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According to Medicare,” Accountable Care Organizations, or ACOs, are all about providing the best types of care for patients with Medicare, while simultaneously helping to lower the cost of healthcare. They consist of a coordinated group of doctors, hospitals and various types of medical providers who work together for the benefit of the patients they serve, allowing them to get the right care when they need it.” Additionally, their mission is to help control the amount of waste in the Medicare system. This includes patients seeing more than one specialist for the same condition and undergoing the same tests, as well as excessive visits. For additional information related to controlling waste and fraud in the Medicare system see my earlier posting  Combating Fraud and Deception: Medicare’s Strategies and Initiatives .

On April 16, 2024, the Congressional Budget Office  (CBO)*  issued a report, Medicare Accountable Care Organizations: Past Performance and Future Directions, which summarizes recent research findings about Medicare accountable care organizations and the factors that have contributed to or limited their ability to achieve net budgetary savings for the Medicare program. The remainder of this posting includes a summary of this report prepared by the CBO and links to both the complete text of the report and to other publications related to it.

SUMMARY:

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Thinking back on my fifty plus years as a practicing law librarian, I have come to believe that criminal law is one of the more humanistic of legal disciplines because it can reach people at such a personal level. Paul H Robinson* and Sarah M Robinson capture this thought in their book, “American Criminal Law: Its People, Principles, and Evolution” (Routledge 2022). It offers a refreshing take on this complex subject.

This book breaks away from dry legal jargon and  instead weaves a compelling narrative that explores the history, core concepts, and ongoing debates within American criminal law. The authors write, “Criminal law is one of the most interesting perspectives on the human adventure,… it requires us to examine how we want people to act, what we will do when they act improperly, and how we decide what we can reasonably expect of people. And to do this, we must assess what makes a successful society, what citizen protections and obligations a society should enforce, as well as the principles of justice that the community shares.”

The authors’ strength lies in their engaging, approach. Each chapter delves into a specific principle, like legality or culpability, by presenting a historical case that illuminates its foundation. This is then contrasted with a modern case, highlighting the evolution of the concept. This back- and- forth through time keeps the reader engaged and demonstrates how the law adapts to societal changes.

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Eyewitness accounts, once considered a gold standard, have faced increasing scrutiny due to their susceptibility to memory errors and biases. Forensic evidence, while highly valuable, comes with its own set of limitations, such as the time-consuming nature of analysis and the potential for contamination.

Enter the age of technology, which has drastically altered the way law enforcement approaches suspect identification. Innovations in data collection, processing, and analysis have paved the way for faster and more accurate identification techniques. The advent of artificial intelligence (AI) technology has proven particularly transformative, revolutionizing the field of criminal investigations.

Eyewitness identification remains a cornerstone of criminal justice, despite its well-documented weaknesses. Human memory is fallible, susceptible to stress, suggestion, and bias. Artificial intelligence (AI) offers a potential revolution in this domain, but its impact is a double-edged sword.
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The American Bar Association Standing Committee on Ethics and Professional Responsibility released Formal Opinion 509 on Feb. 28, 2024.  According to the announcement,  Formal Opinion 509 provides guidance on how disqualification rules apply to both current and former government lawyers under the ABA Model Rules of Professional Conduct. “It specifically addresses issues raised  when these lawyers know confidential government  information about a third person.”

The model rules define confidential government information as “information that has been obtained under governmental authority and which, at the time this rule is applied, the government is prohibited by law from disclosing to the public or has a legal privilege not to disclose and which is not otherwise available to the public.”

For additional discussion of Formal Opinion 509, see the recent article in the ABA Journal, Government lawyers’ use of ‘confidential information’ in private practice clarified in new ABA ethics opinion, by David L Hudson Jr.

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The death penalty remains a highly contested issue in the United States, with arguments raging on both sides. However, beyond the ethical and legal debates lies a lesser-known aspect: the phenomenon of failed executions. These attempts, often characterized by prolonged suffering and technical difficulties, raise serious concerns about the very concept of a humane and constitutional capital punishment system.

