Health Law and Policy Commons^™

Health Care Fraud And Abuse: A Tale Of Behavior Induced By Payment Structure, Arti K. Rai

Faculty Scholarship

The campaign to curtail "fraud and abuse" in the Medicare and Medicaid programs represents an attempt by regulators to evade more fundamental and difficult questions regarding cost and quality control. In the Medicare arena, tackling these larger questions will require dismantling the program's fee-for-service structure and imposing on providers financial incentives to evaluate carefully health care costs and benefits. Commentary on, David A. Hyman, Health Care Fraud and Abuse: Market Change, Social Norms and the Trust "Reposed in Workmen," 30 Journal of Legal Studies 531 (2001)

Understanding Medicaid Home And Community Services: A Primer, Gary Smith, Janet O'Keeffe, Letty Carpenter, Pamela Doty, Brian Burnwell, Robert Mollica, Loretta Williams, George Washington University, Center For Health Policy Research

Center for Health Policy Research

No abstract provided.

Beyond Stigma: What Barriers Actually Affect The Decisions Of Low-Income Families To Enroll In Medicaid?, Jennifer P. Stuber, Kathleen A. Maloy, Sara Rosenbaum, Karen C. Jones

Health Policy and Management Issue Briefs

No abstract provided.

Optional Purchasing Specifications For Child Development Services In Medicaid Managed Care, George Washington University Medical Center, Center For Health Services Research And Policy

Center for Health Policy Research

These sample purchasing specifications were prepared by the George Washington University Center for Health Services Research and Policy (CHSRP) with support from the Commonwealth Fund. Technical guidance on the content of child development services was provided by experts from the Fund and researchers at Northwestern University’s Institute for Health Services Research & Policy Studies (IHSRPS). This document is intended as a tool to assist interested state officials in purchasing child development services from managed care organizations (MCOs) on behalf of children under age three who are eligible for Medicaid.

These sample purchasing specifications are optional, and do not necessarily reflect …

Effect Of The 1996 Welfare And Immigration Reform Laws On Immigrants' Ability And Willingness To Access Medicaid And Health Care Services, George Washington University, Center For Health Services Research And Policy

Center for Health Policy Research

No abstract provided.

An Analysis Of Implementation Issues Relating To Chip Cost-Sharing Provisions For Certain Targeted Low Income Children, Sara J. Rosenbaum, Anne Rossier Markus, Dylan Roby

Health Policy and Management Issue Briefs

This analysis, prepared for the Health Care Financing Administration and the Health Resources and Services Administration, examines issues that arise under laws designed to avert excessive cost-sharing in the case of low income families whose children participate in the State Children’s Health Insurance Program (CHIP). High cost-sharing has been shown to significantly affect children’s participation in insurance programs, as well as their utilization of health services. As a result, the Federal CHIP legislation, while permitting cost-sharing under certain circumstances, also places limitations on the total amount of cost-sharing to which families can be exposed for services covered by State CHIP …

The Continuing Decline In Medicaid Coverage, Leighton Ku, Brian K. Bruen

Health Policy and Management Faculty Publications

No abstract provided.

Medicaid Managed Care Contracting For Childhood Lead Poisoning Prevention Services, Elizabeth Wehr, Sara J. Rosenbaum

Center for Health Policy Research

This study reports on provisions relating to childhood lead poisoning prevention services in Medicaid managed care contract documents (service agreements and requests for proposals, RFPS). The provisions were extracted from the managed care contracts data base of the Center for Health Policy Research of the George Washington University Medical Center. The data base was constructed and is updated as part of the Center's ongoing analytic studies.' As with other Center studies of the contract documents, this is a descriptive study of how state Medicaid agencies addressed a series of contracting issues at a specific point in time.* In brief, we …

Rights And Efficiency In American Health Law, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

During the 1960s and 1970s, the individual rights revolution that swept through American society remade much of the nation's health law in its image. Sick people acquired the right to be told of the risks and benefits of proposed treatments and then to give thumbs-up or thumbs-down to their doctors' decisions. Successful suits for medical negligence went from rare to commonplace. Elderly and poor Americans achieved statutory rights of access to publicly funded healthcare, and courts burnished these rights with myriad procedural protections. The critically ill and their families won the right to refuse aggressive, life-sustaining treatments. Psychiatric patients acquired …

Congress Crafts Child Health Insurance Program, George Washington University Medical Center, Center For Health Policy Research

Center for Health Policy Research

No abstract provided.

The Constitutional Right To Die: Ethical Considerations, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

In this commentary, the author first looks at some ethical reasoning supporting physician-assisted dying. Second, he examines some of the lines that have been drawn between withdrawing and withholding life-sustaining treatment on the one hand, and physician-assisted dying on the other. Finally, he relates both of these matters to constitutional reasoning, beginning with Cruzan and ending with the cases before the Supreme Court at the time of the article's publication.

