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The EPA conducted a study on the effectiveness of the amnesty program after three years of implementation on May 17, 1999. It found that, during the study period, 455 entities had revealed violations of 1,850 facilities and that the rate of disclosure had also gone up. The EPA also noted that the amnesty policy was most beneficial in four major areas. These were overall benefit to human health and the environment, prompt disclosure and correction of violations, improvements in corporate compliance policies and programs, and increased awareness of new environmental issues. The EPA took special note of how the policy encouraged prompt disclosure and correction of violations. Those who disclosed said that the program encouraged them to prove their auditing and reporting procedures. Most of them reported improving corporate programs in the form of a broader scope of corporate compliance activities; greater diligence, thoroughness and frequency of auditing processes; and greater timeliness of internal and external reporting of violations (Mustokoff et al.).
Antitrust Amnesty Program
Promulgated on August 10, 1993, this policy considered the DOJ's most successful amnesty program (Mustokoff et al. 2000). It draws its success from an absolute guarantee of amnesty from criminal prosecution for disclosing directors, officers and employees of the company. The disclosure is shielded from criminal liability if he is the first to report the violation; promptly and effectively ends the violation; reports the violation spontaneously and completely, and cooperates with Antitrust. The disclosure has to be a true corporate act rather than an isolated or individual act. The discloser makes appropriate restitution. He did not coerce another participant into the violation and is not its leader or instigator (Mustokoff et al.).
Before 1992, the DOJ held discretionary authority under the Antitrust Division's self-disclosure policy to exercise leniency, rather than amnesty, to a discloser (Mustokoff et al. 2000). In the 14 years of implementation, only 17 companies applied for leniency and only 10 were granted it. Under the present policy, leniency applications grew 12 times. The revenues accruing from enforcement activities exceeded $200 million in the first year alone. It evidenced that full amnesty would promote voluntary disclosure of antitrust activity. Besides generating enforcement revenues, amnesty agreements effectively put an end to the collusion. This immediately benefited the government by correcting the legal violation (Mustokoff et al.).
Responsive Healthcare Amnesty Model
Successful healthcare fraud enforcement can be effected, gleaning from these specific models (Mustokoff et al. 2000). They provide evidence that voluntary disclosure program will be effective if they offer some guarantee of amnesty to disclosers and on condition. It needs to be guided by clear, uniform and truly enforced standards. These models suggest that an effective voluntary disclosure program for healthcare providers could make the same guarantee of amnesty from civil liabilities and criminal prosecution and on certain conditions. The violation was discovered voluntarily and independently of auditing or whistle-blowing; was disclosed promptly; and came out of appropriate self-disclosure and in full cooperation with the OIG's investigation of the violation. The entity would also repay in full, including overpayments and interest, within the time set by the OIG and operate an OIG-approved compliance plan to prevent recurrence. The shared experiences of the government agencies involved in these proven self-disclosure amnesty programs may prove applicable to healthcare providers who will self-disclose. The correction of violations is perceived to produce considerable positive effects. One is that it will encourage prompt disclosure and correction of the violation. This will lead agents to go after the worst violators. By eliminating the risk, which would ordinarily accompany the act of disclosure, the development and use of more compliant programs can be enhanced. It can also identify types and perpetrators of abuse, increase enforcement revenues and decrease enforcement costs. Most of all, it will establish a desirable environment of greater cooperation and trust between the government and healthcare providers (Mustokoff et al.).
