Healthcare law concerns who can receive healthcare, and who should pay for it. This is a surprisingly complicated area of law given how expensive healthcare can be. In fact, Americans spent $3.65 trillion on healthcare in 2018 alone. This makes healthcare one of the largest and most heavily-regulated industries in the United States. An industry this large — and so closely tied to human health and survival — has many complexities. And where there are regulations and complexities, there are attorneys.
Why Healthcare Law Is Growing
Healthcare law is a growing field because there is plenty of legal work to be done within the healthcare industry. For starters, the regulatory maze that oversees nearly all aspects of healthcare is nearly impossible for non-lawyers to navigate. Additionally, in recent years, state and federal governments have been cracking down on healthcare fraud and abuse in an effort to reclaim the billions of dollars in losses, so being in compliance with these regulations is more important than ever.
Antitrust laws are also being enforced more vigorously, and hospitals and healthcare associations are often accused of illegal practices like conspiring to fix salaries of nurses and other medical employees.
Other issues like bioethics, kickbacks, privacy, and licensing also have legal underpinnings that are keeping healthcare lawyers very busy.
Finally, the cost of healthcare continues to rise, while the U.S. population continues to age, suggesting that the industry won't be slowing down any time soon.
What Does a Healthcare Lawyer Do?
While many areas of law are stagnant or shrinking, healthcare law is growing all the more important. But what exactly do healthcare lawyers do?
Healthcare lawyers represent a broad range of healthcare professionals and entities such as hospital chains, nursing homes, clinics, home health agencies, pharmacies, clinical laboratories, physician groups, health insurers, physicians, nurses, and medical staff.
The work healthcare lawyers do often touches on a variety of niche areas of the law, including but not limited to corporate, regulatory administrative, securities, contracts, commercial, tax, litigation, professional malpractice, and bioethics. Healthcare law is well suited for attorneys who like variety in their work and don't shy away from complexity.
Many healthcare lawyers spend a lot of their time staying up to date on the laws and regulatory compliance because it is such an integral part of all healthcare business dealings. For example, when it comes to the sale of a healthcare business, there are unique and complicating issues that can apply such as regulatory approval of the license transfer, Medicare, Medicaid, and other third party payor liabilities, malpractice issues, tax and ERISA matters, and more.
Fraud and Abuse
Many healthcare lawyers devote their practices to helping providers avoid allegations of healthcare fraud or abuse. Many providers depend on Medicare and Medicaid payment for much of their revenue. In fact, nearly every healthcare transaction can have fraud or abuse implications that are often overlooked by non-lawyers who do not have a clear understanding of applicable federal laws such as the anti-kickback law, the Stark anti-referral law, and the federal False Claims Act.
Finally, healthcare attorneys work with medical providers and patients to ensure that patients' rights are respected. This includes the right to informed consent, which requires doctors to educate you about your medical options before you make a decision, and a patients' right to privacy in their medical records. Healthcare law also governs what procedures doctors may or may not perform. Particularly controversial procedures include assisted suicide and abortion.
What Else Does a Healthcare Lawyer Do?
Other notable healthcare law focus areas include:
- Patient rights: Healthcare lawyers can ensure individuals give, and medical institutions have, consent for medical treatment or medical research.
- Medical privacy: Healthcare lawyers can help protect patients' reasonable expectation of privacy, which often involves the HIPAA Privacy Rule.
- Tax issues: Since many American hospitals are nonprofit and tax-exempt, there are unique tax issues that lawyers can help individuals and entities understand.
As you can see, healthcare law consists of a broad and ever-expanding tangle of issues that keep lawyers busy and in need.
What Healthcare Lawyers Don't Do
Now that we have looked at what type of work healthcare lawyers do, you may have noticed that medical malpractice was not mentioned. Many people want to lump medical malpractice — people suing medical entities or providers after being injured or killed by medical negligence — into the category of healthcare law, but this is inaccurate. Medical malpractice is actually part of personal injury law, and most healthcare lawyers do not get involved with such claims.
However, healthcare lawyers could become involved when the medical malpractice claim triggers a regulatory issue and the medical entity or professional is at risk of losing their license.
Another misconception about healthcare law is that it is related to the governing of pharmaceuticals or medical devices. Intellectual property lawyers are more likely to be involved with these matters, although healthcare lawyers could get involved with helping to acquire approval for Medicare, Medicaid, or health insurers and HMOs after a drug or medical device has been approved by the U.S. Food and Drug Administration.
Some healthcare attorneys help families plan for long term care and elder care, though this help is more likely to come from attorneys who call themselves elder law or estate planning attorneys. As people begin to live longer, their medical care typically becomes more and more expensive. In addition, these elderly patients often lose the mental or physical capacity to care for themselves. Families can plan ahead by setting aside money for medical costs, creating a living will, and deciding which kind of long term care service to use before the need arises.
Finally, healthcare lawyers do not get involved in helping individuals qualify for disability benefits through Medicare, Medicaid, and Social Security Disability Insurance. A disability lawyer assists with these issues.
Perhaps the easiest way to draw the distinction between what healthcare lawyers do and don't do is to remember that healthcare lawyers most commonly represent medical providers, not patients. However, there are healthcare lawyers who assist patients with certain issues like medical bills, discrimination, and insurance coverage.
How Do You Become a Healthcare Lawyer?
If you are thinking that healthcare law sounds like an interesting and rewarding area of law to pursue, the first step is to become a lawyer. You don't have to specialize in healthcare law in law school in order to practice in this area. Everyone graduates with a J.D., and you can choose what area of law you want to focus on while in law school or even after you graduate. However, it can be beneficial to take healthcare law courses in law school if your institution offers them. You can also look for an internship or clerkship at a firm that handles healthcare law.
After law school, you will need to pass the bar in the state you wish to practice in before you can be a healthcare lawyer. According to salary.com, the median salary for a healthcare lawyer in the United States as of 2020 is $92,808.
When Might You Need Help From This Type of Lawyer?
Typically, you won't need help from a healthcare lawyer unless you are a medical professional, work for a healthcare institution, or own a medical-related business. If you fall into one of these categories, a healthcare lawyer can help you if:
- You need help with compliance issues such as the Anti-Kickback Statute, the Stark Law, or the False Claims Act
- You have contracts or company policies that need to be put into place or revisited
- You are being investigated by a governmental agency or your license is at risk
Some healthcare lawyers also assist patients who have health insurance issues, payment issues, or who have been discriminated against when trying to receive healthcare.
Set up a consultation with a healthcare lawyer in your area if you are in need of legal advice.
Related Practice Areas
- Estate Planning: The practice area which creates wills, trusts, and other estate planning documents.
- Elder Law: This practice area concerns all the legal aspects of aging, including estate planning and health care law.
- Insurance Law: Insurance law attorneys help insurance companies determine how much to pay their clients and advocate for clients so that they receive all relevant benefits.
- Medical Malpractice: The area of law which determines the standards doctors must follow when treating patients.
If you have a Medicare or Medicaid issue, or have a question regarding the services a doctor may provide, be sure to contact a qualified local attorney.