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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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CME Test - Class 10
Relevant terms
Congress
Affordable Care Act
States
Fraud & Abuse
Self-Referral
Compliance Plans
HIPAA
Antitrust
ERISA
Other Countries
Considerations
Required Readings
Suggested Readings
New News Class 10

 

For CME Test - Class 10 - Click Here

Class Description - Class 10

Laws and Public Policies and Health Care Delivery Systems in Other Countries

This class examines how the United States government impacts health care which in turn effects providers. This class will look at the Health Security Act originally proposed by President Clinton in 1993 and examine how the United States Congress may be moving more toward managed care. This class will analyze how "Any Willing Provider" and fraud and abuse and "Self Referral" type laws effect physicians and managed care organizations. Also, this class will explore how antitrust type laws effect physicians and managed care organizations. Healthcare systems in some other countries will also be explored.

 

Class 10 Topics:    VARIOUS UNITED STATES LAWS AND PUBLIC POLICES/HEALTH CARE DELIVERY SYSTEMS IN OTHER COUNTRIES

I.    UNITED STATES CONGRESS

    A.    HEALTH SECURITY ACT

    B.    Health Insurance Portability and Accountability Act of 1996 (HIPAA)

    C.    ANTITRUST

    D.    Employee Retirement Income Secuirty Act of 1974 (ERISA)

II.    STATES

    A.    PATIENT PROTECTION AND PATIENT RIGHTS LAWS

    B.    ANY WILLING PROVIDER LAWS

III. FRAUD AND ABUSE LAWS 

    A.    LAWS

    B.    QUI TAM ACTIONS

    C.    OTHER CASES

    D.    TRIAL

IV.    SELF REFERRAL LAWS

V.    COMPLIANCE PLANS

    A.    Potential Pitfalls

    B.    FOR PHYSICIANS

VI. HEALTHCARE SYSTEMS IN OTHER COUNTRIES

A. GERMANY

B. CANADA

C. UNITED KINGDOM

D. POLICY SOLUTIONS

 

Key Objectives 

1.    Examine the effect market based competition compared to legislative regulations in systems-based practice may have on physicians.

2.    Synthesize laws that may effect physicians such as fraud and abuse and antitrust laws.

3.    Examine what the United States can learn from other countries involving systems-based practice in the health care delivery system.

Review 

1.    Analyze the effect market based competition compared to legislative regulations in systems-based practice may have on physicians.

2.    Describe the effect of fraud and abuse and antitrust type laws may have on physicians and systems-based practice.

3.    Synthesize what the United States can learn from other countries involving systems-based practice in the health care delivery system. 

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