Historically, the U.S. has employed various methods for execution, each with its own share of botched attempts. The electric chair, implemented in the late 19th century, witnessed numerous cases where the condemned endured extended periods of agony due to malfunctions or improper application. Lethal injection, the current primary method, has also been plagued by issues. From 2000 to 2020, an estimated 7% of all lethal injection executions were classified as botched, often involving prolonged struggles to establish an intravenous line, raising concerns about unnecessary suffering inflicted upon the condemned. It is estimated that 3% of U.S. executions in the period from 1890 to 2010 were botched.

The case of Thomas Eugene Creech in Idaho in 2023 exemplifies the harrowing realities of failed executions. Despite repeated attempts by medical personnel, a suitable vein could not be located for lethal injection, forcing the execution to be halted. This incident, like many others, highlights the inherent fallibility of the execution process where unforeseen complications can transform the intended punishment into an act of torture. In his article in Verdict discussing this case, Austin Sarat, a professor of jurisprudence and political science at Amherst College, argues that “systemic issues and denial by state officials perpetuate the cruelty and inefficiency of lethal injections, urging an acknowledgment of its failures and a cessation of its use for capital punishment”.

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The following is information compiled by the Congressional Budget Office (CBO) regarding H.R.7322, Standing Up to the Executive Branch for Act 2024, as ordered reported by the House Committee of the Judiciary on February 15. 2024. It includes a brief  summary of the bill, and links to estimated cost of implementation and the full text of the legislation:

SUMMARY:

H.R. 7322 would grant standing to state governments to bring action against the federal government in a federal district court for the purpose of seeking injunctive relief from immigration enforcement decisions that have harmed the state or its residents.

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INTRODUCTION:

Medicare, the federal health insurance program in the United States, serves millions of Americans, providing essential healthcare coverage for seniors and certain individuals with disabilities. However, with its vast reach and substantial funding, Medicare is also a target for fraud and deception. Fraudulent activities not only drain taxpayer dollars but also jeopardize the integrity of the healthcare system and endanger patient well-being. To combat these threats, Medicare employs various strategies and initiatives aimed at detecting, preventing, and prosecuting instances of fraud and deception.  Yet, some people would argue the since Medicare loses billions of dollars every year to fraud, waste, and abuse, they could do a better job at preventing fraud.

DETECTION MECHANISMS:

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Projections of the Congressional Budget Office, 

“The Congressional Budget Office regularly publishes reports presenting its baseline projections of what the federal budget and the economy would look like in the current year and over the next 10 years if laws governing taxes and spending generally remained unchanged. This report is the latest in that series.”

“In CBO’s projections, federal budget deficits total $20 trillion over the 2025–2034 period and federal debt held by the public reaches 116 percent of GDP. Economic growth slows to 1.5 percent in 2024 and then continues at a moderate pace.”

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Microsoft has sponsored and published a valuable collection of essays on the future of AI written by a  group of experts, with specialties encompassing a broad spectrum—spanning the fields of business, economics, education, engineering, healthcare, history, law, mathematics, medicine, mental health, psychology, and the sciences—to explore the capabilities of GPT-4 before its public release and provide their insightful reflections” on the future of AI. The collection includes an Introduction, Reflections on AI and the Future of Human Flourishing. by Eric Horvitz, Chief Scientist at Microsoft.

Experts who participated  in this project were asked to consider the following two questions when preparing their essays:

How might this technology and its successors contribute to human flourishing?

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Between December 3, 2023, and January 3, 2024, LexisNexis Legal and Professional conducted a survey across 266 Managing Partners and other leaders at American Law 200 and other large law firms. Nearly a third of the executives surveyed indicated their firms had a dedicated budget for generative AI for 2024 and almost 90% indicated they expect their investment in generative AI to increase over the next five years. “Findings include results from 114 executives across 68 Am Law 200 firms, 102 executives across 79 other  large law firms, and 50 executives across 44 Fortune 1000 companies. Firms recognize the potential return on their investment, with 47% believing generative AI technology will decrease costs and 30% believing it will increase revenue. Nearly half of executives are exploring new business opportunities made possible by the technology (47%).” Surveys were conducted in English via the Forsta  survey platform.

For more details regarding survey findings,  Click here  to view the Executive Summary (an overview),  Findings (Full Survey Results), an Appendix, and a discussion of the methodology.

 

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