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Health law and Regulations

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Regulation and regulatory agencies play an important role in the health care arena. The array of regulations that govern healthcare are overwhelming, however, each individual regulatory agency has a specific scope that focuses on protecting and maintaining quality care, and work to improve access and affordability for Americans. The path to practicing medicine has a display of regulatory hurdles. Healthcare regulatory agencies monitor practitioners and facilities, channel information on industry changes, promote safety, enforce legal compliance, and quality services. The driving force behind these agencies is to reduce costs while ensuring quality services. The current financial trends in healthcare move from volume to value. Cost effectiveness will drive the growth of integrated delivery systems focusing on higher quality, better outcomes, and greater satisfaction. When a hospital focuses on value, it requires the hospital to clarify on every dollar they spend. With that said, the significance of government agencies within the healthcare arena take on additional challenges in enforcing compliance to operating standards.

Government agencies permeate virtually all day-to-day aspects of healthcares goods, services, reimbursement rates, patient protection, hospital accreditation, and licensure of professionals practicing healthcare. The regulatory agencies that enforce compliance to healthcare regulations and legislature provide structure and shape to Americas fragmented healthcare system. From the movement of each dollar in the healthcare arena to how patients and doctors communicate regulatory agencies will continue to translate policy into action and monitor and enforce compliance with healthcare regulations. There are two health care regulatory agencies I have chosen to discuss The Department of Health and Human Services (HHS) which protects the public from a number of health risks and provides programs for public health and welfare, and The Center for Disease Control (CDC), they produce tools to protect the health of the public. They repeatedly try to educate the public, healthcare professionals, and the national populous on the prevention of disease, disability, and injury. They prepare the public for new health threats detected, explore health issues, and research to raise awareness for prevention.

The CDC strives to overcome hurdles, challenges, and circumstances generated from the demands of diseases. They provide preventative education and public awareness on many prevalent healthcare topics such as heart disease, obesity, strokes, diabetes, and sexually transmitted diseases. Disease developments have a result on the delivery of health care services. There have been current health challenges. Numerous individuals are displeased with health and are forced with the rising cost of health care paying out-of-pocket. (Cattell, 2001). The Role of Governmental Regulatory Agencies and Impact on the Health Care Industry The display of regulations that control health care can become overwhelming to the people who work in the health care industry. One regulatory body or another oversees virtually every aspect of the health care field. Many health care professionals sometimes feel they spend more time having to comply with rules that direct their work than actually doing the work itself. The pervasive nature of health care regulation stems from the fundamental concerns that are at stake. Even those who are especially suspicious of heavy-handed government bureaucracy see a public interest is some form of external supervision of this field. (Field, 2008).

When debates are taking place, for the most part, they revolve not around whether oversight should exist but, instead, around the way it should be structured. However, at the present, many healthcare regulations are formulated and implemented at all levels of government such as Federal, State, and Local, as well as a large number of private organizations. Sometimes, they even operate without coordination. Two Laws and Regulations Currently Faced by Health Care Industry In the past, health care was not easily accessible to everyone like it is today. Health care in the past was only provided to individuals who wee privileged enough to make payments. Today, healthcare is easily accessible for all individuals, even the people who have no health insurance or no income to pay for services. With the support of regulations set up by the United States government all healthcare employees and services provided should follow strict policies and rules. Regulations benefit society as an entire entity in many ways. The regulations that are established are in place to manage actions of health care groups and to make certain that all health care employees and services are held responsible for all procedures. (Shi, Singh, 2012).

The first example of regulation the healthcare industry is facing is false claims and whistleblowers. The False Claims Act is a federal law that covers fraud involving any federally funded contract or program, including Medicare or Medicaid, allowing healthcare providers to be prosecuted for various actions leading to the submission of a fraudulent claim (beckershospitalreview.com). There are many guidelines that fall under FCA. Healthcare professional who are knowingly submitting false claims or conspiring with others to submit false claims are with violation of the FCA. Whistleblowers are protected under FCA Under PPACA (Patient Protection and Affordable Care Act), whistleblowers may initiate false claims actions based on information publicly disclosed through federal criminal, civil and administrative proceedings in which the government or its agent is a party, as well as federal reports, hearings, audits or investigations (beckershospitalreview.com). Whistleblowers are protected regardless if a lawsuit is filed and protect them from retaliation from their employers.

