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What one does for love and money! The love being Francine Toutant. The money being one Bill Riley--notorious Dakota Territory outlaw. Thus, we find bounty hunter T. J. Ragland riding across the bleak Dakota Territory carrying the head of Bill Riley in a gunny sack, bound for Fort Leavenworth where a three-thousand-dollar bounty reward awaits him. Reaching the sorry little town of Bend City, tucked into a wide bend in the Missouri River, Ragland intends to catch a riverboat to Fort Leavenworth. Due to some poor decisions, Bill Riley's head is stolen. Marshal Bethany Bulger is a no-nonsense sort of woman who would like nothing better than for Ragland to leave town. Ragland finds this curious until he discovers that Bethany and some other folks are neck deep in insurance fraud. Throw in a drunken Indian, an undercover Pinkerton's detective, foreign agents, and murder, and Ragland quickly discovers a lot more is happening in Bend City than its sleepy appearance suggests.

Nurses make significant contributions to the American healthcare system and should have knowledge of major healthcare policies such as the Patient Protection and Affordable Care Act (PPACA), particularly those nurses in leadership. More nurse leaders of African descent need an understanding of PPACA to advocate for the policy provisions in the law as it relates to social determinants of health (SDH). This paper illustrates a need for a better understanding of PPACA among nurses of African descent to promote health equity. Keywords Patient protection and affordable care act; Social determinants of health; African American nurse leaders; Health equity; Health disparities. Introduction Nurses are the most trusted healthcare providers[1] and are ideally positioned to play an integral role in moving the U.S. healthcare system forward. With the passage into law, the Patient Protection and Affordable Care Act (PPACA) have provided opportunities that may help achieve health equity. Communicating aspects of the law with patients, families, and communities is a major objective of nursing leaders[2]. Fellows of the Leadership Institute for Black Nurses (LIBN) have a duty, as healthcare providers, to be equipped with the tools that promote health equity. LIBN Fellows were immersed in healthcare both professionally and educationally, and it was expected that they would have more knowledge of PPACA than those of the general public who were surveyed by Kaiser[3] in 2010. Understanding provisions in the law is fundamental to healthcare leadership, and nurse leaders have a mandate to remain current in policy and practice[2]. Kaiser[4] reported that by the end of 2015, the number of uninsured nonelderly adults had decreased by nearly 13 million since 2013 due to PPACA. The decrease was due, in part, to the removal of barriers such as pre-existing conditions and healthcare insurance coverage for dependent children up to age 26. In addition, the Department of Health and Human Services5 (DHHS) reported that PPACA has improved the quality of healthcare along with lowering the cost. For example, the cost of prescriptions for seniors has been reduced, and there are now tax credits for small business owners[5]. However, provisions in PPACA that improved access to care such as the health insurance exchanges remain a mystery to many. Moreover, awareness of the benefits of the law still eludes many currently including nurses and more importantly, those who it is intended to help the most. Therefore, this topic remains an issue and more education is needed among nurses as they advocate for healthcare consumers. Knowing fact from fiction is essential to effective leadership. It is necessary that nurses understand new and exciting programs in the U.S. healthcare system regardless of whether the nurse is: • providing direct patient care as a staff nurse, • directing patients’ care as an Advance Practice Nurse (APN), • overseeing a nursing department as a healthcare administrator, • preparing future nurses as a nurse educator, or • Generating nursing science as a scholar. Moreover, since many African American nurses work in urban settings and care for large minority populations, an understanding of PPACA is essential. Purpose The purpose of this paper is to (1) highlight policy provisions in PPACA; (2) discuss the link between social determinants of health (SDH) and PPACA; (3) compare knowledge levels of the American public in December, 2010 to nurses of African descent in December, 2013; and (4) recommend strategies to identify and improve areas of PPACA knowledge deficit. Summary of PPACA PPACA consists of two bills that were signed into law by President Barack Obama on March 23, 2010. The two bills consisted of the Patient Protection and Affordable Care Act (H.R. 3590) and Education Reconciliation Act of 2010 (H.R. 4872). Once signed by President Obama, the bills became Public Law 111-148[6] (Table 1) and Public Law 111-152[7] respectively (Table 2). Approximately two years later, on June 28, 2012, the Supreme Court rendered a final decision to uphold the healthcare law[8]. However, there are still efforts to repeal the law. PPACA focuses on provisions to expand coverage, control healthcare costs, and improve the healthcare delivery system. One key provision of PPACA bans discrimination against preexisting conditions[9]. There are ten titles in the law6 which address various areas in healthcare that contribute to the improvement of the U.S. healthcare delivery system (Table 1). The focus of the provisions of PPACA are quality of healthcare, affordable healthcare for all Americans, improved efficiency of healthcare, prevention of chronic disease, and improvement of public health. Title V of PPACA focuses on improving workforce training and development, and encompasses several areas targeting nursing education and training aimed at adequately preparing nurses at all levels to serve the population. Public Law 111-1527 adjusted revenue and financing schedules for private