Health and health care law are federal and state laws that encompass public health, mental health, private health insurance matters, contracts, administrative law, financing, torts, corporation, antitrust, and ethics. Health care law”s wide foundation can be attributed to the wide range of issues it encompasses. From genetic testing and the rising cost of health insurance, to bioterrorism and malpractice, to regulatory compliance of health care services and devices, health care law covers it all.
The Department of Health and Human Services (HHS) enforces a variety of federal laws and regulations related to human services. An important part of the HHS are the Centers for Medicare and Medicaid Services, which oversee the Medicare and Medicaid Programs, State Children”s Health Insurance Program (SCHIP), Health Insurance Portability and Accountability Act of 1996 (HIPAA), and Clinical Laboratory Improvement Amendments (CLIA). Their goal is to ensure that elderly and needy individuals receive proper medical care. The HHS also administers a wide variety of health care programs, including providing financial assistance to needy individuals, conducting medical and scientific research, and providing health care and advocacy services.
Individual states also have laws pertaining to public health. Check with a qualified health law attorney in your area for more information. In addition to public health issues, both the federal government and state governments also regulate private health insurance.
Private health insurance originated with the Blue Cross system in 1929. The underlying principle was to spread the risk of high hospitalization bills between all individuals. Typical private insurance plans include health maintenance organizations (HMO”s), Preferred Provider Organizations (PPO”s) and fee-for-service plans.
An HMO provides health services through a network of doctors, hospitals, laboratories, etc. The health care providers may either be HMO employees or have some other contract arrangement with the HMO. HMO plans typically pay providers a monthly set amount regardless of the amount of services performed. When you enroll in an HMO, you choose one of the doctors as your primary care provider (PCP) to manage your health care. Whenever you need health care, you first consult your primary care provider; he or she then may refer you to an HMO-approved specialist.
HMO”s are governed by federal and state laws. The main federal law that governs HMO”s is the Health Maintenance Organization Act of 1973, and each state has its own set of laws.
Preferred Provider Organizations (PPO) are not insurance carriers but groups of providers who sell their services by contract to carriers.
Fee-for-service plans allow subscribers to select their own providers and receive direct reimbursement of valid health-care costs. Although these plans are less common today, they may be offered by either HCSCs or commercial carriers.
Point-of-service plans allow their subscribers to go to providers outside the network, but usually do not reimburse costs at the same level as network providers.
Health law is one of those areas of the law where an experienced health attorney is highly recommended. There are often highly complex laws and regulations governing the delivery of health services, the production and marketing of medical and pharmaceutical devices, the employment of health care professionals, and compliance with heath care policies. Whether you are an individual, health care worker, health care organization or otherwise involved in a health care matter, hiring an experienced health care attorney can best protect your rights. A health attorney will be able to assess your situation and advise you of your legal rights and obligations. Use the form on this page to find a health attorney best suited to your needs and legal situation.