?The collaboration with Irene D?Amico and Carsten Ullrich has been particularly powerful to disentangle the puzzle of our data. In our first joint work we constructed an interpretation of the phenomenon which was confirmed in a second investigation carried out on a different system. This paved the way for a universality of the effect.?
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The above story is reprinted from materials provided by University of York, via AlphaGalileo.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal References:
F. Baboux, F. Perez, C. A. Ullrich, I. D?Amico, J. G?mez, M. Bernard. Giant Collective Spin-Orbit Field in a Quantum Well: Fine Structure of Spin Plasmons. Physical Review Letters, 2012; 109 (16) DOI: 10.1103/PhysRevLett.109.166401
F. Baboux, F. Perez, C. A. Ullrich, I. D'Amico, G. Karczewski, T. Wojtowicz. Coulomb-driven organization and enhancement of spin-orbit fields in collective spin excitations. Physical Review B, 2013; 87 (12) DOI: 10.1103/PhysRevB.87.121303
Note: If no author is given, the source is cited instead.
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Contact: Jade Boyd jadeboyd@rice.edu 713-348-6778 Rice University
Researchers study code that allows bacteria to either bet on the present or travel in time
HOUSTON -- (April 22, 2013) -- Individual freedom and social responsibility may sound like humanistic concepts, but an investigation of the genetic circuitry of bacteria suggests that even the simplest creatures can make difficult choices that strike a balance between selflessness and selfishness.
In a new study the journal Scientific Reports, researchers from Rice University's Center for Theoretical Biological Physics (CTBP) and colleagues from Tel Aviv University and Harvard Medical School show how sophisticated genetic circuits allow an individual bacterium within a colony to act on its own while also ensuring that the colony pulls together in hard times.
"Our findings suggest new principles for collective decisions that allow both random behavior by individuals and nonrandom outcomes for the population as a whole," said study co-author Eshel Ben-Jacob, a senior investigator at CTBP and adjunct professor of biochemistry and cell biology at Rice. "These new principles could be broadly applicable, from the study of cancer metastasis to the study of collective decisions by humans during times of stress."
Some species of bacteria live in complex colonies that can contain millions of individual cells. An increasing body of research on bacterial colonies has found that members often cooperate -- even to the point of sacrificing their lives -- for the survival of their colony. For example, in response to extreme stress, such as starvation, most of the individual cells in a colony of the bacteria Bacillus subtilis will form spores. Spore formation is a drastic choice because it requires the cell to kill itself to encase a copy of its genetic code in a tough, impervious shell. Though the living cell dies, the spore acts as a kind of time capsule that allows the organism to re-emerge into the world of the living when conditions improve.
"This time-travel strategy of waiting and safeguarding a copy of the DNA in the spore ensures the survival of the colony," Ben-Jacob said. "But there are other, less desperate options that B. subtilis can take to respond to stress. Some of these cells turn into highly mobile food seekers. Others turn cannibalistic, and about 10 percent enter a state called 'competence' in which they bide their time and bet on present conditions to improve."
Scientists have long been curious about how bacteria decide which of these paths to pursue. Years of studies have determined that each individual constantly senses its environment and continuously sends out chemical signals to communicate with its neighbors about the choices it is making. Experimental studies have revealed dozens of regulatory genes, signaling proteins and other genetic tools that cells use to gather information and communicate with one another.
"Bacteria don't hide their intentions from their peers in the colony," said study co-author Jos Onuchic, co-director of CTBP, Rice's Harry C. and Olga K. Wiess Professor of Physics and Astronomy and professor of chemistry and biochemistry and cell biology. "They don't evade or lie, but rather communicate their intentions by sending chemical messages among themselves."
Individual bacteria weigh their decisions carefully, taking into account the stress they are facing, the situation of their peers, the statistics of how many cells are sporulating and how many are choosing competence, Onuchic said. Each bacterium in the colony communicates via chemical "tweets" and performs a sophisticated decision-making process using a specialized complex gene network comprised of many genes connected via complex circuitry. Taking a physics approach, Onuchic, Ben-Jacob and study co-authors Mingyang Lu, Daniel Schultz and Trevor Stavropoulos investigated the interplay between two components of the circuitry -- a timer that determines when sporulation occurs and a two-way switch that causes the cell to choose competence over sporulation.
