Introduction to Healthcare and Public Health in the US Lecture b Regulating Healthcare This material (Comp1_Unit6b) was developed by Oregon Health and

Introduction to Healthcareand Public Health in the US

Lecture b

Regulating Healthcare

This material (Comp1_Unit6b) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

IU24OC000015.

Regulating HealthcareLearning Objectives

• Describe the role of accreditation, regulatory bodies, and professional associations in health care in the US. (Lecture a)

• Describe the basic concepts of law in the United States: the legal system, sources of law, classification of laws, the court system, and the trial process. (Lecture b)

• Describe legal aspects of medicine involving the Affordable Care Act, professional standards in health care, medical malpractice, Tort reform, and Medicare and Medicaid Fraud and Abuse (Lecture c)

• Describe key components of the Health Insurance Portability and Accountability Act (HIPAA) and current issues of privacy and patient safety in the US (Lecture d)

• Discuss the need for quality clinical documentation for the use of the health record as a legal document, communication tool and a key to prove compliance for health care organizations. (Lecture e)

2Health IT Workforce Curriculum Version 3.0/Spring 2012

Introduction to Healthcare and Public Health in the US Regulating Healthcare

Lecture b

The Legal System in the US

• Legislative–House of Representatives and the Senate

• Executive– The president and numerous departments

and agencies

• Judicial–Judges and courts



Lecture b

Balance of Power

• Separation of powers– Three branches of government– Designed to prevent any one branch from

becoming too powerful• Checks and balances

– Legislative branch makes laws– Executive branch enforces laws– Judicial branch interprets laws



Lecture b

Sources of Law

• Legislative branch makes statutory laws • Executive branch makes administrative laws• Laws made by the courts are called common law

or case law



Lecture b

The Judicial System: Courts

• Trial court– Hears evidence and hands down verdicts– Can be federal, state, or local

• Appellate court– Losing party can appeal– Court usually does not hear new evidence– Reviews case to determine if the law was

properly applied to the facts as determined by the trial court



Lecture b

The Judicial System: Jurisdiction

• Federal courts– Constitutionality of a federal law– Disputes primarily involving federal law – Disputes between citizens of different states

• State courts– Often called courts of common pleas or

county courts • City or municipal courts



Lecture b

Comparing Court Systems:An Example

US Government State of Ohio City of Cleveland

Trial courts US District Court for the Northern District of Ohio

Cuyahoga County Court of Common

Pleas

Cleveland Municipal Court

Appellate courts

US Sixth Circuit Court of Appeals

Ohio Eighth District Court of Appeals

Highest court US Supreme Court Ohio Supreme Court

6.2 Table: Example of court jurisdiction on various levels of government.



Lecture b

Classification of Laws

• Civil or private law – Relationships between people– Relationships between people and

organizations– Relationships between organizations– Includes family, property, inheritance,

corporate, contract, and tort law• Public law

– Relationships between people and the government



Lecture b

Two Kinds of Penalties

• Civil law—exchange of money between the private parties to the lawsuit

• Public law—can result in fines paid to the government and/or imprisonment

• The same action can result in both kinds of penalties



Lecture b

Example: Traffic Accident

• Drunk driver crashes car, causing serious injury to the driver of the other car

• Criminal (public) penalty– State vs. drunk driver

• Civil (private) damages– Injured driver vs. drunk driver



Lecture b

General Classification:Private Law

6. 3 Figure: Two important sub classifications of civil law are contract law and tort law (OHSU, 2010).



Lecture b

Contract Law

• Contract elements– Offer– Acceptance– Consideration: something of value given in

exchange for a promise• Express contract

– Written or oral• Implied contract



Lecture b

Tort Law

• Intentional torts– Battery– Defamation

• Negligence– Does not act with a reasonable amount of

care– As a result, someone is injured



Lecture b

General Classification:Public Law

6.4 Figure: The two types of Public Law that have the most effect on individuals are criminal law and administrative law (OHSU, 2010).



Lecture b

Litigation: Parties

• Adversary system– Each party presents his or her case– Facts determined by neutral fact-finder

• Civil case: plaintiff and defendant• Criminal case: government and defendant



Lecture b

Pre-trial Litigation: Discovery

• Purpose is to fully develop the facts• Depositions are one kind of discovery

– Sworn testimony recorded by court reporter– Parties– Witnesses– Expert witnesses



Lecture b

Administrative Hearings

• Sometimes an administrative agency has a system of hearings that is outside the normal court system

• The agency may or may not have an appellate level

• Usually reviewable in a court of law



Lecture b

Administrative Hearing Example

• Social Security Administration (SSA)– Hearing officers– Social Security Appeals Council– Decisions of the SSA appeals board can be

further appealed to the US District Court



Lecture b

Regulating HealthcareSummary – Lecture b

• 3 branches of government: legislative, executive, judicial (the courts)

• Courts are divided into:– Trial courts and appellate courts– Federal, state, city/municipal courts

• The courts are neutral arenas where the parties to a dispute face off in an adversarial process

• 2 main types of law: private and public



Lecture b

References• Administrative Office of the US Courts. The federal court system in the United States. 2010. 3rd ed.

http://www.uscourts.gov/uscourts/FederalCourts/Publications/English.pdf. Accessed April 8, 2011.• Administrative Office of the US Courts. Understanding federal and state courts.

http://www.uscourts.gov/EducationalResources/FederalCourtBasics/CourtStructure/UnderstandingFederalAndStateCourts.aspx. Accessed April 8, 2011.

• Administrative Office of the US Courts. United States Courts. http://www.uscourts.gov/Home.aspx. Accessed April 8, 2011.• Centers for Medicare and Medicaid Services. Guidance to laws and regulations: overview.

https://www.cms.gov/GuidanceforLawsAndRegulations. Accessed April 10, 2011.• Cornell University Law School Legal Information Institute. Tort. http://topics.law.cornell.edu/wex/tort. Accessed April 10, 2011.• Social Security Online. Information about Social Security's hearings and appeals process. http://www.ssa.gov/appeals. Accessed April 10,

2011.• The Library of Congress. Law Library of Congress. http://www.loc.gov/law. Accessed April 10, 2011.• US Citizenship and Immigration Services. Welcome to the United States: A guide for new immigrants.

ttp://www.uscis.gov/files/nativedocuments/M-618.pdf. Accessed April 8, 2011.• USA.gov. Federal executive branch. http://www.usa.gov/Agencies/Federal/Executive.shtml. Accessed April 10, 2011.

Charts, Tables and Images• 6.2 Table: Example of court jurisdiction on various levels of government.• 6. 3 Figure: Two important sub classifications of civil law are contract law and tort law. OHSU (2010).• 6.4 Figure: The two types of Public Law that have the most effect on individuals are criminal law and administrative law. OHSU (2010).



Lecture b

Regulating HealthcareReferences – Lecture b

http://www.uscourts.gov/uscourts/FederalCourts/Publications/English.pdf

Documents

Introduction to Healthcare and Public Health in the US Lecture b Regulating Healthcare This material (Comp1_Unit6b) was developed by Oregon Health and