Running a hospital or medical practice involves more than just treating diseases or fixing broken bones. Numerous laws and regulations affect how doctors should handle patient information, bill insurers, refer patients, and so forth.
7 Laws to Keep in Mind
Among the most prominent laws doctors should keep in mind are the following:
1. HIPAA
HIPAA, or the Health Insurance Portability and Accountability Act, outlines numerous rules that are designed to keep patient information private while also making their medical data available to them personally.
Another law, called the HITECH (Health Information Technology for Economic and Clinical Health) Act helps enforce HIPAA by detailing rules regarding information technology in the healthcare industry while also increasing penalties for violations.
2. HCQIA
The Health Care Quality and Improvement Act created a database listing incompetent physicians while also protecting doctors from monetary damages if they peer review providers who are potentially inept. The purpose is to help keep doctors accountable for the quality of their work while protecting those who might point out issues with their peers’ practice of medicine.
3. Anti-Kickback Statute
The Anti-Kickback Act prevents doctors from accepting payment of any kind for referring Medicare and Medicaid patients to others. Payment can include monetary payment, but it also includes items such as vacations, fine dining, or free rent.
4. Stark Law
The Stark Law is also called the Physician Self-Referral Law, and it prohibits doctors from referring patients to services in which the doctor or a member of their family has a financial interest. There are some exceptions to this law, such as referrals to in-house auxiliary services, but the point is to avoid financial gain at the expense of a patient’s well-being.
5. HRRP
The Hospital Readmissions Reduction Program tracks hospitals that have higher than normal readmission rates for patients with certain illnesses, such as heart failure, pneumonia, hip/knee replacements and reconstruction, and others. If readmissions seem excessive for those illnesses, the law reduces Medicare payments to that institution and publicly reports their data.
6. EMTALA
EMTALA (Emergency Medical Treatment and Active Labor Act) helps make sure patients receive emergency medical care, regardless of whether they are able to pay for it. It achieves this by prohibiting doctors from postponing emergency treatment or examinations in order to inquire about payment. In addition, treatment may not be denied based on income, ethnicity, and so forth.
7. False Claims Act
Passed during the Civil War, the False Claims Act imposes penalties on those who attempt to defraud Medicare, Medicaid, or other government programs, such as by upcoding procedures or performing treatment that isn’t necessary.
Additional Medical Laws
In addition to the above laws, others apply to physicians and hospitals, including:
- GINA
- PSQIA
- CHIP
- FDASIA
Ensuring Regulatory Compliance
Keeping up with the numerous rules and regulations set forth in each of these laws can be overwhelming, especially for a small practice. Often, it takes dedicated administrative staff to make sure your practice is in full compliance. An attorney can ease that burden by helping you identify the laws that pertain to your practice and giving counsel on implementing the measures needed to keep within legal limits.