Major Components That Comprise the Legal System
The legal system that governs the healthcare industry is a multifaceted framework comprising several components that shape healthcare delivery today. These components play a crucial role in defining the rights and responsibilities of healthcare providers, organizations, and patients, as well as in ensuring the integrity and efficiency of healthcare. Laws and statutes establish the fundamental principles and guidelines that regulate the healthcare industry. (Famakin et al., 2020) These laws are enacted at the federal, state, and local levels, covering many areas, including patient rights, privacy protections, and medical malpractice liability. Regulations issued by government agencies, such as the Centers for Medicare and Medicaid Services (CMS) in the United States, provide more detailed guidelines and requirements for healthcare providers and organizations.
The distinction between for-profit and not-for-profit healthcare organizations is one area in which tax regulations are particularly important in the healthcare system. Not-for-profit organizations are eligible for tax benefits and must adhere to certain rules to keep their tax-exempt status (Bird & Maier, 2023). Another essential element is the interaction between public programs like Medicare and Medicaid and commercial insurance. While Medicare and Medicaid offer healthcare coverage for particular demographics, such as older and low-income people, private insurance is primarily employer-based and offers several coverage alternatives. Laws against fraud and abuse are in place to stop illegal activities within these programs, like invoicing for services that weren’t provided or giving unnecessary treatments. The delivery of healthcare is continuously shaped by new legislation. For instance, the Affordable Care Act (ACA) in the United States introduced significant reforms, including the individual mandate, expansion of Medicaid eligibility, and the establishment of health insurance exchanges.
Medicare/Medicaid, fraud and abuse laws illustrate how a component of the legal system affects healthcare delivery systems. These restrictions are intended to stop dishonest behavior that could jeopardize these initiatives’ credibility and long-term viability. For instance, healthcare practitioners responsible for filing false claims, overcharging clients, or rendering extra services may be subject to severe sanctions, such as fines and exclusion from federal healthcare programs. By ensuring that the available monies are used to deliver necessary healthcare services to qualified beneficiaries, these laws help protect public money while preserving the credibility and long-term viability of the Medicare and Medicaid programs.
References
Bird, D., & Maier, E. (2023). Wayward Samaritans: “Non-Profit” Hospitals and Their Tax Exempt Status. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.4406495
Famakin, I. O., Aigbavboa, C., & Molusiwa, R. (2020). Exploring challenges to implementing health and safety regulations in a developing economy. International Journal of Construction Management, 1–35. https://doi.org/10.1080/15623599.2020.1850201
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Explain the major components that comprise the “legal system” that we see present within health care today.
Major Components That Comprise the Legal System
Possible areas: laws and statutes, regulations, tax laws, for-profit vs not-for-profit, private insurance vs. Medicare/Medicaid fraud/abuse, and new legislation. Give an example of how a component of the legal system impacts our current healthcare delivery systems.
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