insurance coverage, Medicare, Medicaid; and reduced fraud, waste, and abuse in healthcare financing. In addition, key components of this law addressed investing in students and families through student loan reform, modifying financial assistance for higher education, and eligibility criteria for dependent children (Table 2). Together, Public Laws 111- 148 and 111-152 are referred to as the Patient Protection and Affordable Care Act. Quality Affordable Health Care for All Americans a.Eliminates lifetime annual limits on benefits. b.Prohibits rescissions of health insurance policies. c.Provides assistance for those who are uninsured because of a pre-existing condition. d.Prohibits pre-existing condition exclusions for children. e.Provides coverage of preventative services and immunizations. f.Extends dependent coverage up to age 26. g.Develops uniform coverage documents to help consumers better compare policies. h.Limits insurance company non-medical administrative expenditures. i.Ensures consumers have access to an effective appeals process. j.Creates a temporary re-insurance program to support coverage for early retirees. k.Establishes an internet portal to assist in identifying coverage options. l.Facilitates administrative simplification to lower health system costs. Role of Public Programs a.Expands Medicaid availability to consumers previously ineligible. b.Requires states to maintain eligibility levels for the Children’s Health Insurance Program (CHIP) through September 2019. c.Simplifies enrollment through state-run Web sites. d.Creates the availability of the Community First Choice Option. e.Reduces states’ Disproportionate Share Hospital Allotments (DSH). f.Improves federal and state coordination for individuals enrolled in Medicare and Medicaid. Quality and Efficiency of Health Care a.Links payment to quality performance on common, high-cost conditions. b.Establishes national strategy to improve service delivery, patient outcomes, and population health. c.Encourages development of new patient care, payment, and delivery models. d.Ensures beneficiary access to physician care. e.Offers rural protections. f.Improves payment accuracy. g.Rearranges Medicare Advantage (Part C) payment schedules. h.Reduces Medicare Prescription Drug Plan (Part D) costs. i.Ensures Medicare sustainability. j.Improves quality of community health care. Chronic Disease and Public Health a.Modernizes disease prevention and public health systems. b.Increases access to clinical preventive services. c.Creates healthier communities. d.Offers supports for prevention and public health innovation. Health Care Workforce a.Encourages innovative review of the workforce. b.Increases the supply of health care workers. c.Enhances health care workforce education and training. d.Supports the existing health care workforce. e.Strengthens primary care and other workforce improvements. f.Improves access to health care services. Transparency and Program Integrity a.Encourages physician ownership and transparency. b.Improves nursing home transparency. c.Targets enforcement. d.Improves staff training. e.Institutes nationwide program for background checks on direct patient access employees of long term care facilities and providers. f.Establishes patient-centered outcomes research. g.Establishes integrity provisions for Medicare, Medicaid, and CHIP. h.Enhances integrity provisions for Medicare and Medicaid. i.Encourages additional Medicaid program integrity provisions. j.Encourages additional program integrity provisions. k.Encourages enforcement of the Elder Justice Act. l.Expresses the sense of the Senate regarding medical malpractice. Access to Innovative Medical Therapies a.Establishes biologics price competition and innovation. b.Provides more affordable medicines for children and underserved communities. Community Living Assistance Services and Supports a.Establishes national voluntary insurance program for purchasing Community Living Assistance Services and Support (CLASS). Revenue Provisions a.Levies excise tax on high cost employer-sponsored health coverage. b.Increases transparency in employer W-2 reporting of health benefits values. c.Supports distributions for medicine qualified only if for prescribed drugs or insulin. d.Increases additional tax on distributions from HSAs and Archer MSAs not used for qualified medical expenses. e.Limits health-care related FSA contributions. f.Institutes requirement of corporate information reporting. g.Establishes new requirement for non-profit hospitals. h.Imposes a pharmaceutical manufacturer’s fee. i.Imposes a medical device manufacturer’s fee. j.Imposes an insurance provider fee. k.Instates requirement of Department of Veterans Affairs report. l.Eliminates the deduction for employer Part D subsidy. m.Modifies the threshold for claiming the itemized deduction for medical expenses. n.Limits executive compensation. o.Imposes additional hospital insurance tax for high-wag

In Victorian society, women of the middle class were particularly vulnerable to white-collar crimes. Denied opportunities to earn their own living, single women were especially dependent on invested capital. Women, in fact, made up a significant portion of investors during the nineteenth century, especially in such key areas of the economy as banking, railways and insurance. Yet, bourgeois notions of gentility required that women remain ignorant of money matters and refrain from active participation in business affairs, leaving women especially exposed to all manner of fraud and malfeasance. This article uses financial literature, newspaper debates and popular fiction to demonstrate how women were victimized by white-collar crime. Women's financial victimization was a common theme of the popular press, economic journals and fiction. These discourses contributed to a feminist discourse of economic and political empowerment, and suffragists and other progressives argued that women had to reform an economy and financial system in which they were both marginalized and deeply implicated.