"We found that the sporulation timer and the competence switch work in a coordinated fashion, but the interplay is complex because the two circuits are affected very differently by noise," said Schultz, a postdoctoral fellow at Harvard Medical School and a former graduate student at CTBP.
Noise results from random fluctuations in a signal; every circuit -- whether genetic or electronic -- responds to noise in its own way. In the case of B. subtilis, noise is undesirable in the sporulation timer but is a necessity for the proper function of the competence switch, the researchers said.
"Our study explains how the two opposite noise requirements can be satisfied in the decision circuitry in B. subtilis," Onuchic said. "The circuits have a special capacity for noise management that allows each individual bacterium to determine its fate by 'playing dice with controlled odds.'"
Ben-Jacob said the timer has an internal clock that is controlled by cell stress. The noise-intolerant timer typically keeps the competence switch closed, but when the cell is exposed to stress over a long period of time, the timer activates a decision gate that opens brief "windows of opportunity" in which the competence switch can be flipped.
Thanks to its architecture, the gate oscillates during the window of opportunity, he said. At each oscillation, the switch opens for a short time and grants the cell a short window in which it can use noise as a "roll of the dice" to decide whether to escape into competence.
"The ingenuity is that at each oscillation the cell also sends 'chemical tweets' to inform the other cells about its stress and attempt to escape," said Ben-Jacob, the Maguy-Glass Professor in Physics of Complex Systems and professor of physics and astronomy at Tel Aviv University. "The tweets sent by others help regulate the circuits of their neighbors and guarantee that no more than a specific fraction of cells within the colony will enter into competence."
Onuchic said the decision-making principles revealed in the study could have implications for synthetic biologists who wish to incorporate sophisticated decision systems as well as for cancer researchers who are interested in exploring the decision-making processes that cancer cells use in choosing to become dormant or to metastasize.
"This represents a real fusion of ideas from statistical physics and biology," he said.
###
Lu is a postdoctoral research fellow at CTBP and Stavropoulos is a former graduate student and CTBP fellow at the University of California, San Diego. The research was funded by the National Science Foundation, the Cancer Prevention and Research Institute of Texas and the Tauber Family Foundation.
A copy of the Scientific Reports article is available at:
http://www.nature.com/srep/2013/130417/srep01668/full/srep01668.html
[ | E-mail | Share ]
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Contact: Jade Boyd jadeboyd@rice.edu 713-348-6778 Rice University
Researchers study code that allows bacteria to either bet on the present or travel in time
HOUSTON -- (April 22, 2013) -- Individual freedom and social responsibility may sound like humanistic concepts, but an investigation of the genetic circuitry of bacteria suggests that even the simplest creatures can make difficult choices that strike a balance between selflessness and selfishness.
In a new study the journal Scientific Reports, researchers from Rice University's Center for Theoretical Biological Physics (CTBP) and colleagues from Tel Aviv University and Harvard Medical School show how sophisticated genetic circuits allow an individual bacterium within a colony to act on its own while also ensuring that the colony pulls together in hard times.
"Our findings suggest new principles for collective decisions that allow both random behavior by individuals and nonrandom outcomes for the population as a whole," said study co-author Eshel Ben-Jacob, a senior investigator at CTBP and adjunct professor of biochemistry and cell biology at Rice. "These new principles could be broadly applicable, from the study of cancer metastasis to the study of collective decisions by humans during times of stress."
Some species of bacteria live in complex colonies that can contain millions of individual cells. An increasing body of research on bacterial colonies has found that members often cooperate -- even to the point of sacrificing their lives -- for the survival of their colony. For example, in response to extreme stress, such as starvation, most of the individual cells in a colony of the bacteria Bacillus subtilis will form spores. Spore formation is a drastic choice because it requires the cell to kill itself to encase a copy of its genetic code in a tough, impervious shell. Though the living cell dies, the spore acts as a kind of time capsule that allows the organism to re-emerge into the world of the living when conditions improve.
