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Health care law encompasses a wide range of issues. The U.S. Department of Health and Human Services is the primary governmental agency responsible for legal aspects of U.S. health care. The U.S. Food and Drug Administration controls regulations surrounding pharmaceutical issues. The various states establish regulations applicable to financial guidelines and other factors that impact interaction among health care providers, third-party payors (insurance companies and managed-care groups) and patients. A state health board or a state department of health services exists in each state to oversee and enforce the regulations.

Attorneys with health care practices most often represent plaintiffs or defendants on medical malpractice matters or on Medicare fraud and abuse cases. Health care lawyers also handle business/corporate law matters (such as purchase/lease of health care facilities) and regulatory compliance for physicians, medical clinics, nursing homes and hospitals or for payor groups.

Issue: Bioethics

With health care records and other business processes increasingly being transmitted over the Internet, patient privacy and confidentiality of records concerns triggered the enactment of several federal laws in recent years. The Health Insurance Portability and Accountability Act (HIPAA) and now govern the sharing of research data and patient records.

Look for coming legislation (and political campaign rhetoric) to focus on regulating bioethics issues around emerging technologies. Bioethics deals with such topics as research involving human and animal participants, cloning, stem cell research, genetic testing, medicines that prolong life and nanomedicine and neuroethics. (Nanomedicine is the science of molecular nanotechnology, which manipulates human molecules to maintain and improve human health. Neuroethics is the use of neuroimaging technology, such as MRIs, to evaluate and predict certain diseases and capabilities.)

Bioethical considerations involve complex moral evaluation of when life begins, when and how it should progress and end. Legislation is necessary to ensure use of these emerging technologies and research data is handled in a responsible manner.

Issue: Health Care Insurance, HMOs

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are part of the insurance concept of “managed care.” The Employee Retirement Income Security Act (ERISA) protects managed-care plans for insured employees.

HMOs are regulated primarily by the federal government through the Health Maintenance Organization Act of 1973 but also by individual states' boards of insurance (Health Maintenance Organization Division). HMOs are organizations that function as both health care providers (the physicians) and payors (the insurer); this enables tighter control of costs. HMOs were originally established as a means of containing escalating health care costs.

Nevertheless, HMO costs have risen dramatically since 1999, forcing employers to raise co-payments and deductibles, reduce coverage, or motivate employees to establish medical savings accounts. HMO plans have also experienced a decrease in the number of participating physicians.

Health care reform now on the horizon — aimed at reducing costs and ensuring service to patients will undoubtedly impact American patients, physicians and payors with new regulations.

By Kathleen Goolsby           

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