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Health Law

Common terms and definitions.
Jones Health Law > Practice Areas > Health Law

Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the health care industry and its patients; and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.

Accountable Care Organizations – Were created to help reduce health care costs. An ACO is a network of providers that work together to coordinate patient care. Providers are eligible for bonuses when they deliver that care to patients according to the levels satisfactory with the ACO. The goal is to keep patients healthy and help fix the payment system that rewards more, not better care. Patients are not required to stay within the ACO especially if they do not feel comfortable with having their health information throughout the network.

 

“An ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. At the heart of each patient’s care is a primary care physician.”

 

Administrative Law – “Administrative law encompasses laws and legal principles governing the administration and regulation of government agencies (both Federal and state). Such agencies are delegated power by Congress (or in the case of a state agency, the state legislature) to act as agents for the executive. Generally, administrative agencies are created to protect a public interest rather than to vindicate private rights.”

 

Adult Day Care Centers – “Adult Day Care Centers are designed to provide care and companionship for older adults who need assistance or supervision during the day. Programs offer relief to family members and caregivers, allowing them to go to work, handle personal business, or just relax while knowing their relative is well cared for and safe. The goals of the programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem, and to encourage socialization.”

 

Advanced Registered Nurse Practitioner (ARNP) Representation – Is a nurse who has obtained a Master’s Degree or Post-Master’s Degree in Nursing. Jones Health Law represents ARNPs in most legal matters.

 

Agency for Health Care Administration (AHCA) Investigations –Jones Health Law will investigate with due diligence any allegations against Agency employees and AHCA Contractors. Specifically, allegations of whistle-blowing, sexual harassment, discrimination, violations of Florida Statutes, Florida Administrative Code, and Agency Policies are all subject to investigation.

 

Ambulatory Surgical Centers – “Ambulatory surgery centers (ASCs) are health care facilities that offer patients the convenience of having surgeries and procedures performed safely outside the hospital setting. Since their inception more than four decades ago, ASCs have demonstrated an exceptional ability to improve quality and customer service while simultaneously reducing costs. At a time when most developments in health care services and technology typically come with a higher price tag, ASCs stand out as an exception to the rule.”

 

Assisted Living Facility – These facilities are much like apartments where people that need some daily assistance can receive help, meals, and other housework tasks but are otherwise independent. “The Assisted Living Federation of America defines Assisted Living as a long-term care option that combines housing, support services and health care, as needed.”

 

Bioethics – Bioethics is the study of health care decisions regarding basic humans values such as rights to life and health, and the review of developments in medicine, health technology, health professionals, healthcare institutions and new procedures for care. Bioethics also looks at society’s responsibility for the life and health of its members.

 

Board Hearings – A board hearing convenes to discuss complaints and issues surrounding the purpose of the board hearing.

 

Clinic Trials and Licensing – “Clinical trials are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. These studies also may show which medical approaches work best for certain illnesses or groups of people. Clinical trials produce the best data available for health care decision-making.”

 

Licensing is a request for permission to introduce a new product or procedure into society.

 

Compliance Programs – Compliance programs are created to prevent and detect violations of state and federal health-care laws and regulations. The Department of Health and Human Services and its Office of the Inspector General encourages all health care entities to implement an effective compliance program. A compliance program helps create a method for employees to express concerns with compliance issues and for entities to appropriately address the issues.

 

Concierge Medical Practices – Is also known as boutique medicine, retainer-based medicine or direct care. Concierge Medical Practice involves a doctor that provides care for longer amounts of time to lesser patients. Patients pay out of pocket fees and have a closer relationship with their doctors, short wait times, and quick access to their doctors. This is attractive for doctors because they have control of the patient fees and they do not have to associate with third parties.

 

Denial of VA Benefits – Upon denial of VA benefits, Veterans are allowed to appeal the Board of the VA for a rehearing. A Notice of Disagreement must be filed with the VA and all deadlines must be met.

 

Dental Complaints – The Florida Board of Dentistry allows for complaints to be filed by patients. The Department of Health investigates the complaint. Common dental complaints include gross negligence, incompetence, fee sharing, fraud, sexual misconduct with a patient, infection control, and use of a controlled substance, or alcoholic beverage during practice of dentistry.

 

Department of Health Investigations – “The Department of Health investigates complaints and reports involving health care practitioners regulated by the department and enforce appropriate Florida Statutes. The departments cannot represent you in civil matters to recover fees paid or seek remedies for injuries.”

