Health Law

by Furrow, Barry R.; Greaney, Thomas L.; Johnson, Sandra H.; Jost, Timothy Stoltzfus; Schwartz, Robert L.

• ISBN13: 9780314239396
• ISBN10: 0314239391
• Edition: 2nd
• Format: Hardcover
• Copyright: 2000-07-01
• Publisher: West Academic

Summary

Expert authors overview health law as it affects the professionals, institutions, and entities that deliver and finance health care in the United States. Considers the law's response to quality and error through institutional and professional regulation, and malpractice litigation against professionals, hospitals, and managed care organizations. Surveys tax, corporate, and organizational issues. Explores the government's efforts to control costs and expand access through Medicare and Medicaid. Examines government attempts to police anticompetitive activities, fraud, and abuse. And considers the legal and ethical issues involving death, human reproduction, medical treatment decision making, and medical research.

Table of Contents

Preface	v
Westlaw Overview	vii
Regulation of Health Care Institutions	1	(37)
Taxonomy of Health Care Institutions	3	(3)
Private Accreditation and Public Quality Control Regulation	6	(7)
State and Federal Authority to Regulate	13	(1)
Establishing Regulatory Standards	14	(1)
Substantive Review of Standards	15	(2)
Specific Federal Regulatory Standards	17	(4)
Enforcement	21	(7)
Health Planning and Certificate of Need	28	(10)
Federal Tax Exemption of Health Care Institutions	38	(20)
Tax--Exempt Purposes	40	(9)
Joint Ventures	49	(2)
Tax Exemption of Alternative Delivery Systems	51	(6)
Conclusion	57	(1)
Regulation and Licensure of Health Care Professionals	58	(37)
Entry Requirements	60	(2)
Unauthorized Practice	62	(9)
Scope of Practice	71	(4)
Discipline	75	(7)
Substantive Grounds for Discipline	82	(9)
The Medicare Utilization and Quality Control Peer Review Organization Program	91	(4)
Professional Relationships in the Health Care Enterprise	95	(77)
Staff Privileges	97	(10)
Physician--Hospital Contracts for Physician Services	107	(7)
Employment--at--Will	114	(1)
National Labor Relations Act	115	(4)
Anti--Discrimination Statutes	119	(9)
Quality Assurance and Risk Management	128	(15)
Medical Information and Records: Confidentiality and Disclosure	143	(29)
Health Care Business Associations	172	(85)
For--Profit Corporations	175	(27)
Not--for--Profit Corporations	202	(26)
Professional Corporations	228	(6)
Partnerships	234	(9)
Limited Liability Companies and Limited Liability Partnerships	243	(4)
Structuring Health Care Enterprises	247	(10)
The Liability of Health Care Professionals	257	(115)
Physician Liability for Patient Injury	259	(51)
Physician Obligations to Obtain a Patient's Informed Consent	310	(34)
Reforming the Tort System for Medical Injuries	344	(28)
The Liability of Health Care Institutions	372	(46)
Tort Liability of Hospitals	373	(20)
Tort Liability of Managed Care Systems	393	(25)
The Employee Retirement Income Security Act of 1974 and Health Plan Liability and Regulation	418	(43)
ERISA: Introduction	418	(5)
ERISA: Preemption	423	(22)
ERISA Claims and Obligations	445	(16)
Regulation of Private Health Care Financing	461	(48)
Regulation of Private Insurance	462	(20)
Federal Insurance Regulation	482	(10)
Regulation of Managed Care	492	(17)
Obligations to Provide Medical Care	509	(27)
Emergency Medical Treatment and Labor Act	512	(11)
Obligations to Provide Emergency Care Under State Law	523	(2)
Obligations Under the Hill--Burton Act	525	(2)
Nondiscrimination Obligations Under Title VI	527	(3)
Discrimination Against Persons Based on Medical Condition	530	(5)
Conclusion	535	(1)
Medicare	536	(48)
Authority and Administration	539	(1)
Eligibility	540	(1)
Covered and Excluded Services	541	(6)
Provider Participation	547	(4)
Medicare Prospective Payment Under Diagnosis--Related Groups	551	(8)
Cost--Based Reimbursement	559	(1)
Medicare Part B Payment	560	(5)
Billing and Claims	565	(4)
Medicare Part C: Medicare Managed Care	569	(5)
Administrative Appeals and Judicial Review of Medicare Determinations	574	(8)
The Medicare as Secondary Payer Program	582	(2)
Medicaid	584	(41)
Introduction	585	(2)
Eligibility	587	(14)
Benefits	601	(8)
Medicaid Payment for Services	609	(3)
Medicaid Managed Care	612	(4)
Administration	616	(1)
Federal and State Medicaid Funding	617	(1)
Medicaid Appeals and Judicial Review	617	(5)
The State Children's Health Insurance Program (SCHIP)	622	(3)
Medicare and Medicaid Fraud and Abuse	625	(43)
Introduction	626	(2)
False Claims and Statements	628	(8)
Bribes, Kickbacks, and Much Else	636	(12)
Self--Referrals	648	(8)
Civil Penalties and Exclusions	656	(7)
Investigations by the Office of Inspector General and Compliance Plans	663	(2)
State Medicaid Fraud and Abuse Laws	665	(3)
Antitrust Law	668	(136)
Statutes and Interpretative Principles	671	(17)
Professionalism and Competition	688	(19)
Physician--Hospital Relationships	707	(30)
Health Care Financing: Relationships Between Providers and Payers	737	(30)
Relationships Among Hospitals and Other Health Facilities	767	(37)
Definitions of Death	804	(11)
Making Decisions About Death and Dying	815	(95)
Introduction--The Right to Forgo Life Sustaining Treatment	819	(12)
Significant State Interests That Limit the Judicially Recognized Right to Forgo Life Sustaining Treatment	831	(4)
Determining Decisional Capacity or Competency of Patients for Whom Life Sustaining Medical Treatment Is Appropriate	835	(3)
The Right to Forgo Life Sustaining Treatment and Competent Adults	838	(2)
The Right to Forgo Life Sustaining Treatment and Incompetent Adults	840	(19)
The Right to Forgo Life Sustaining Treatment and Children	859	(11)
Religion and the Right to Forgo Life Sustaining Treatment	870	(7)
Judicial Process in Cases Involving Decisions to Forgo Life Sustaining Treatment	877	(6)
Civil Liability for Failing to Recognize a Decision to Forgo Life Sustaining Treatment	883	(3)
Homicide Liability and the Decision to Forgo Life Sustaining Treatment	886	(4)
Physician Assisted Death	890	(9)
Special Issues in Terminating Particular Kinds of Life Sustaining Treatment	899	(7)
The Patient Self--Determination Act	906	(4)
Wrongful Birth, Wrongful Life and Wrongful Conception	910	(13)
Abortion	923	(18)
The Constitutional Framework	925	(5)
Particular Limitations and Restrictions on Abortion	930	(8)
Actions to Protect Women Seeking Abortions and Abortion Providers	938	(3)
Potential Fetal--Maternal Conflicts	941	(13)
Assisted Reproduction	954	(23)
Regulation of Research Upon Human Subjects	977	(16)
Appendix: Researching Health Law on Westlaw	993	(16)
Table of Cases	1009	(62)
Table of Statutes	1071	(34)
Index	1105