The Epidemics Of Injecting Drug Use And Blood-Borne Disease: A Public Health Perspective, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

In this article, the author first examines the mechanism by which blood-borne disease is transmitted through sharing of injection equipment. Thereafter, he presents a public health strategy for reducing multi-person use of contaminated injection equipment. This strategy includes: repealing or modifying current laws and regulations making possession and distribution of sterile injection equipment a criminal offense; implementing syringe exchange programs to expand access to new syringes for users of injection drugs; and counseling, education, and treatment targeted to injecting drug users (IDUs), including those in the prison and health care system. The objective of a public health approach is not …

Integrating Indian Health Programs Into Medicaid Managed Care Systems, Part 2, Sara J. Rosenbaum, Ann Zuvekas

Center for Health Policy Research

The Indian Health Service (IHS), recognizing that state Medicaid programs are rapidly purchasing managed care plans for their beneficiaries and that managed care enrollment has significant implications for both Indians and Indian health facilities, convened this Roundtable to discuss options for participation in such care. The purpose of this roundtable was to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by IHS, programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act.By design, Roundtable participants were a group …

Integrating Indian Health Programs Into Medicaid Managed Care Systems, Part 1, Sara J. Rosenbaum, Ann Zuvekas

Center for Health Policy Research

The Indian Health Service (IHS), recognizing that state Medicaid programs are rapidly purchasing managed care plans for their beneficiaries and that managed care enrollment has significant implications for both Indians and Indian health facilities, convened this Roundtable to discuss options for participation in such care. The purpose of this roundtable was to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by IHS, programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act.By design, Roundtable participants were a group …

Comment On The L, Susan Grover

Faculty Publications

No abstract provided.

Learning How To Heal: An Analysis Of The History, Policy, And Framework Of Indian Health Care, Betty Pfefferbaum, Rennard J. Strickland, Everett R. Rhoades, Rose L. Pfefferbaum

American Indian Law Review

No abstract provided.

Child Health Supervision: Analytical Studies In The Financing, Delivery, And Cost-Effectiveness Of Preventive And Health Promotion Services For Infants, Children, And Adolescents, Michele R. Solloway, Peter Budetti

Center for Health Policy Research

Contents: Financing and Delivery of Child Health Supervision Services (An Overview of Health Insurance Coverage and Access to Child Health Supervision Services, Private Health Insurance Coverage of Preventive Benefits for Children, A 20-Year Retrospective of Child Health Supervision in Ambulatory Pediatric Settings, Ensuring Adequate Health Care Benefits for Children and Adolescents); Child Health Supervision Services and Medicaid (Informing State Medicaid Providers about EPSDT, Barriers to Full Participation in EPSDT and Possible Strategies for the Maternal and Child Bureau, Medicaid Managed Care: A Briefing Book on Issues for Children and Adolescents; State Implementation of OBRA '89 EPSDT Amendments within Medicaid Managed …

Tuberculosis And The Power Of The State: Toward The Development Of Rational Standards For The Review Of Compulsory Public Health Powers, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article uses tuberculosis as the paradigm for exploring rational standards for the exercise of compulsory public health powers. Extant doctrine in disability and constitutional law provides a lens for examining judicial review of state interventions. The author first sets out the central epidemiological and biological aspects of tuberculosis to demonstrate the strength of the governmental interest in curtailing the epidemic. Second, he examines the interventions of testing, screening, and confinement of persons with tuberculosis, where he focuses on two congregate settings--correctional and health care facilities--that present substantial health risks and are principal foci for the exercise of state intervention. …

Genetic Privacy, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Human genomic information is invested with enormous power in a scientifically motivated society. Genomic information has the capacity to produce a great deal of good for society. It can help identify and understand the etiology and pathophysiology of disease. In so doing, medicine and science can expand the ability to prevent and ameliorate human malady through genetic testing, treatment, and reproductive counseling.

Genomic information can just as powerfully serve less beneficent ends. Information can be used to discover deeply personal attributes of an individual's life. That information can be used to invade a person's private sphere, to alter a person's …

Health Information Privacy, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Thoughtful scholarship in the area of informational privacy sometimes assumes that a significant level of privacy can coexist with the development of a modern health information infrastructure. Some commentators suggest that we can have it both ways: that adequate legal protection of informational privacy will eliminate the need to significantly limit the collection of health data. This article demonstrates that there is no such easy resolution of the conflict between the need for information and the need for privacy. Because significant levels of privacy cannot realistically be achieved within the health information infrastructure currently envisaged by policymakers, we confront a …