 

Diagnostic Centers and Laboratories – Diagnostic Centers and Laboratories offer innovative tests for integrative health professionals. Diagnostic care is used when patients have trouble getting a clear diagnosis. Tests are run until you receive the correct medical diagnosis.

 

Due Diligence Investigations – Due Diligence is a legal obligation, which include a full and complete review of the issue or issues during an investigation. Depending on what is being investigated, due diligence will be very different. A due diligence investigation is essentially a fact finding mission.

 

Durable Medical Equipment, Prosthetics, Orthotics and Supplies – Durable medical equipment is ordered by healthcare providers for everyday or extended use by patients to help their healing or therapeutic efforts. Medicare Part B covers medically necessary durable medical equipment that your doctor can prescribe for use in your home.

 

Electronic Health Records – “An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization.”

 

ERISA – (Employment Retirement Income Security Act of 1974) ERISA has been defined as an employee welfare benefit plan and welfare plan which also includes hospital care or benefits or benefits in the event of sickness, accident, disability, death or unemployment. ERISA supersedes any and all state laws insofar they may now or hereafter related to any employee benefit plan. Employers are not required to provide health care to employees. However, the law “sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.”

 

Facility Licensure – In order to practice legally, a healthcare entity and facility need to be properly licensed by the state and any regulatory agency. The purpose of licensing is to protect consumers from faulty products and from receiving poor care.

 

False Claims Act and Qui Tam Actions – The False Claims Act was created to impose liability on those who are defrauding governmental programs. For example, any provider that does not return a Medicare/Medicaid overpayment is defrauding the government and subject to the False Claims Act. Qui Tam actions is the same as a whistleblower. A whistleblower is allowed to bring a suit on behalf of the government.

 

FDA Law – The Federal Food and Drug Act was created in 1906 to create an agency that was responsible to review consumer drugs and foods. The agency is responsible for the general welfare of all Americans. The FDA has laws governing many aspects of healthcare.

 

Group Practice Representation – Jones Health Law will provide representation to an association of health professionals who work together usually in the same office.

 

Group Purchasing Organizations – (GPO) Are entities that provide services to health care facilities to help keep costs down by aggregating purchasing volume and using that leverage to negotiate discounts with vendors. Providers can work together when ordering supplies to negotiate discounts with vendors.

 

Health Information Technology – “The term “health information technology” (health IT) is a broad concept that encompasses an array of technologies to store, share, and analyze health information.  More and more, health care providers are using health IT to improve patient care. But health IT isn’t just for health care providers. You can use health IT to better communicate with your doctor, learn and share information about your health, and take actions that will improve your quality of life.”

 

Healthcare Labor and Employment – Jones Health law provides traditional labor services to healthcare employers and employees.

 

Healthcare Provider Agreements – An agreement between the provider and an insurance company for participation in the insurance company plans and policies. Providers provide care to patients and seek reimbursement from insurance companies depending on the agreement between the parties.

 

Healthcare Transactions –Jones Health Law provides services to all health care transactions including mergers, hospital consolidation, acquisitions, sales contracts, supplier contracts, antitrust enforcement, and other transactions to keep your entity successful.

 

HIPAA – (Health Insurance Portability and Accountability Act) was created in 1996 . Title I of HIPAA ensures that laid off workers maintain health insurance coverage. Title II of HIPAA requires national standards for electronic health care transactions. The act has expanded to include privacy requirements for patients. Entities covered by HIPAA must report data breaches.

 

HIV Employee Rights – “People living with HIV, or people who have relationships with those living with HIV, often face significant discrimination in the workplace. While employers may attempt to justify this discrimination by referencing the need for safety or by invoking non-discriminatory rationales, HIV status in itself is not a valid basis for limiting an individual’s employment options. Employers’ exclusions of workers living with HIV typically are based on stigma and significant ignorance about the routes and actual risks of HIV transmission. This ignorance, and the consequent limits on employment and training opportunities, has had devastating effects on the personal and professional lives of people living with HIV.”

 

State and federal law prohibits employment discrimination on the basis of HIV.

 

Holistic Care Centers – “Holistic medicine is a form of healing that considers the whole person — body, mind, spirit, and emotions — in the quest for optimal health and wellness. According to the holistic medicine philosophy, one can achieve optimal health — the primary goal of holistic medicine practice — by gaining proper balance in life.” Holistic treatment includes exercise, psychotherapy, acupuncture, chiropractic care, homeopathy, massage therapy, naturopathy, and others.

 

Home Health Agency Licensing – “An agency that provides skilled services (nurses, therapists, social workers) and/or unskilled services (home health aides, certified nursing assistants, homemakers, companions) to patients in their homes.  A home health agency may also provide staffing to health care facilities on a temporary basis.”