"This time-travel strategy of waiting and safeguarding a copy of the DNA in the spore ensures the survival of the colony," Ben-Jacob said. "But there are other, less desperate options that B. subtilis can take to respond to stress. Some of these cells turn into highly mobile food seekers. Others turn cannibalistic, and about 10 percent enter a state called 'competence' in which they bide their time and bet on present conditions to improve."
Scientists have long been curious about how bacteria decide which of these paths to pursue. Years of studies have determined that each individual constantly senses its environment and continuously sends out chemical signals to communicate with its neighbors about the choices it is making. Experimental studies have revealed dozens of regulatory genes, signaling proteins and other genetic tools that cells use to gather information and communicate with one another.
"Bacteria don't hide their intentions from their peers in the colony," said study co-author Jos Onuchic, co-director of CTBP, Rice's Harry C. and Olga K. Wiess Professor of Physics and Astronomy and professor of chemistry and biochemistry and cell biology. "They don't evade or lie, but rather communicate their intentions by sending chemical messages among themselves."
Individual bacteria weigh their decisions carefully, taking into account the stress they are facing, the situation of their peers, the statistics of how many cells are sporulating and how many are choosing competence, Onuchic said. Each bacterium in the colony communicates via chemical "tweets" and performs a sophisticated decision-making process using a specialized complex gene network comprised of many genes connected via complex circuitry. Taking a physics approach, Onuchic, Ben-Jacob and study co-authors Mingyang Lu, Daniel Schultz and Trevor Stavropoulos investigated the interplay between two components of the circuitry -- a timer that determines when sporulation occurs and a two-way switch that causes the cell to choose competence over sporulation.
"We found that the sporulation timer and the competence switch work in a coordinated fashion, but the interplay is complex because the two circuits are affected very differently by noise," said Schultz, a postdoctoral fellow at Harvard Medical School and a former graduate student at CTBP.
Noise results from random fluctuations in a signal; every circuit -- whether genetic or electronic -- responds to noise in its own way. In the case of B. subtilis, noise is undesirable in the sporulation timer but is a necessity for the proper function of the competence switch, the researchers said.
"Our study explains how the two opposite noise requirements can be satisfied in the decision circuitry in B. subtilis," Onuchic said. "The circuits have a special capacity for noise management that allows each individual bacterium to determine its fate by 'playing dice with controlled odds.'"
Ben-Jacob said the timer has an internal clock that is controlled by cell stress. The noise-intolerant timer typically keeps the competence switch closed, but when the cell is exposed to stress over a long period of time, the timer activates a decision gate that opens brief "windows of opportunity" in which the competence switch can be flipped.
Thanks to its architecture, the gate oscillates during the window of opportunity, he said. At each oscillation, the switch opens for a short time and grants the cell a short window in which it can use noise as a "roll of the dice" to decide whether to escape into competence.
"The ingenuity is that at each oscillation the cell also sends 'chemical tweets' to inform the other cells about its stress and attempt to escape," said Ben-Jacob, the Maguy-Glass Professor in Physics of Complex Systems and professor of physics and astronomy at Tel Aviv University. "The tweets sent by others help regulate the circuits of their neighbors and guarantee that no more than a specific fraction of cells within the colony will enter into competence."
Onuchic said the decision-making principles revealed in the study could have implications for synthetic biologists who wish to incorporate sophisticated decision systems as well as for cancer researchers who are interested in exploring the decision-making processes that cancer cells use in choosing to become dormant or to metastasize.
"This represents a real fusion of ideas from statistical physics and biology," he said.
###
Lu is a postdoctoral research fellow at CTBP and Stavropoulos is a former graduate student and CTBP fellow at the University of California, San Diego. The research was funded by the National Science Foundation, the Cancer Prevention and Research Institute of Texas and the Tauber Family Foundation.
A copy of the Scientific Reports article is available at:
http://www.nature.com/srep/2013/130417/srep01668/full/srep01668.html
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
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Public release date: 22-Apr-2013
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