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.
Health care law impacts who can receive health care services and who should pay for these services. Americans spent $4.3 trillion on health care in 2021 alone. This makes health care one of the largest and most heavily regulated industries in the United States. 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 the health care industry and a health care attorney's scope of practice.
Defining the Health Care Industry
Before diving into health care law, it is essential to understand who is a part of the health care industry. The following is a noninclusive list of organizations and professionals who make up the health care industry:
- Health care organizations
- Physician practices or practice groups
- Insurers, both public and private
These groups are subject to health care laws that regulate access to care, privacy, and patient rights.
What Is Health Care Law?
As a body of law, health care law is difficult to describe. 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."
Why Is Health Care Law Growing?
Health care law is a growing field because the regulatory maze that oversees the health care 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:
Finally, health care costs continue to rise while the U.S. population ages and as the need for health care lawyers grows.
What Does a Health Care Lawyer Do?
While many areas of law are stagnant or shrinking, health care law remains critical. Health care lawyers represent a broad range of health care professionals and entities, including:
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 but are not limited to:
- Corporate law, including mergers and acquisitions
- Tax law (especially for nonprofit health care organizations)
Health care law is good for attorneys who like variety and don't shy away from complex legal issues.
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
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:
- Stark Laws (also known as the Physician Self-Referral Act)
Many health care organizations have teams of lawyers to address compliance with these federal laws.
Compliance extends to laws that aim to protect patients' rights. These rights include but are not limited to:
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 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.
Health care attorneys are not usually involved with intellectual property issues like medical devices or pharmaceutical development. Intellectual property lawyers are best suited for these types of concerns.
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.
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 lawyer can help.