Over the course of 2010, many hospitals, health systems and pharmaceutical companies were targeted by the federal government for their roles in submitting false claims. (beckershospitalreview.com). The second example of a regulation currently faced by the health care industry is the HIPAA regulation. The Health Insurance Portability and Accountability Act. HIPAA was signed on August 21,1996 by U.S. President Bill Clinton and was made compliant by the health care industry by April 2003. HIPAA has two primary components to which hospitals and healthcare providers must conform Administrative Simplification, which calls for the use of the same computer language industry-wide Privacy protection which requires healthcare providers to take reasonable measures to protect patients written, oral, and electronic information. The HIPAA law is a multi-step approach in that it is geared to improve the health insurance system. The approach of the HIPAA regulations is to protect privacy and confidentiality by enforcing a standard for the privacy of individually identifiable health information and govern its disclosure.

Analysis of the Impact of Laws on the Provider, or Hospital One out of every seven dollars spent in the United States is spent for healthcare services. This is a greater percentage than in any other industrialized country. (Statistical Abstract of the U.S. 2001). As we continue to study the topic of health care and the direct effects of regulatory agencies, we can apply this concept to the current healthcare reforms implemented by Obama care. The demand for healthcare can follow a downward-slope curve for services just as there is for other goods and services. There are moments when the demand curve for healthcare occurs because consumers respond to changes in the price of healthcare making it more available. When analyzing the demand curve for healthcare you must also analyze the forces that may sway the curve upward or downward. Hospitals might also see an increase in unintentional efforts, even within states where hospitals have conventionally stay union-free. Whereas unionization works for many services and offer a meaning of security to staff, it can also offer complexity for hospital administration.

For instance, unionized environment, if an employee has a concern, he or she must go through a union representative and consult the union agreement rather than verbal communicating directly with a manager. More than a few hospitals and health systems have been hindered by employee strikes in current months. (Shi Singh, 2012). As I live in Massachusetts, where in 2006 the landmark legislation passed a law ensuring near-universal health insurance coverage to residents of the state through a combination of mechanisms. By 2008, only 2.6 percent of Massachusetts residents were uninsured, considerably below the national average of 15 percent. (Rand Health, 2009). Massachusetts is continually trying to find ways to reduce spending on healthcare as a major focus for private and public policymakers in the state. Conclusion Health laws and regulations in the health care industry are extremely stringent. They are implemented to help protect patient and providers from repercussions and legality issues. There is an array of regulations and agencies who guideline and monitor compliance.

For example, as stated in this paper, HIPPA is one of the regulations healthcare professionals must observe. Hefty monetary fines maybe enforced if a HIPPA violation is determined after the investigatory procedures of yet another regulatory agency The Department of Civil Rights. Regulations are in place to improve the quality of service, protect the public, and ensure healthcare professionals abide by a set standard. Virtually no aspect of the healthcare industry escapes regulatory oversight. Each individual segment from pharmaceutical, acute care hospitals, medical professional, reimbursement, and patient protection have regulatory agencies that oversee and govern their operations and standard of conduct to maintain the integrity of the healthcare industry.


Field, R. (2008). Why is Health Care So Complex Pharmacy and Therapeutics. 33(10). 607-608. Morrison. E.E. (2011). Ethics in Health Administration A Practical Approach for Decision Makers. (2nd ed.). Sudbury. Ma Jones and Barlett. Rand Publications (2009). Retrieved from www.rand.org/pubs/research_briefs/ RB9464-1/Indexl.htmlanalysisoftheproviderinmassachusetts. SHI, L., Singh, D.A. (2012). Essentials of the US Healthcare system. Jones Bartlett Publishers. Statistical Abstract of the United States. (2001). Retrieved from http//www.census. Gov/prob/www/statistical-abstract-us.html. Table 119, p. 91. Thirteen Legal issues for Hospitals and Health Systems. (2001). Retrieved from http//www.beckerhospitalreview.com/hospital-management-administration/13- legal-issues-for-hospitals-and-health-systems.html. What is HIPPA (2008). Retrieved from April 28, 2008.

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