01-06B - Introduction To Healthcare and Public Health in The US - Unit 06 - Regulating Healthcare - Lecture B

Introduction to Healthcare
and Public Health in the US

Lecture b
Regulating Healthcare
This material (Comp1_Unit6b) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Learning Objectives
Describe the role of accreditation, regulatory bodies, and
professional associations in health care in the US. (Lecture a)
Describe the basic concepts of law in the United States: the legal
system, sources of law, classification of laws, the court system, and
the trial process. (Lecture b)
Describe legal aspects of medicine involving the Affordable Care
Act, professional standards in health care, medical malpractice, Tort
reform, and Medicare and Medicaid Fraud and Abuse (Lecture c)
Describe key components of the Health Insurance Portability and
Accountability Act (HIPAA) and current issues of privacy and patient
safety in the US (Lecture d)
Discuss the need for quality clinical documentation for the use of the
health record as a legal document, communication tool and a key to
prove compliance for health care organizations. (Lecture e)
2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Lecture b
The Legal System in the US
Legislative
House of Representatives and the Senate
Executive
The president and numerous departments
and agencies
Judicial
Judges and courts
3
Lecture b
Balance of Power
Separation of powers
Three branches of government
Designed to prevent any one branch from
becoming too powerful
Checks and balances
Legislative branch makes laws
Executive branch enforces laws
Judicial branch interprets laws

4
Lecture b
Sources of Law
Legislative branch makes statutory laws
Executive branch makes administrative laws
Laws made by the courts are called common law
or case law
5
Lecture b
The Judicial System: Courts
Trial court
Hears evidence and hands down verdicts
Can be federal, state, or local
Appellate court
Losing party can appeal
Court usually does not hear new evidence
Reviews case to determine if the law was
properly applied to the facts as determined by
the trial court
6
Lecture b
The Judicial System: Jurisdiction
Federal courts
Constitutionality of a federal law
Disputes primarily involving federal law
Disputes between citizens of different states
State courts
Often called courts of common pleas or
county courts
City or municipal courts
7
Lecture b
Comparing Court Systems:
An Example
US Government State of Ohio City of
Cleveland
Trial courts US District Court for the
Northern District of Ohio
Cuyahoga County
Court of Common
Pleas
Cleveland
Municipal Court
Appellate
courts
US Sixth Circuit
Court of Appeals
Ohio Eighth District Court of Appeals
Highest court US Supreme Court Ohio Supreme Court
6.2 Table: Example of court jurisdiction on various levels of government.
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Lecture b
Classification of Laws
Civil or private law
Relationships between people
Relationships between people and
organizations
Relationships between organizations
Includes family, property, inheritance,
corporate, contract, and tort law
Public law
Relationships between people and the
government

9
Lecture b
Two Kinds of Penalties
Civil lawexchange of money between the
private parties to the lawsuit
Public lawcan result in fines paid to the
government and/or imprisonment
The same action can result in both kinds of
penalties

10
Lecture b
Example: Traffic Accident
Drunk driver crashes car, causing serious injury
to the driver of the other car
Criminal (public) penalty
State vs. drunk driver
Civil (private) damages
Injured driver vs. drunk driver
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Lecture b
General Classification:
Private Law
6. 3 Figure: Two important sub classifications of civil law are contract law and tort law (OHSU, 2010).
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Lecture b
Contract Law
Contract elements
Offer
Acceptance
Consideration: something of value given in
exchange for a promise
Express contract
Written or oral
Implied contract

13
Lecture b
Tort Law
Intentional torts
Battery
Defamation
Negligence
Does not act with a reasonable amount of
care
As a result, someone is injured
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Lecture b
General Classification:
Public Law
6.4 Figure: The two types of Public Law that have the most effect on individuals are criminal law and administrative law (OHSU, 2010).
15
Lecture b
Litigation: Parties
Adversary system
Each party presents his or her case
Facts determined by neutral fact-finder
Civil case: plaintiff and defendant
Criminal case: government and defendant
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Lecture b
Pre-trial Litigation: Discovery
Purpose is to fully develop the facts
Depositions are one kind of discovery
Sworn testimony recorded by court reporter
Parties
Witnesses
Expert witnesses

17
Lecture b
Administrative Hearings
Sometimes an administrative agency has a
system of hearings that is outside the normal
court system
The agency may or may not have an appellate
level
Usually reviewable in a court of law
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Lecture b
Administrative Hearing Example
Social Security Administration (SSA)
Hearing officers
Social Security Appeals Council
Decisions of the SSA appeals board can be
further appealed to the US District Court
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Lecture b

Summary Lecture b

3 branches of government: legislative, executive,
judicial (the courts)
Courts are divided into:
Trial courts and appellate courts
Federal, state, city/municipal courts
The courts are neutral arenas where the parties
to a dispute face off in an adversarial process
2 main types of law: private and public

20
Lecture b
References
Administrative Office of the US Courts. The federal court system in the United States. 2010. 3rd ed.
http://www.uscourts.gov/uscourts/FederalCourts/Publications/English.pdf. Accessed April 8, 2011.
Administrative Office of the US Courts. Understanding federal and state courts.
http://www.uscourts.gov/EducationalResources/FederalCourtBasics/CourtStructure/UnderstandingFederalAndStateCourts.aspx.
Accessed April 8, 2011.
Administrative Office of the US Courts. United States Courts. http://www.uscourts.gov/Home.aspx. Accessed April 8, 2011.
Centers for Medicare and Medicaid Services. Guidance to laws and regulations: overview.
https://www.cms.gov/GuidanceforLawsAndRegulations. Accessed April 10, 2011.
Cornell University Law School Legal Information Institute. Tort. http://topics.law.cornell.edu/wex/tort. Accessed April 10, 2011.
Social Security Online. Information about Social Security's hearings and appeals process. http://www.ssa.gov/appeals. Accessed April 10,
2011.
The Library of Congress. Law Library of Congress. http://www.loc.gov/law. Accessed April 10, 2011.
US Citizenship and Immigration Services. Welcome to the United States: A guide for new immigrants.
ttp://www.uscis.gov/files/nativedocuments/M-618.pdf. Accessed April 8, 2011.
USA.gov. Federal executive branch. http://www.usa.gov/Agencies/Federal/Executive.shtml. Accessed April 10, 2011.

Charts, Tables and Images
6.2 Table: Example of court jurisdiction on various levels of government.
6. 3 Figure: Two important sub classifications of civil law are contract law and tort law. OHSU (2010).
6.4 Figure: The two types of Public Law that have the most effect on individuals are criminal law and administrative law. OHSU (2010).
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Lecture b
References Lecture b

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