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Some Of The Most Important Regulations In The Healthcare Industry

Friday, March 15th, 2019
laws a healthcare attorney can help you understand

Any business that handles healthcare is in a unique position where they must blend business with providing medical care. The sensitive nature of the industry makes it one of the most regulated in the United States. It is vital for any healthcare operation to understand the laws that have been created to help guide them in the right direction for patients. Here are some of the most basic and important regulations that you should follow to ensure your business is compliant.


Medicaid was introduced in 1965 by President Johnson to provide insurance for individuals that have little to no income. As of 2014, about 70 million American citizens were covered through this program to some extent. In the same year, Medicaid accounted for about 50% of all medical expenses reimbursed to hospitals. This program is good for laid-off workers, people that have a disability, expectant mothers, children, and those that fall under a certain income level.


Medicare is similar to Medicaid, but is used to provide insurance coverage to senior citizens. It covers about 50 million United States citizens as of 2014.

Healthcare Quality Improvement Act of 1986

The Healthcare Quality Improvement Act of 1986 was created to protect medical professionals and healthcare institutions from lawsuits brought about from peer review. It gives physicians an opportunity to report peers for unethical and dangerous actions without fear of retaliation.

Health Insurance Portability and Accountability Act of 1996

The Health Insurance Portability and Accountability Act of 1996 is commonly referred to as HIPAA. This law was put in place to protect patients and their privacy. It is best known for its focus on keeping health information safe. But, it also allows people to take their health care policy from one employer to another and adjust their policy for life changes like getting married. HIPAA prevents discrimination against an applicant because of any health conditions that they have as well.

The Stark Law

This law prevents physicians and other healthcare workers from referring Medicare or Medicaid patients to a service or business where they have a financial interest. This is not limited to direct interest, such as referring to businesses where you are an owner or partner. It also means indirect interest, like referring patients to immediate family members who work in the healthcare industry.

Patient Safety and Quality Improvement Act of 2005

The Patient Safety and Quality Improvement Act of 2005 was put into place to protect healthcare workers. The intention is to protect whistleblowers that report any unsafe conditions, such as medical errors, while protecting the privacy of patients. This law is enforced by the Office for Civil Rights.

Affordable Care Act of 2010

The Affordable Care Act of 2010 or ACA is commonly referred to as Obamacare. This act provides the American Health Benefits Exchange as a way for citizens to find health insurance plans. The law also required that the majority of uninsured individuals to get health insurance coverage or face paying a penalty.

Hospital Readmissions Reduction Program

The Hospital Readmissions Reduction Program is an initiative of the ACA that is aimed at hospitals that provide services paid for by Medicare and Medicaid. It addresses the issue of repeat patient admissions over a 30-day period by reducing the amount of payouts given to care providers. There are some exceptions, such as specific conditions that could cause a patient to be readmitted shortly after their last stay. These include heart failure or having multiple illnesses.

Staying compliant with healthcare laws

You may wonder how your healthcare operation can stay compliant when there are so many different laws to follow. It helps to have an experienced attorney to explain the regulations and any changes that happen to them in the future. For example, staying HIPAA compliant means protecting patient information as well as training and monitoring employees. This can be difficult to do when keeping up with regular duties. An attorney can help you understand laws, come up with policies for your business, and alert you if aren’t staying compliant, among other benefits.

Do you need a healthcare attorney?

Healthcare businesses should stay aware of all regulations to help keep them on the right side of compliance. If you would like more information, contact the Health Law team at Brown & Fortunato, P.C. today. You can call us at (833) 228-6300 or Send Us an email to learn more about our Practice Areas. We are experienced in helping small, medium, and large healthcare businesses across the country.