Health Care Tools
The health care industry is currently the largest sector of the U.S. economy, and arguably, the most heavily regulated. Health law is a burgeoning specialty area, which primarily focuses on regulatory and policy issues facing health care providers such as hospitals, treatment centers, clinics, doctors, and pharmaceutical companies. However, due to its complexity, health law intersects and overlaps with many other areas of law including medical malpractice, personal injury, and insurance law.
Health law is a rapidly growing legal specialty in a rapidly changing marketplace. Because the health care industry is currently the largest sector of the U.S. economy, many interesting issues and challenges arise. The practice of health law is deeply influenced by the fact that health care is the most heavily regulated industry in the US.
If you have a health law issue, contact an attorney at The Stevenson Law Firm, PC. in Houston, Texas today for experienced legal advice.
Generally, health law is practiced by lawyers representing industry players rather than patients. Health lawyers include in-house counsel for hospitals, clinics and nursing homes; attorneys representing pharmacies and laboratories; and those managing regulatory compliance, HIPAA and billing policy issues for health insurers, HMOs, managed care organizations and corporate human resource departments. They also can be solo practitioners representing a single doctor’s office, substance abuse treatment center, AIDS advocacy organization or health care industry trade association.
Although medical malpractice, dangerous drugs and medical devices, recalls, standards of care and other issues involving harm to individuals are legal areas that intersect health law, it is more likely that health law attorneys will become involved in the regulatory or policy end of these matters. Bioethics, professional ethics, policies and procedures and political issues are all related to this broad legal specialty.
- Medical record retention rules, confidentiality and HIPAA compliance
There are many regulations in place to ensure that health care providers take adequate care regarding patients’ privacy, record retention, and confidentiality. In 1996, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted. HIPPA was enacted to make transmitting health care information electronically, more efficient for health care providers.
In response to privacy concerns, the Department of Health and Human Services (HHS) developed privacy standards and enacted the Privacy Rule, in 2001. The Privacy Rule sets out procedures regarding storing and retaining documents, informing patients of the health care providers’ procedures, and the patients’ rights. The information protected by the Privacy Rule is any information received by a health care provider, which is individually identifiable information relating to the health care (mental or physical) of an individual. This information is often referred to as Protected Health Information (PHI). The HITECH Act, passed in2009, requires additional policies and procedures for protecting that health information.
In summary, HIPPA prohibits discrimination of individual participants and beneficiaries based on health status, sets standards for privacy of medical records, requires specific information to be communicated to patients regarding their privacy, and to reduce administrative costs of providing and paying for healthcare. HIPPA governs a wide range of entities including employer-sponsored group insurance plans, insurance companies, and managed care organizations (MCO).
- Regulatory approval and licensing for health care providers
- Hospital accreditation, provider affiliation, staff privileges and academic affiliation of teaching hospitals
- HIPAA compliance
- Stark and anti-kickback laws
- Mergers and acquisitions of for-profit and non-profit hospitals and antitrust law
- Obtaining and maintaining tax exempt status
- Drafting and enforcing hospital bylaws
- Managed care entities: MCOs, IPAs, PPOs, PHOs, PSOs, IHSs, MSOs, PPMs and IDSs
- Nursing home and other assisted living facility administration and regulation
- Preventing and dealing with deficiencies in patient care, medical protocols and procedures
- Regulation of medical practice, professional ethics and bioethics
- Choice and implementation of new technology in health care
Living wills (also known as advanced directives) and durable powers of attorney are legal documents that can assist your family members and health care provider make decisions for you, in the event you are unable.
Living wills appoint a person to make decisions for another should they become incompetent or unable to make decisions for themselves. Living wills provide specific instructions to the decision maker and can address issues such as end-of-life decisions, specific definitions of acceptable quality of life, disposition of the body (cremation vs. burial), and organ donation.
Durable powers of attorney give the named agent power to make medical and health care decisions for a person. However, a durable power of attorney does not include specific instructions for care or end-of-life decisions. Because specific instructions and wishes are not included, it is important to discuss these issues with the person to whom you give power of attorney.
- Insurance, Medicare/Medicaid and third-party payor liability and reimbursement rates
- Health insurance coverage, disputes and bad faith claims
- Medicaid and Medicare billing issues
- Medicaid, Medicare and SCHIP disputes
- Health care, Medicare and Medicaid fraud
- Hospital lien-for-payment rules
- Prompt payment laws
- Illegal kickbacks, patient referrals, physician incentive plans, percentage fee arrangements and other payment issues
Employer-sponsored group insurance plans are common and often confusing. If there are multiple plans offered, the choices may seem overwhelming. When selecting health insurance (whether it is an employer-sponsored program or an individual policy) it is important to understand costs and benefits of different types of plans. For example, selecting a Preferred Provider Organization plan (PPO) may be attractive due to its lower cost. However, PPOs offer the lower prices for participating providers, meaning if you wish to visit a medical professional who is outside of the network, there will be out-of-pocket expense for the services. On the other hand, Health Maintenance Organizations (HMO) may provide more choices, but at a higher cost. It is important to remember that each insurance coverage plan is different, and when selecting coverage you should review the plans carefully and select one that fits your individual needs.
- Drafting hospital-physician employment agreements, physician rate regulation, doctors’ unions and collective bargaining
- Food and Drug Administration issues
- Dispenser liability
- Prescription drug advertising and marketing
- Over-the-counter drug, dietary supplement, cosmetics, food labeling and advertising regulation
- Regulation of exports and imports of foods and cosmetics
- Public health policy and regulation
- Withdrawal of life support, refusal of care and death-and-dying issues
- Assisted reproduction and rights of ownership over embryos
- Medicaid, Medicare and SCHIP policy
Medicare is federal program, which provides health care coverage for people who are over the age of 65 or who are disabled. Medicare may be used for doctor or clinic visits as well as for long-term medical treatment and rehabilitation. Medicare coverage can also used for assisted-living facilities including nursing homes. Not all health care providers accept Medicare, and it is necessary to ensure coverage that a patient using Medicare verify before treatment.
Medicaid is a federal program, which works in conjunction with state programs to provide medical insurance assistance to low-income people, in particular, children. Much like Medicare, not all health care providers accept Medicaid as a form of payment or insurance coverage, and it is necessary to verify that Medicaid will be accepted before receiving treatment. In some states, the Medicaid programs have been expanded to include the State Children’s Health Insurance Program (SCHIP). This program was established specifically to provide health care to uninsured and low-income children. In states where it is not included under an expanded state Medicaid program, it is often offered through a separate program.
Health law is a complex, far-reaching, vast field serving many interests; involving HIPPA compliance and compliance with other state and federal health regulations. From advising physician groups on choice of entity to providing legal representation to hospital CEOS, to regulating the implementation of new medical devices to handling medical billing disputes, attorneys practicing health law offer many different services.
If you have questions regarding qualifying for Medicaid or Medicare, the manner in which your health care provider handled your Protected Health Information or any other HIPPA compliance issue, an experienced health law attorney can provide guidance.