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Product description

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View or download Chapter 5 for this product.

This Seventh Edition of AHLA's Fundamentals of Health Law is a comprehensive resource for individuals who need to understand not only fundamental health law requirements, but also the complex web of legal relationships among patients, providers, suppliers, payers, technology vendors, researchers, and others. There are two additional chapters on Medicaid and Data Sharing.

Fundamentals of Health Law contains substantive expert explanations of:
  • Health Law Terminology;
  • Patient Care;
  • Medicare;
  • Medicaid;
  • Fraud and Abuse;
  • Tax-Exemption;
  • Antitrust;
  • Regulation of Private Health Plans;
  • Regulation of Hospitals;
  • Representing Physicians;
  • Post-Acute Providers and Suppliers;
  • Health Care Transactions and Contracting;
  • Bioethics;
  • Data Sharing; and
  • Dispute Resolution.
The Seventh Edition incorporates analysis of recent high-impact changes in the health care industry and how it is regulated:
  • Increased industry integration
  • Physician employment
  • The 21st Century Cures Act
  • Health Insurance Portability and Accountability Act (HIPAA) guidance
  • Fraud enforcement
  • Evolution of payment schemes, including the Medicare Access and CHIP Reauthorization Act (MACRA)
  • Legislative and regulatory changes, United States Supreme Court decisions, and more.

eBooks, CDs, downloadable content, and software purchases are noncancelable, nonrefundable and nonreturnable. Click here for more information about LexisNexis eBooks. The eBook versions of this title may feature links to Lexis+® service for further legal research options. A valid subscription to Lexis+ is required to access this content.

Published April, 2018.


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Table of contents


Chapter 1 Terminology

1.1  Glossary
1.2  Table of Acronyms and Abbreviations

Chapter 2 Patient Care
2.1  Creation of the Provider-Patient Relationship; Duty to Treat and Ending Provider-Patient Relationships; Patient Abandonment
2.2  Consent to Medical Treatment
2.3  End-of-Life Decision Making
2.4  Disclosure and Protection of Patient Medical Information
2.5  Conclusion

Chapter 3 Medicare
3.1  Introduction
3.2  Overview of the Medicare Program
3.3  Program Administration
3.4  Reimbursement Overview
3.5  Eligibility
3.6  Coverage
3.7  Certification
3.8  Payment—The Prospective Payment System
3.9  Payment—The Resource-Based Relative Value Scale Fee Schedule
3.10  Payment—Blended Capitation
3.11  Payment—New Competitive "Market-Based" Systems
3.12  Assignment and Reassignment
3.13  Appeals—Parts A and B
3.14  Appeals—Part C
3.15  Appeals—Part D
3.16  Conclusion
3.17  Useful Websites and Other Resources

Chapter 4 Medicaid Fundamentals
4.1  Introduction
4.2  The Evolution of the Medicaid Program
4.3  Administration
4.4  Eligibility
4.5  Covered Benefits
4.6  Reimbursement and Financing Mechanisms
4.7  Delivery Systems
4.8  Affordable Care Act of 2010
4.9  SCOTUS & Medicaid Impact

Chapter 5 Fundamentals of Health Law Fraud and Abuse
5.1  The Federal Health Care Program's Anti-Kickback Statute
5.2  Federal Anti-Kickback Safe Harbor Regulations
5.3  Federal "Sunshine Law"
5.4  Federal Physician Self-Referral Law
5.5  Stark Exceptions
5.6   Federal Criminal Prohibitions Against False Claims and Fraudulent Billing Practices
5.7  Federal Civil Prohibitions Against False Claims and Fraudulent Billing Practices
5.8  Corporate Compliance Programs

Chapter 6 Tax-Exempt Issues
6.1  Introduction
6.2  Exemption Requirements—Generally
6.3  Practical Application of the Fundamental Exemption Requirements
6.4  Section 509(a) Public Charity Status

Chapter 7 Antitrust Law
7.1  Introduction
7.2  The Substantive Antitrust Statutes and Their Analyses
7.3  Exemptions, Immunities, and Scope of Coverage
7.4  Government Enforcement
7.5  Private Enforcement
7.6  Conclusion
7.7  References

Chapter 8 The Source of Payment: The State and Federal Regulation of Private Health Care Plans
8.1  The Basis of Regulation
8.2  The State Regulation of Private Health Care Plans
8.3  The Federal Regulation of Private Health Care Plans
8.4  Conclusion

Chapter 9 Regulation of Hospitals
9.1  Introduction
9.2  State and Local Regulations
9.3  Federal Regulation
9.4  Accreditation; Survey Activity

Chapter 10 Representing Physicians
10.1  Introduction
10.2  Life Cycle of Physician-Practice Association
10.3  Physician/Hospital Arrangements
10.4  Licensure and Credentialing
10.5  Reimbursement Issues
10.6  Telemedicine
10.7  Physician/Patient Relationships
10.8  Accountable Care Organizations
10.9  Conclusion

Chapter 11 Post-Acute Providers and Suppliers
11.1  Introduction
11.2  Home Medical Equipment Suppliers
11.3  Home Health Care
11.4  Hospice Care
11.5  Long Term Care
11.6  Home and Community-Based Services—Long Term Services and Supports

Chapter 12 Health Care Transactions and Contracting
12.1  Introduction
12.2  Getting Started: Initial Discussions and Preliminary Documents
12.3  Structure of Health Care Transactions
12.4  Health Care Corporate Structures
12.5  Key Issues in Structuring Transactions
12.6  Unwinding Transactions
12.7  Types of Health Care Contracts
12.8  Termination of Agreements
12.9  Current Climate of Health Care Transactions and Contracting

Chapter 13 Bioethics
13.1  Human Reproduction
13.2  Organ Transplantation
13.3  The New Genetics
13.4  Conclusion

Chapter 14 Data Sharing for Clinical Integration and other "Big Data" Initiatives
14.1  Introduction
14.2  Health Insurance Portability and Accountability Act (HIPAA)
14.3  Federal Confidentiality of Substance Use Disorder (Alcohol and Drug Abuse) Patient Records
14.4  State Privacy Laws
14.5  Common Rule
14.6  Antitrust
14.7  Nonprofit Tax Exemption

Chapter 15 Dispute Resolution
15.1  Introduction
15.2  Arbitration
15.3  Mediation
15.4  Conflict Management
15.5  Conclusion