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Articles 571 - 600 of 727
Full-Text Articles in Health Law and Policy
Table Of Contents, Annals Of Health Law
Table Of Contents, Annals Of Health Law
Annals of Health Law and Life Sciences
No abstract provided.
The "Knowingly And Willfully" Continuum Of The Anti-Kickback Statute's Scienter Requirement: Its Origins, Complexities, And Most Recent Judicial Developments, Douglas A. Blair
The "Knowingly And Willfully" Continuum Of The Anti-Kickback Statute's Scienter Requirement: Its Origins, Complexities, And Most Recent Judicial Developments, Douglas A. Blair
Annals of Health Law and Life Sciences
Mr. Blair analyzes the evolution of the Anti-Kickback Statute's scienter requirement. The article includes a historical review of the Anti-Kickback Statute and an in-depth discussion of three notable cases in this area, United States v. Greber, Hanlester Network v. Shalala, and United States v. Davis. The author concludes that without further guidance from either Congress or the Department of Health and Human Services, the split among circuits as to the proper definition of the Statute's scienter requirement makes the matter ripe for Supreme Court review.
Regulating Risk In A Managed Care Environment: Theory Vs. Practice, The Minnesota Experience, Barbara C. Colombo, Robert P. Webber
Regulating Risk In A Managed Care Environment: Theory Vs. Practice, The Minnesota Experience, Barbara C. Colombo, Robert P. Webber
Annals of Health Law and Life Sciences
Professor Colombo and Mr. Webber address the challenges that state regulators face in controlling the various forms of managed care as numerous hybrid risk-bearing entities emerge. This article also highlights the tensions between consumer protection and market competition and focuses on the experience of Minnesota regulators in this area.
The Police Power And The Regu0lation Of Medical Practice: A Historical Review And Guide For Medical Licensing Board Regulation Of Physicians In Erisa-Qualified Managed Care Organizations, Edward P. Richards
Annals of Health Law and Life Sciences
Professor Richards reviews the use of the state police power to regulate the medical profession. In addition, Professor Richards analyzes the role of physicians in managed care organizations, and describes how this role can be controlled through state police power regulation.
The Role Of The States In Combating Managed Care Fraud And Abuse, Joan H. Krause
The Role Of The States In Combating Managed Care Fraud And Abuse, Joan H. Krause
Annals of Health Law and Life Sciences
Professor Krause describes the weapons available to state regulators to address managed care fraud. Although many commentators have focused on recent federal anti-fraud efforts, Professor Krause argues that the states, through the use of a number of existing legal theories, have the most flexibility to combat fraudulent managed care practices. By using these targeted state-based efforts (in contrast to broader federal provisions), state regulators may be able to resolve problems more efficiently and with greater patient benefits.
Health Care Providers And Fraud Investigations: What Can You Do When The Goverment Changes The Rules In The Middle Of The Game?, Gordon E. Rountree Jr.
Health Care Providers And Fraud Investigations: What Can You Do When The Goverment Changes The Rules In The Middle Of The Game?, Gordon E. Rountree Jr.
Annals of Health Law and Life Sciences
Mr. Rountree addresses the federal government's multi-pronged attack on health care fraud and focuses on the options available to health care providers who are under investigation by the government. The article proposes three potential responses to fraud investigations, including: (1) lobbying the government for relief, (2) suing the government; or (3) waiting to defend or settle the fraud action. After analyzing each method, Mr. Rountree concludes that an aggressive lobbying campaign is likely to be the most successful of the three possible provider responses.
White Coat, Blue Collar: Physician Unionization And Managed Care, Ellen L. Luepke
White Coat, Blue Collar: Physician Unionization And Managed Care, Ellen L. Luepke
Annals of Health Law and Life Sciences
Ms. Luepke provides a historical review of the rise of the physician unionization movement in the United States. This article also examines the barriers faced by employed and independent physicians that prevent or limit their collective bargaining, and reviews the responses of the various organized medical societies to the physician unionization movement.
Table Of Contents, Annals Of Health Law
Table Of Contents, Annals Of Health Law
Annals of Health Law and Life Sciences
No abstract provided.
Federal Regulation Comes To Private Health Care Finnancing: The Group Health Insurance Provisions Of The Health Insurance Portability And Accountability Act Of 1996, Jack A. Rovner
Annals of Health Law and Life Sciences
Attorney Rovner presents a very detailed accounting of the impacts of the Health Insurance Portability and Accountability Act as it relates to group health insurance including provisions that concern pre-existing conditions, special enrollment rights, premium discrimination, maternity lengths of stay, parity for mental health benefits and small groups coverage. The article concludes with a discussion of the federalism question as it relates to regulation of private market health financing.
Foreword, John D. Blum
Regulating Managed Care Coverage: A New Direction For Health-Planning Agencies, Thaddeus J. Nodzenski
Regulating Managed Care Coverage: A New Direction For Health-Planning Agencies, Thaddeus J. Nodzenski
Annals of Health Law and Life Sciences
The article focuses on the role of health planning agencies in the context of managed care. The author argues that health planning agencies can be redirected toward assessment of managed care plans. Planning entities can be used to evaluate the viability of managed care markets taking into account societal, financial and medical considerations.
