What Laws Regulate the Healthcare Industry?

Healthcare professionals face more regulation than just about every other industry in the United States. They are subject to inspection, review, reporting requirements, and enforcement actions by an alphabet soup of state and federal agencies, and they must follow myriad local, state, and federal regulations. Below we discuss some of the more important laws that regulate the healthcare industry. If you have a regulatory matter or any other issue of healthcare law, reach out to a knowledgeable California healthcare law attorney for advice and representation.

HIPAA

The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) was originally passed to protect healthcare for workers between jobs. These days, HIPAA is most directly associated with the protection of confidential patient healthcare information. HIPAA outlines how medical professionals can store, use, and disseminate patient healthcare information and provides for civil and criminal penalties for violations.

The HITECH Act

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted in 2009, is often called the “teeth” of HIPAA. It mandates audits of healthcare providers to ensure that they are in compliance with HIPAA privacy and security requirements. The Act sets high standards for information security, providing financial security and penalties for healthcare providers and associated businesses in order to encourage them to adequately protect patient information.

EMTALA

The Emergency Medical Treatment and Labor Act (EMTALA), enacted in 1986, is a federal law that requires hospitals to provide stabilization and treatment for anyone who comes to an emergency department, regardless of their insurance status or ability to pay.

Anti-Kickback and Stark Laws

The federal Anti-Kickback Statute (AKBS) was passed to prevent the intentional abuse of the healthcare system for financial gain. The AKBS prevents the exchange of anything of value for an award or referral within the federal healthcare program. Violation of the AKBS is a crime.

The Stark Law is a set of federal healthcare fraud and abuse laws that prohibits physicians from referring patients for certain designated health services paid for by Medicare to another entity with which they have a financial relationship. The Stark Law is not a criminal statute, but it does provide for significant civil penalties.

PSQIA

The Patient Safety and Quality Improvement Act of 2005 (PSQIA) protects healthcare workers who report unsafe conditions at their practices. The law encourages individuals to report medical errors while maintaining patient confidentiality.

Fraud and Abuse Laws

Healthcare providers are subject to a variety of federal and state laws that prohibit fraud and abuse. Healthcare providers cannot issue fraudulent bills to private insurance companies or government insurance providers such as Medicare. They also may not prescribe or recommend unnecessary procedures or medications to generate more funds or to get a kickback from a distributor, they may not conduct money laundering, and they may not otherwise engage in acts of fraud or abuse.

These are just a few areas of regulation faced by healthcare officials. If you have a question about your legal obligations or the compliance requirements for your practice, if you are facing an audit, or if you are dealing with allegations of fraud or abuse, call a seasoned healthcare lawyer for help.

Protect your practice, your license, and your livelihood

For assistance with matters pertaining to healthcare compliance, business disputes, claims of fraud, licensing or any other legal issue, contact the Law Offices of Art Kalantar for a free initial consultation in Los Angeles or statewide at 310-773-0001.