Physician's Self-Disclosure and Patient Satisfaction recent non-randomized study of surgeons found that their occasional self-disclosure made the patients perceive their warmth and friendliness and resulted in patient satisfaction (Beach et al. 2005). Physician self-disclosure may or may not conduce to trust and rapport. Some may even consider it inappropriate as it crosses professional boundaries between physician and patient. A study conducted on patient satisfaction involved 59 primary care physicians and 65 surgeons and audio-taped statements by patients who made 1,265 office visits. The patients were surveyed with questions on their overall satisfaction, whether they would recommend their doctor to others, how well he knew them and his qualities as a person. Other studies revealed the occurrence of self-disclosure at 17% of primary care visits and 14% of surgical visits. In these cases, 71% of physicians self-disclosed to patients at least once. Surveyed patients rated primary physicians as much less warm and friendly when they self-disclosed to patients. Fewer patients were satisfied with the visit when primary care physicians self-disclosed. But the study found that surgeons' self-disclosure elicited patients' high level of warmth and friendliness at 60% and reassurance or comfort at 59%. The overall finding was that patients described their visit as very satisfactory at 88% (Beach et al.).
Patterns of Self-Disclosure in Northern Ireland
Self-disclosure has been grabbing attention since the pioneering studies made by Jourard so that gathered data on the subject have become voluminous (Hargie 2001). But the areas of adolescence and religion have been largely unexplored. Northern Ireland is divided between Catholics and Protestants and between Nationalists and Unionists. As a result of this division, children of one religion never get to meet children of the other religion. People worship in different churches. They live and socialize in their own homogenous communities. They play their own sports and engage in their own cultural activities. Almost all Protestants in many part of Northern Ireland attend "State" or "controlled schools." Meantime, Catholic attended "maintained" schools. Young Protestants and Catholics differed in their attitude towards disclosure. A growing tendency to integrate children from the two denominations together for their education has also remained at a 2% low (Hargie).
A series of investigations was conducted to address these and other issues, including gender and patterns of self-disclosure (Hargie 2001). The general finding of the investigations was that self-disclosure increases as people age. They self-disclosed least during adolescence as this is the stage of development when the personality is still forming. It is the time of self-search, when they find self-disclosing most difficult. One of the studies on adolescent friendships revealed that 66% of the girls wanted to just talk with other girls more than did boys of their age at 60%. The girls got involved in personal and supportive discussions while the boys had little or no such intimate involvement. The girls self-disclosed on family problems and personal experiences. Boys, on the other hand, revealed only non-confidential or personal matters, such as school events or grades (Hargie).
Another study in the series said that female adolescents made more emotional disclosure to parents and peers than male adolescents (Hargie 2001). Younger adolescents also disclosed more than older ones to their peers. Still another study was made on gender differences in self-disclosure to four targets. These targets were mother, father, best female friend and best male friend. The subjects were more inclined to open up to mothers and best female friends than to fathers and best male friends. This meant that female targets were favored as recipients of disclosure as they are perceived to be more empathic and understanding than male targets. In one study concerning revealing secrets, the researchers found gender differences as a main factor. Girls expressed greater willingness to divulge family secrets than boys. Boys, on the other hand, were more willing to reveal secrets about moral offenses and possessions (Hargie).
One early study found that people would disclose to parents and friends of both genders, regardless of religion (Hardie 2001). Jewish people also tended to be disclosers more than those of other denominations, such as Baptists, Catholics and Methodists. Researchers attributed this to the Jewish culture rather than their religion. Jewish families are closely-knit. Still another study discovered that males were more likely to disclose to a person not wearing a habit. On the other hand, women were more prone to open up to a religious wearing a habit, like a nun or priest. Thus, it was the impact of clothing, rather than religious affiliation, which elicited more self-disclosure. A comparative study on clients and counselors who said they were devout Christian, Jew or another denomination. Jewish clients disclosed much less to Christian counselors. Researchers, therefore, concluded that the counselor's disclosure of religion would not enhance client disclosure but even reduce or inhibit it (Hardie).
Researcher Greer suggested that Catholics were more disclosing or "open" than Protestants because of their practice of confession (Hardie 2001). A study of Protestant and Catholic female undergraduates in Northern Ireland showed the difference in their level of disclosure was negligible. The Catholic female would, however, disclose more to another Catholic female than would a Catholic to a Protestant, a…[continue]
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