 

Hospital Privileges – When a hospital grants privilege to a physician this means they are allowing the physician to practice certain procedures within the confines of the hospital under the hospital guidelines.

 

Imaging and Surgical Centers – Jones Health Law provides service to centers that provide imaging and surgery to patients. Imagining and surgical centers offer coordinated care to help treat patients efficiently. Most centers provide state of the art technology with a vast array of medical specialties.

 

Independent Practice Associations – (IPA) An IPA “is a legal entity organized and directed by physicians in private practice to negotiate contracts with insurance companies on their behalf. Participating physicians are usually paid on a capitated or modified fee-for-service basis and may also continue to care for patients not covered by the insurers with whom the IPA contracts. Perhaps the most significant function of an IPA is to exert influence on behalf of its members to counterbalance the leverage of health care insurers.”

 

Independent Provider Networks – Is a network of providers that meet together to discuss important issues along with learning new opportunities and in some cases get updates from a local government.

 

Licensed Mental Health Counselor Investigations –Jones Health Law will provide services to any investigation involving a licensed mental health counselor. Licensed Mental Health Counselors include Psychologists, Psychoanalysts, Psychiatrists, Psychiatric Nurse Mental Health Clinical Specialists, Social Workers, Family and Marriage Therapists, Mental Health Counselors, Rehabilitation Counselors, Education Psychologists and others.

 

Licensed Practical Nurse Defense – These nurses care for the sick, injured, convalescent and disabled in health care entities. LPNs provide hands-on care to patients under the supervision of RNs or physicians. Jones Health Law provides defense to any LPN that may be in need.

 

Licensing – Jones Health Law provides services to any healthcare professional that needs licensing. Licensing is required in most health care settings in order to be legally authorized to practice.

 

Managed Care – “Health insurance A health care delivery system consisting of affiliated and/or owned hospitals, physicians and others which provide a wide range of coordinated health services; an umbrella term for health plans that provide health care in return for a predetermined monthly fee and coordinate care through a defined network of physicians and hospitals Examples HMO, POS. See HMO, Point of service plan, PPOs.” Jones Health Law provides services related to Managed Care.

 

Management Services Organization – “Is a business that provides non-clinical services to providers. MSOs most commonly provides administrative services to physician practices, but services provided by particular MSOs can vary widely. Some MSOs provide a variety of services. Other specializes exclusively in a certain type of service.”

 

Medicaid – “Medicaid is a federal and state health coverage program available to people who have low incomes and limited resources.” Jones Health Law provides services to those having issues with Medicaid. Medicaid can be a difficult and complex system for anyone to handle.

 

Medical Financial Audits – “Quality health care is based on accurate and complete clinical documentation in the medical record. The best way to improve your clinical documentation and the livelihood of your health care organization is through medical record audits. They are necessary to determine areas that require improvements and corrections. The goals of an audit are to provide efficient and better delivery of care and to improve the financial health of your medical provider. Medical record audits specifically target and evaluate procedural and diagnosis code selection as determined by physician documentation. Once areas of weakness are revealed through an audit, you can present the audit findings and identify opportunities for training in your health care organization.”

 

Medical Practice Sales & Purchases – Jones Health Law provides service to those planning on selling or purchasing a medical practice. The price of a medical practice is critical must be done with extreme caution. Jones Health Law looks to provide a win-win scenario for buyer and sellers alike.

 

Medical Real Estate Transactions – Jones Health Law provides healthcare clients in all aspects of their real estate transactions. There are many regulatory issues that must be fully complied with during the course of a medical real estate transaction. Jones Health Law will fully comply with regulatory issues and ensure your transactions comply with healthcare regulatory requirements.

 

Medical Spas – “A Medical Spa is a place where you can get results oriented, corrective medical skin care products and procedures for treating fine lines,’ wrinkles, hyperpigmentation (sun spots), skin laxity, loss of facial volume and all of the other unwanted consequences of aging skin.  You can also receive laser hair removal treatments as well as vein, scar and stretch mark therapy.”

 

Medical Staff Disputes – Jones Health Law provides service in any medical staff dispute to find the best solution. Medical staff disputes need to be resolved in order for patients to receive optimal and efficient care.

 

Medicare – “Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).” Medicare has 4 different parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage Plans) and Part D (prescription drug coverage).

 

Mental Health Centers – Mental Health Centers are providers of mental health services. They can be inpatient, outpatient, home-based, school, and community based programs for individuals and families.