The Resurgent Tuberculosis Epidemic In The Era Of Aids: Reflections On Public Health, Law, And Society, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The resurgence of tuberculosis and the rise in drug-resistant cases is neither inexplicable nor unexpected, but rather is the predictable outcome of a complex configuration of biological, social, and behavioral factors that have converged in America over the past decade. This article examines the biological, social, and behavioral causes of the epidemic, and suggests a comprehensive public health strategy for curtailing tuberculosis and other infectious diseases. When thoughtfully conceived, public health strategies can be implemented that are consistent with the limitations that both constitutional law and disability law place on the authority of the state. While traditional concepts of public …

Securing Health Or Just Health Care? The Effect Of The Health Care System On The Health Of America, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The author first analyzes why the prevention of illness and promotion of health provide the leading justification for the government to act for the welfare of the population. His analysis focuses principally on the foundational importance of health for human happiness, the exercise of rights and privileges, and the formation of family and social relationships. He explains why health care, although critically important; is not the only, nor even the most important, determinant of health. Most morbidity and mortality in the United States is attributable to environmental conditions, pathogens, and human behavior, which are all more responsive to population-based interventions …

Consensus Development At Nih: What Went Wrong, Itzhak Jacoby

RISK: Health, Safety & Environment (1990-2002)

A close observer identifies the Science Court concept as inspiring consensus development conferences at the National Institutes of Health and describes the extent to which they have followed the model. Professor Jacoby also argues that, if the model were more closely followed, conference objectives would be better realized.

The Science Court: Reminiscence And Retrospective, Allan Mazur

RISK: Health, Safety & Environment (1990-2002)

A self-described "agnostic" on the merits of the Science Court proposal describes how he independently arrived at a similar notion and played a role in efforts to secure a major test of the proposal. Professor Mazur also analyzes university-based experiments structured around that model and concludes that the controversial "judges" are probably unnecessary to achieve his original objectives.

Procedural Choices In Regulatory Science, Sheila Jasanoff

RISK: Health, Safety & Environment (1990-2002)

This paper compares four approaches to using science in regulatory decision making - one very similar to the Science Court proposal. Professor Jasanoff argues generally that that proposal would be less useful than procedures more sensitive to the distinctive characteristics of regulatory science.

Regulation Of Physician Self-Referral Arrangements: Is Prohibition The Answer Or Has Congress Operated On The Wrong Patient, Christian D. Humphreys

San Diego Law Review

Rapidly increasing health care costs have created a national crisis. Perceiving physician referral behavior as the principal cause, Congress and several state legislatures have prohibited certain referrals. This Comment analyzes the data that spawned such legislation and critiques prohibition of referrals as a solution to the crisis. The Comment asserts that the prohibition remedy is overly broad and largely ineffective. The author recommends a more farsighted solution, such as the creation of a prepaid physician compensation system. The author argues that such a system would minimize the incentive to make unnecessary referrals while simultaneously reducing the level of health care …

Toward A Sustainable Maine : The Politics, Economics, And Ethics Of Sustainability, Richard Barringer (Ed.)

Maine Collection

Toward A Sustainable Maine : The Politics, Economics, and Ethics of Sustainability

Richard Barringer, editor, Professor Emeritus at the University of Southern Maine

Edmund S. Muskie Institute of Public Affairs, University of Southern Maine, Portland, Maine, 1993.

The proceedings of a conference presented at Bowdoin College on March 19 and 20, 1993, by the Edmund S. Muskie Institute of Public Affairs at the University of Southern Maine, and by the Natural Resources Council of Maine. Ellen Baum, conference organizer.

Contents; Foreword by Richard Barringer / Welcome by Everett Carson / Global, Canadian, and Maine Perspectives / Sustaining Our Natural and …

The Americans With Disabilities Act And The Corpus Of Anti-Discrimination Law: A Force For Change In The Future Of Public Health Regulation, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

In this paper the author reviews the constitutional history of the courts' attempts to check the powers of the public health department. He demonstrates how ineffective and inconsistent constitutional review has been, and suggests that adequate review criteria have not emerged. The author shows that, whether the courts are applying First, Fourth, or Fourteenth Amendment standards, ultimately they are highly deferential to public health officials. Then he carefully examines the key concepts in the Americans with Disabilities Act (ADA) as they apply to communicable disease. He reveals Congress' clear intention to include communicable disease, even asymptomatic infection, as a disability. …

Drawing A Line Between Killing And Letting Die: The Law, And Law Reform, On Medically Assisted Dying, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Traditional medical ethics and law draw a sharp distinction between allowing a patient to die and helping her die. Withholding or withdrawing life sustaining treatment, such as by abating technological nutrition, hydration or respiration, will cause death as surely as a lethal injection. The former, however, is a constitutional right for a competent or once-competent patient, while the latter poses a risk of serious criminal or civil liability for the physician, even if the patient requests it.

Health Care Reform In The United States, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The author presents a brief description of the design features and objectives of the health care reform package, together with the reasons to support reform of the health care system in the United States.