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Law and Healthcare

Since law is not an exact science, what are the implications re: Law & Health care?

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Please see response below, which is also attached. In addition, I have provided numerous other highly relevant links that you may find helpful. I hope this helps and take care.

RESPONSE:

1. Since law is not an exact science, what are the implications re: Law & Health care?

Indeed, Law is not an exact Science, meaning that there is room for personal and legal interpretation and, thus, an increased number of misunderstandings and misgivings. In other words, the subjective side of the law has serious implications for disagreements, litigations, and court cases (i.e., fraud and abuse, and appeal cases, etc.) to occur within the healthcare system.

A. Implications for increased legal cases, and thus, legal consultation

For example, many issues focus on legal, regulatory and reimbursement matters arising under the Medicare, Medicaid and other third party payment programs. In addition, lawyers are in demand for legal counsel in the areas of federal and state fraud issues including corporate compliance, anti-kickback, self-referral, false claims, and false billings. One does not have to look far (i.e., legal aid advertisements) for the important legal issues within the health care system. One lawyer advertises his expertise this way:

Mr. Alexander has represented a number of healthcare providers in connection with reimbursement disputes before various Medicare contractors and before the Health Care Financing Administration. In addition, Mr. Alexander has defended national and regional providers in matters arising under the federal civil false claims act. He has assisted clients in settling billing and other health regulatory disputes with the Department of Justice, in resolving potential civil exclusionary actions, and in negotiating and implementing corporate integrity agreements with the Department of Health and Human Services' Office of the Inspector General (http://www.business.com/bdcframe.asp?ticker=&src=http%3A//rd.business.com/index.asp%3Fbdcz%3Dil.l.ml.e%26bdcr%3D2%26bdcu%3Dhttp%253A//www.abanet.org/health/%26bdcs%3D6B92ABBE-3BED-46B7-AEDA-2DD450E425BB20041075175059%26bdcf%3D02fcbfe2-dc07-11d3-82d1-00c04f01021c%26bdcp%3D%26partner%3Dbdc%26title%3DABA%2520Health%2520Law%2520Section&back=http%3A//www.business.com/directory/law/practice_areas/healthcare_law/reference/&path=/directory/law/practice_areas/healthcare_law/reference)

In other words, because "law is not an exact science" the following issues come to the fore:

1. Court cases against national and regional providers arising under the federal civil false claims act.
2. Billing and other health regulatory disputes between clients and the Department of Justice
3. Civil exclusionary actions
4. Corporate disagreements with the Department of Health Human Services' Office of the Inspector General.

As a function of the ambiguous nature of laws and regulations, many legal disputes arise and need to be managed within the healthcare system. These include:

5. Disputes concerning Medicare Secondary Payer, and Fraud Investigations (i.e., suspected fraud involving the company's private insurance products).

6. Disputes in areas of government contracting and corporate compliance.

For example, Sheryl ...

Solution Summary

This solution responds to the question: Since law is not an exact science, what are the implications re: Healthcare? through 'real life' illustrative healthcare examples. Supplemented with numerous related links for further research.

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