Together, they managed to bill Amtrak's health insurance for procedures that were either medically unnecessary or simply... imaginary. Figueroa and her team would gather Amtrak employees' health insurance details, sign off on bogus treatments, and kick back cash rewards to their compliant \"patients.\" Health insurance Medicaid fraud scheme nets over $93 million and 14 years in jail Once again, Florida doesn't disappoint on the \"seriously?\" front. Medicare was sent invoices for countless hours of therapy sessions and health services that never happened.

One winter's morning in London, loss adjuster Lorimer Black - handsome, clever, insomniac - goes to keep a routine appointment to assess an insurance claim and finds a hanged man. Not a good start to the day by anyone's standards, but for Lorimer it is the beginning of a time of confusion and betrayal that turns his life upside down. As Lorimer, increasingly stressed and baffled by the actions and deceptions of those around him, battles through, he realises the peace and security he craves - his personal insurance - can only be provided by escape ... Adapted by William Boyd from his best-selling novel, Armadillo is a darkly comic and acute exploration of modern life.

One winter's morning in London, loss adjuster Lorimer Black - handsome, clever, insomniac - goes to keep a routine appointment to assess an insurance claim and finds a hanged man. Not a good start to the day by anyone's standards, but for Lorimer it is the beginning of a time of confusion and betrayal that turns his life upside down. As Lorimer, increasingly stressed and baffled by the actions and deceptions of those around him, battles through, he realises the peace and security he craves - his personal insurance - can only be provided by escape ... Adapted by William Boyd from his best-selling novel, Armadillo is a darkly comic and acute exploration of modern life.

One winter's morning in London, loss adjuster Lorimer Black - handsome, clever, insomniac - goes to keep a routine appointment to assess an insurance claim and finds a hanged man. Not a good start to the day by anyone's standards, but for Lorimer it is the beginning of a time of confusion and betrayal that turns his life upside down. As Lorimer, increasingly stressed and baffled by the actions and deceptions of those around him, battles through, he realises the peace and security he craves - his personal insurance - can only be provided by escape ... Adapted by William Boyd from his best-selling novel, Armadillo is a darkly comic and acute exploration of modern life.

In two prior papers, \"Properly Documenting a File and Forensic Examination of IME Doctors\" and \"Qualifications and Paradigms for the Independent Examiner,\" we first explained how field practitioners can better document case files to withstand challenges, including those made by Independent Examiners (IEs, a.k.a. IMEs, ICE, DME, QME), and addressed forensically examining the IE, as well. The second paper sought to establish reasonable standards and protocols to which IEs should be held. It is thought that, in this way, the examiner's credibility can be established, to say nothing of actuating fair and accurate examinations. Still, despite nationwide protest and outrage among practicing doctors and angry patients, the reality is that in a vast majority of jurisdictions in the U.S., any doctor can become an IE merely by making application with an insurance company or intermediary; for most states, there are simply no standards or guidelines to organize this process. We have always spoken out against this. The previous two papers represent two of the few published works on this subject. This paper will demonstrate the excesses some IEs go to in cutting claims. While we hasten to add that this is not an indictment against all Independent Examiners, these are stories that need to be told because they shed light on what is becoming alarmingly commonplace in health care: IEs who ignore patients, ignore factual medical realities, and ignore sworn testimony, downgrading real injuries under the fiction of being \"independent.\" When called to task, the IE has only to say, \"That's my opinion,\" without threat of lawsuit, discipline, or any form of sanction. We consider such scenarios a moral outrage and an injustice to patients who suffer as the result of biased \"independent\" examinations. Many IEs do \"reviews\" and \"independent examinations\" full time and do not actually treat patients anymore. Although business is booming, it's the patients who lose out. [PUBLICATION ABSTRACT]

This qualitative article examines the use of real crime stories as inspiration for storylines within the Law & Order franchise. Using cultivation theory as an anchor, the author explores motivations behind viewers' fascination with the \"ripped from the headlines\" episodes featured on Law & Order, Law & Order: Criminal Intent and Law & Order: Special Victims' Unit. Parallels are made between the fictional stories and real crime news. In addition, entertainment media strategies are studied as the means by which crime drama writers attempt to meld fiction with reality in a fashion that is both entertaining and informative for the audience. Among the most significant of the strategies employed by the L&O franchise is its ability to turn out stories mere weeks after crime news hits the streets. Finally, the author demonstrates that, in some cases, when the crime drama serves as tutorial for potential offenders, fiction inspires real crime. [PUBLICATION ABSTRACT]