Managed Care At The Crossroads: Can Managed Care Organizations Survive Government Regulation?, Vickie Yates Brown, Barbara Reid Hartung
Managed Care At The Crossroads: Can Managed Care Organizations Survive Government Regulation?, Vickie Yates Brown, Barbara Reid Hartung
Annals of Health Law and Life Sciences
Attorneys Brown and Hartung provide a comprehensive overview of the development and structural components of managed health care plans. The article discusses the state regulatory controls affecting managed care including Patient Protection Acts. Mandated benefit provisions, any willing provider laws, and consumer access provisions. The article considers liability problems facing managed care organizations, in particular liabilities which arise from utilization and medical review discussions as well as gag clauses and financial incentive arrangements. The authors also review relevant federal regulatory initiatives.
Boards Of Directors Under Fire: An Examination Of Nonprofit Board Duties In The Health Care Environment, Naomi Ono
Annals of Health Law and Life Sciences
Attorney Ono presents a detailed discussion of fiduciary duty principles as applied to the directors of nonprofit health care corporations in the current health care environment. The article reviews general corporate responsibilities, the implication of the taxpayer's Bill of Rights 2, the care of In re Caremark International Inc. Derivative Litigation and particular issues faced by boards in nonprofit conversions.
Recent Chages To The Internal Revenue Code May Require Tax-Exempt Hospitals To Restructure Ownership Of Certain Activities, Joseph C. Mandarino
Recent Chages To The Internal Revenue Code May Require Tax-Exempt Hospitals To Restructure Ownership Of Certain Activities, Joseph C. Mandarino
Annals of Health Law and Life Sciences
This article by attorney Mandarino explores the implications of a 1997 change in the Internal Revenue Code affecting tax-exempt hospitals which run or operate for-profit businesses. The piece explores the application of prior law to hospital ownership of for profit ventures and continues on to review the implications of the 1997 amendment, particularly on existing structures. The article concludes with suggestions to avoid applications of the amended section.
Responsibilities Of Directors Of Not-For-Profit Corporations Faced With Sharing Control With Other Nonprofit Organizations In Health Industry Affiliations: A Commentary On Legal And Practical Realities, L. Edward Bryant Jr.
Annals of Health Law and Life Sciences
This article concerns the legal responsibilities of not-for-profit corporation directors in merges and affiliations with other not-for-profits. The article considers three sets of legal duties board members have, ancillary contractual obligations, madatory statutes and procedural laws, and contextual legal duties.
States, Congress, Or The Courts: Who Will Be First To Reform Erisa Remedies?, Curtis D. Rooney
States, Congress, Or The Courts: Who Will Be First To Reform Erisa Remedies?, Curtis D. Rooney
Annals of Health Law and Life Sciences
Curtis Rooney's article reviews the ERISA law and it relationship to managed care. The piece continues with a review of the relevant preermption provisions and a extentivsive discussion of related U.S. Supreme Court decisions. The author discusses malpractice and design liabilities. The article concludes with a discussion of reform initiatives directed toward the ERISA preemption and damage provisions.
A Look Back At The Year In Health Law, Jeffrey R. Bennett
A Look Back At The Year In Health Law, Jeffrey R. Bennett
Annals of Health Law and Life Sciences
The Bennett article takes us back to 1997 and reviews key legislators, regulations and judicial developments in Medicare, antitrust, tax and ERISA, all of which greatly impact the practice of health law.
Kidcare And The Uninsured Child: Options For An Illinois Health Insurance Plan, Anna Wermuth
Kidcare And The Uninsured Child: Options For An Illinois Health Insurance Plan, Anna Wermuth
Loyola University Chicago Law Journal
No abstract provided.
Surrogate Health Care Decisions For Adults In Illinois - Answers To The Legal Questions That Health Care Providers Face On A Daily Basis, Rebecca J. O'Neill
Surrogate Health Care Decisions For Adults In Illinois - Answers To The Legal Questions That Health Care Providers Face On A Daily Basis, Rebecca J. O'Neill
Loyola University Chicago Law Journal
No abstract provided.
Table Of Contents, Annals Of Health Law
Table Of Contents, Annals Of Health Law
Annals of Health Law and Life Sciences
No abstract provided.
Foreword, John D. Blum
The Brave New World Of Health Care Compliance Programs, Thomas E. Bartrum, L. Edward Bryant Jr.
The Brave New World Of Health Care Compliance Programs, Thomas E. Bartrum, L. Edward Bryant Jr.
Annals of Health Law and Life Sciences
The need for corporate compliance programs in health care delivery systems is ever increasing. This article identifies the key items a good program should contain, and addresses issues raised by the existence of a program as well as its implementation.
Interpreting The 1996 Federal Antitrust Guidelines For Physician Joint Venture Networks, Edward Hirshfeld
Interpreting The 1996 Federal Antitrust Guidelines For Physician Joint Venture Networks, Edward Hirshfeld
Annals of Health Law and Life Sciences
The Statements of Antitrust Enforcement Policy in Health Care, issued by the FTC and the DOJ, dramatically change how the agencies evaluate physician joint venture networks. This article analyzes the Statements, providing useful guidance to the health lawyer.
