Some of the Many Federal Laws that Apply to Physicians and the Medical Practice

There are many federal laws that physicians and those who work in the medical profession must know. Failure to comply with these laws may be a sign of negligence if a patient was injured while under the care of a physician, hospital, managed care provider, or other health care professional.

We wanted to take a look at a few of those laws today, and to offer a brief explanation of what they are. Some medical negligence cases rely heavily on these laws, and knowing what they do can help you understand how they could apply to your case, if we discuss them with you during a consultation.

  • HIPAA. The Health Insurance Portability and Accountability Act of 1996 provides rules for protecting the privacy of electronic health protection information (e-PHI) of healthcare patients. Each doctor and medical practice must work to protect the security and the privacy of patient medical data.
  • The HITECH Act. The Health Information Technology for Economic and Clinical Health Act was enacted in 2009. This law provides for strong civil and criminal enforcement of HIPAA. The HITECH Act is part of the American Recovery and Reinvestment Act of 2009 (ARRA). HITECH increased the penalties for violations and also increased who could be held liable as compared to HIPAA.
  • HCQIA. The Health Care Quality and Improvement Act was enacted in 1986 in response to the movement of medically incompetent doctors from state to state to try to avoid disclosure of their incompetence. The law essentially protects members of medical review bodies and their staffs who take steps to “adversely affect the clinical privileges or professional society membership of a physician.” In short, the act encourages peer review of physicians. The law also requires any entity such as an insurance company that makes a payment in response to a medical malpractice claim – to report that payment (along with the name of any hospitals the doctor was associated with, the name of the doctor, and the reason for the payment) – to state licensing boards. The Act also creates a national database to track incompetent doctors.
  • HRRP. The Hospital Readmissions Reduction Program is part of the Affordable Care Act. The aim of the law is track hospitals that readmit patients too often. Medicare will reduce the payments to hospitals who readmit patients more than normal for specific health issues such as heart failure, COPD, and pneumonia.
  • PSQIA. The Patient Safety and Quality Improvement Act of 2006 aims to improve patient safety by providing certain privilege and confidentiality protections.
  • GINA. The Genetic Information Nondiscrimination Act protects patients from being discriminated against by an insurance company or an employer based on their genetic test results. An employer can’t use information about a patient’s illness that indicates what his/her ethnicity is, for example, in hiring, firing, or promoting the employee. Insurers can’t deny coverage based on that same knowledge.
  • FDASIA. The Food and Drug Administration Safety and Innovation Act of 2012  was a joint recommendation of the Department of Health and Human Services and Federal Drug Administration to review health information technology so that mobile applications promote patient safety and provide healthcare innovation.

While not a law, the Joint Commission on Accreditation of Healthcare Organizations accredits hospitals and facilities that participate in Medicare.

Anti-referrals laws

Physicians must also comply with The Stark Law and the Anti-Kickback Statute. Both laws seek to prohibit referrals by doctors to lab testing facilities, medical device companies, and other medical companies, if the referral is based on what helps the physician instead of what helps the patient. The Stark Law prohibits doctors from referring patients to a designated medical facility in which the doctor or a family member of the doctor has an interest. The AKS prohibits drug companies or anyone from inducing referrals based on cash kickbacks, providing fancy meals and vacations, or paying the doctor to serve on boards when the doctor doesn’t do any work for the board.

There are exceptions to the Stark Law and safe harbors to the AKS law which doctors can use. The idea behind these exceptions/safe harbors is that a financial interest may be allowed if there’s a genuine medical reason for it.

Violations of Stark Law and the AKS are generally also considered violations of the False Claims Act (FCA). The FCA protects Medicare, Medicaid, TRICARE, and other federal programs from fraud and the submission of false bills.

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