 

MRI Facilities – (Magnetic Resonance Imaging) “MRI is a noninvasive way for your doctor to examine your organs, tissues and skeletal system. It produces high-resolution images that help diagnose a variety of problems.” MRI Facilities are entities where individuals go to receive diagnostic imaging tests. MRI machines

 

National Board of Medical Examiners Representation – The National Board of Medical Examiners screens all applicants and may deny an applicant due to an alleged wrongdoing. After the allegation, applicants can appeal the decision and Jones Health Law provides legal representation to applicants.

 

Non-Physician Providers – Non-physician providers are typically supervised by a physician. Providers that are considered non-physician include: audiologists, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Doctors of Optometry, Marriage and Family Therapists, Physical Therapists, Physician Assistants, Nurse Practitioners and many more health care professions. Jones Health Law provides service to all types of non-physician providers.

 

Nursing Law – Nursing laws are “[t]he essential documents from the profession serve as the foundation for legislation and regulatory policy-making that help assure the public’s safety. Advanced Practice Registered Nurse (APRN) practice is typically defined by the Nurse Practice Act and governed by the Board of Nursing, but other laws and regulations may impact practice, and other boards may play a role.”

 

Jones Health Law provides service related to any nursing law.

 

Office of the Inspector General (OIG) Actions – “Since its 1976 establishment, OIG has been at the forefront of the Nation’s efforts to fight waste, fraud and abuse in Medicare, Medicaid and more than 100 other HHS programs. HHS OIG is the largest inspector general’s office in the Federal Government, with approximately 1,600 dedicated to combating fraud, waste and abuse and to improving the efficiency of HHS programs. A majority of OIG’s resources goes toward the oversight of Medicare and Medicaid — programs that represent a significant part of the Federal budget and that affect this country’s most vulnerable citizens.”

 

Pain Management Clinics – Is “a pain clinic is a location where doctors offer solutions to intractable pain. Conditions that generally respond well to pain clinic services are arthritis, back pain, and cancer. In addition, migraine headaches, shingles pain, and carpal tunnel syndrome pain frequently respond favorably to pain clinic treatments. Many primary care doctors refer their patients to pain clinics when they have exhausted other methods of pain relief.”

 

Payor Disputes – Jones Health Law provides representation to providers in disputes with commercial payors. Typical issues are reimbursement for out-of-network reimbursement disputes, managed care contracting disputes, federal preemption issues, coverage disputes, coordination of benefits issues, network and preferred provider disputes, and single patient agreement breaches.

 

PEER Review – Involves a co-worker or other health care professionals evaluate each other’s performance. Physician Peer Review is the most common but there are other options. Some hospitals prefer external peer review, nursing peer review, or have peer review boards.

 

Pharmacy Law – Pharmacy Law was created to ensure the protection of the public and protect the public from mis-medication and pharmacy abuse. Pharmacy Law covers many issues from controlled substances to prescriptions. The DEA, local, and state governments enforce pharmacy Law.

 

Prescription Fraud – Prescription fraud involves using fraud, deceit or misrepresenting yourself to a physician to obtain prescription drugs. This crime is a major problem in America as the drugs involved are usually addictive narcotics.

 

Physician Dispensing – Physician dispensing is the legal right physicians have to write medication prescriptions for patients at the point of care as opposed to going to a pharmacy to fill their prescription. The State’s Board of Pharmacy regulates the guidelines covering physician dispensing.

 

Physician Hospital Privileges Disputes – Physicians contract to be able to practice at hospitals. Disputes arise due to different credentialing and privileging. Physicians need to know the best way to protect themselves from any dispute. The Joint Commission on Accreditation of Health Care Organizations states privileging should be based on documented training, experience, and current clinical competence.

 

Stark and Anti-Kickback – The Stark law is a limitation on physician referrals. It prohibits anyone from purposefully offering, soliciting, or receiving anything of value to generate referrals for items or services payable by any Federal health care program.

 

State and Federal Investigations – Jones Health Law provides representation to any individual subject to state and or federal investigations.

 

Substance Abuse Rehab Programs – Jones Health Law offers service to any person or family interested in a substance abuse rehab program. These programs vary in procedure and can be difficult to be accepted into. Taking your first step in rehab is an important process.

 

Telemedicine – “Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.”

 

Veterans Affairs Claims – Jones Health Law offers service to veterans having difficulty with the claims process with Veteran Affairs. The claims process can be confusing and complex and what is needed often varies. Many veterans need help with preparing their claims for VA benefits and some never fully apply.

Do you need legal help or advice? Contact us now.