Mixing Oil And Water: The Government's Mistaken Use Of The Medicare Anti-Kickback Statute In False Claims Act Prosecutions, Robert Salcido
Mixing Oil And Water: The Government's Mistaken Use Of The Medicare Anti-Kickback Statute In False Claims Act Prosecutions, Robert Salcido
Annals of Health Law and Life Sciences
In 1996, billing integrity generated a great deal of debate and litigation in the health care arena. Significantly, the federal government views a violation of the Anti-Kickback Act as a basis for a False Claims Act action. While federal courts are split on the issue, the author strongly contends that using the False Claims Act to do what the Anti-Kickback Act was intended to do is inappropriate, given Congress' intention in enacting each legislation.
The Government's Use Of The Civil False Claims Act To Enforce Standards Of Quality Of Care: Integrity Or The Heavy Hand Of The 800-Pound Gorilla, Michael M. Mustokoff, Jody A. Werner, Michael S. Yecies
The Government's Use Of The Civil False Claims Act To Enforce Standards Of Quality Of Care: Integrity Or The Heavy Hand Of The 800-Pound Gorilla, Michael M. Mustokoff, Jody A. Werner, Michael S. Yecies
Annals of Health Law and Life Sciences
Fraud and abuse issues abound in health care. A new, rather unique assertion is that submitting a bill for health care that is inadequate constitutes a violation of the Civil False Claims Act. The authors contend that there are more effective and appropriate ways to address poor quality of care, and that using the False Claims Act in this matter is like fitting a square peg in a round hole.
Directors' Duty Obtain A Fair Price In The Conversion Of Nonprofit Hospitals, Eric S. Tower
Directors' Duty Obtain A Fair Price In The Conversion Of Nonprofit Hospitals, Eric S. Tower
Annals of Health Law and Life Sciences
Boards of Directors of tax-exempt hospitals are increasingly struggling with whether to convert their facilities to for-profit status. Other than the traditional duties of loyalty and fair dealings imposed upon directors, there is currently little guidance to assure that boards obtain a fair price for the hospital in such conversions. The author provides recommendations to assure proper valuation.
Post-Decision Diagnosis: Medical Device Preemption Alive And Mostly Well After Medtronic, Inc. V. Lohr, Scott W. Sayler, Steven M. Thomas
Post-Decision Diagnosis: Medical Device Preemption Alive And Mostly Well After Medtronic, Inc. V. Lohr, Scott W. Sayler, Steven M. Thomas
Annals of Health Law and Life Sciences
In Medtronic, Inc. v. Lohr, the United States Supreme Court, in a five-to-four split, held that the Medical Device Amendments of 1976 did not preempt state tort claims against a pacemaker manufacturer. A careful reading of the factually specific holding of this case suggests that manufacturers of medical devices distributed pursuant to premarket approval requirements and investigational device exemption can still successfully raise preemption as a defense to state common law tort claims.
To Resuscitate Or Not ... In The Operating Room: The Need For Hospital Policies For Surgeons Regarding Dnr Orders, Vassyl A. Lonchyna
To Resuscitate Or Not ... In The Operating Room: The Need For Hospital Policies For Surgeons Regarding Dnr Orders, Vassyl A. Lonchyna
Annals of Health Law and Life Sciences
As more Americans have become aware of end-of-life planning, health care professionals are faced with more "Do Not Resuscitate" orders. A patient with a terminal condition who has signed such an order may enter the operating room for a surgical procedure; few hospitals have developed protocols to assist the medical staff. In most hospitals, it is unclear whether the medical staff should honor the "DNR" or follow the traditional resuscitation protocol of the operating room.
Health Care Fraud And Abuse: New Weapons, New Penalties, And New Fears For Providers Created By The Health Insurance Protability And Accountability Act Of 1996 ("Hipaa"), Colleen M. Faddick
Health Care Fraud And Abuse: New Weapons, New Penalties, And New Fears For Providers Created By The Health Insurance Protability And Accountability Act Of 1996 ("Hipaa"), Colleen M. Faddick
Annals of Health Law and Life Sciences
The Health Insurance Portability and Accountability Act of 1996 may well be the most significant increase ever in the federal government's health care fraud and abuse enforcement authority. This new authority coupled with increased scrutiny of the health care industry generally creates a compelling incentive for health care facilities to develop corporate compliance programs.
The Role Of The Federal Government In Ensuring Quality Of Care In Long-Term Care Facilities, David R. Hoffman
The Role Of The Federal Government In Ensuring Quality Of Care In Long-Term Care Facilities, David R. Hoffman
Annals of Health Law and Life Sciences
Quality of care is a concept most important to our vulnerable populations, including the elderly. When the government pays for nursing care for the elderly, it expects that it is paying for quality care. When the quality is substandard, as it was with Tucker House II, the government can and will use the False Claims Act to recover monies paid.