Health law is the wide body of law that regulates the provision of healthcare services.
Health law governs the relationship between those who provide healthcare and those who receive it.
There are many topics and subtopics involved in the provision of healthcare law including the provision of services, contracts, employment law, and fraud.
Health lawyers may focus on one area of healthcare law, or they may provide comprehensive legal services for a healthcare provider.
Major Health Law Legislation in the United States
There are a number of key federal laws that influence health services in the United States:
Social Security Amendments of 1965
The Social Security Amendments of 1965 established the federal Medicaid and Medicare programs.
Medicare provides government-funded health insurance to qualifying seniors.
Medicare exists because seniors may have a hard time securing health insurance in the private market.
Medicaid is government-sponsored health insurance for low-income individuals.
Each state administers its own Medicaid program based on federal guidelines.
Emergency Medical Treatment and Active Labor Act (EMTALA)
The Emergency Medical Treatment and Active Labor Act of 1986 requires healthcare providers to deliver medical services to anyone in an emergency situation.
A health services provider may not refuse to provide services based on a person’s inability to pay.
The healthcare provider must stabilize the individual or transfer them to a facility that can offer appropriate services.
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act requires health services providers to keep personal health information private.
Providers must allow patients to access their own medical records.
HIPPA creates strict rules about when providers can share a patient’s treatment information.
The purpose of the law is to help individuals receive better care knowing that their information must be kept confidential.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
The Consolidated Omnibus Budget Reconciliation Act allows individuals and families to keep group health insurance in place for a certain period of time following a change in employment for covered reasons.
Because private health insurance is often provided by an employer, a person who loses their job may find themselves and their family suddenly lacking health insurance.
COBRA laws require the employer to continue to keep the employee on the group plan for a period of time after their employment ends.
The provision of coverage is at the employee’s own expense.
Although individuals electing COBRA may have to pay the cost of the premium, COBRA laws allow individuals to keep their health insurance in place while they go through a personal change and make new arrangements.
Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act of 2010 is commonly known as the Affordable Care Act.
The Act expands Medicaid eligibility and is funded by increased taxes for high-income earners.
Under the Act, insurers must accept all applicants. In turn, all citizens must purchase insurance.
Insurers can’t discriminate on the basis of pre-existing conditions, and they must charge uniform rates regardless of a person’s medical history.
Consumers may qualify for premium subsidies based on income.
Areas of Health Law
Health law is a complex collection of a variety of legal matters and issues.
Many of the issues in health law are complex and diverse.
Health lawyers may focus on one issue for a large company, or they may help a healthcare organization with a variety of the following legal needs:
There are many healthcare laws and regulations that exist at the federal, state, and local levels.
Healthcare providers must comply with complex laws like HIPPA, COBRA, and the Affordable Care Act.
Compliance efforts are critical to ensure that healthcare providers both large and small follow the laws and provide care in the best way possible.
Insurance and the Third-Party Payer System
In the United States, the healthcare system largely relies on third-party payers.
Individuals often rely on private insurance to cover a portion of the cost of care.
Government-sponsored insurance programs like Medicare and Medicaid may also cover the cost of care.
Individuals may purchase health insurance privately or receive it as a benefit of employment.
In addition to insurance policies for all health service expenses, car insurance policies may also provide benefits that cover injuries that clients sustain in a vehicle accident.
Health attorneys help their clients comply with health insurance laws and disputes.
When parties dispute whether a health insurance contract should provide coverage, they rely on health attorneys to litigate the dispute.
Health insurance providers also need attorneys to help them understand, implement, and comply with federal and state laws regarding health insurance.
Fraud and Abuse
Health attorneys must work to fight fraud and abuse in the healthcare system.
They may work for a state or federal attorney’s office that investigates or pursues allegations of healthcare fraud.
Healthcare fraud may involve insurance fraud or drug fraud.
Medical fraud and abuse may even involve reports to a state medical licensing board and actions taken against the professional license of a doctor, nurse, or other healthcare professional.
Creation of Healthcare Service Entities and Management
Organizations that provide health services depend on attorneys to help them incorporate and operate.
Provider organizations need help to incorporate as an entity, to keep records, and to make reports.
Once they’re established, they may need help with operational tasks like contracting with service providers.
They may help the organizations they represent manage relationships with third parties including law enforcement.
Pharmaceutical and Medical Device Manufacturing
There’s a great deal of work that goes into creating a new drug or medical device and placing it into the marketplace.
Pharmaceutical companies and device manufacturers need attorneys to guide them through the approval process.
They may also create contractual agreements for the marketing and sale of their products.
Health attorneys help their clients file for patent protection for their new products.
When disputes arise regarding drugs or medical devices, health attorneys may litigate on behalf of their clients in order to resolve the dispute.
Medical Malpractice and Tort Law
Medical care doesn’t always go as planned.
When a patient believes that they may be the victim of negligence or intentional misconduct at the hand of a medical care provider, they may bring a claim for damages.
Each state has its own laws or common law for medical malpractice claims.
Some states have limitations that may apply like a cap on non-economic damages.
Health attorneys represent clients as both plaintiffs and defendants in medical malpractice litigation.
Who Practices Health Law?
Because health law encompasses so many different types of law, health lawyers may also practice many different types of law.
A lawyer may serve as in-house counsel for an organization that is in the health industry such as a hospital or insurer.
In the role of in-house counsel, a health lawyer may spend a great deal of their efforts advising the organization on compliance issues and how to implement various laws impacting the provision of healthcare.
Attorneys may also work in private practice on behalf of health providers and consumers.
Because health law is such a large and diverse body of law, health lawyers have a great deal to learn in order to properly advise clients on how to comply with the law.
Some states allow for special certification in health law.
There are numerous opportunities to practice health law as a government employee.
For example, states rely on government attorneys to help them implement Medicaid programs.
They also rely on attorneys to prosecute healthcare fraud and abuse.
Federal and state governments rely on health lawyers to implement their laws, develop healthcare policies, and address waste and fraud.
Why Become a Health Lawyer?
Health lawyers are critical to the efficient and fair provision of healthcare.
Health laws influence every resident of the United States.
Health lawyers have the opportunity to influence how a society gives and receives healthcare.
For lawyers who are passionate about public health, they have the opportunity to contribute to the public welfare with their work.
In addition, health law may be interesting to attorneys who have an interest in science, medicine, or ethics.
Health lawyers may enjoy long, stable careers working for a single employer or for a government entity.
Public Health, Healthcare, and the Law
The law has a profound impact on how health providers offer their services.
Health lawyers have the opportunity to change and improve the healthcare system.
Health law can be a challenging, satisfying, and influential career path for attorneys choosing it as a specialty.