What Do Health Care Attorneys Do?

Health care law is not a specific area like contract law, tort law, or property law. Rather, many different areas of the law comprise health care law. Because the health care industry is massive and heavily regulated, these laws cover everything from patient rights and privacy to fraud prevention and insurance requirements.

An industry this large — closely tied to human health and survival — is complex. And where there are complex regulations, there are attorneys. This article explores this body of law and how health care attorneys support both patients and providers.

What Is Health Care Law?

Health care law combines administrative and regulatory law, health law, contract and tort law, employment law, and judicial precedent. According to Georgetown Law Center: “Health care law focuses on the legislative, executive, and judicial rules and regulations that govern the health care industry.”

Who Does the Health Care Industry Include?

To understand health care law, it is essential to know who is a part of the health care industry. The following is a noninclusive list of organizations and professionals who make up this industry:

• Health care systems
• Care facilities
• Health care organizations
• Health care providers
• Health care practices
• Physician practices or practice groups
• Mental health facilities
• Insurers, both public and private
• Pharmaceutical companies

These groups are subject to health care laws that regulate access to care, privacy, and patient rights.

Why Is Health Care Law Growing?

Health care law is a growing field because the regulatory maze governing the industry is almost impossible for non-lawyers to navigate. Moreover, federal and state agencies are tackling health care fraud and abuse, requiring close compliance. And government agencies are vigorously enforcing antitrust laws to encourage robust competition for the benefit of consumers.

Health care lawyers can offer legal counsel to organizations facing antitrust lawsuits. Health care lawyers also cover issues including the following:

• Bioethics
• Kickbacks
• Privacy
• Licensing

Finally, health care costs continue to rise while the U.S. population ages. Thus, the need for health care lawyers grows.

How Do Health Care Lawyers Help Organizations and Providers?

Health care lawyers represent a broad range of health care professionals and entities, including:

• Hospital chains
• Nursing homes
• Insurance companies
• Home health agencies
• Pharmacies
• Physician groups
• Health insurers

Because health law is a broad area of law, health care lawyers often work in various niche areas. Like all other lawyers, they attend law school and earn a juris doctor, but they can go on to specialize in niche areas of health care law. These niche practice areas include:

• Corporate law, including mergers and acquisitions
• Contract law
• Real estate law
• Tax law (especially for nonprofit health care organizations)
• Civil litigation
• Professional malpractice
• Bioethics

Health care law is good for attorneys who like variety and don’t shy away from complex legal issues.

Regulatory Compliance

Regulatory compliance is essential to all aspects of the health care business. Health care lawyers must remain current on federal and state laws affecting their clients. For example, in a merger of two health care systems, health care lawyers may have to deal with the following legal issues:

• Regulatory approval of the merger
• Insurance law
• Employment law

Health Care Fraud and Abuse

Fraud abuse can run rampant in health care organizations, leading to criminal charges. Some health care lawyers devote their practices to helping providers avoid fraud and abuse allegations. Some examples of health care fraud:

• Billing a health insurer for services not performed
• Asking for reimbursement at higher rates for services typically billed at lower rates

Health care abuse is different from health care fraud. Some common examples:

• Billing a health insurer for medically unnecessary services
• Overcharging for supplies
• Using the wrong codes on insurance claims

Given the health care industry’s reliance on Medicare and Medicaid for much of its revenue, clients need lawyers who understand the intricacies of federal laws.

Applicable federal laws include:

• The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• The Affordable Care Act of 2010
• Stark Laws (also known as the Physician Self-Referral Act)
• Anti-Kickback Statute
• False Claims Act

Many health care organizations have teams of lawyers to address compliance with these federal laws.

Patient Rights

Compliance extends to laws that aim to protect patients’ rights. These rights include the right to privacy and the right to informed consent.

Non-Health Care Law Matters

Health care lawyers may overlap in other niche areas of the law, including medical malpractice, intellectual property, or estate planning.

Medical Malpractice

Medical malpractice is typically outside the scope of practice for health care attorneys. Medical malpractice involves tort law or personal injury law. Medical malpractice deals with injuries or deaths resulting from medical negligence. Health care lawyers are rarely involved in these claims unless the malpractice claim triggers a regulatory issue, such as physician licensing.

Intellectual Property

Health care attorneys are not usually involved in intellectual property issues such as medical devices or pharmaceutical development. Intellectual property lawyers are best suited for these types of concerns.

Estate Planning

Some health care attorneys help families plan for long-term care and elder care as part of estate planning. Given the issues associated with aging and the increasing costs of medical care, some families plan for long-term care. Advance health care directives also fall under estate planning law.

How To Find Health Care Legal Help

Some health care lawyers help patients with health insurance issues or those who have faced discrimination in getting care. If you need legal advice or legal services in any of these areas, including long-term care planning, an experienced local health care attorney can help.

FindLaw’s directory of health care lawyers can get you started. Enter your city or ZIP code for a list of qualified legal professionals near you. Your search results will also show ratings and contact information. Many attorneys offer free consultations.