This practice manual contains more than 100 forms and documents. Each form includes commentary explaining when and how each form should be used. The manual is organized into five parts: managing the elder law practice; estate and long-term care planning; powers of attorney, medical directives and wills; trusts; and miscellaneous topics.

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Provides answers to questions concerning Medicaid, long-term care planning, healthcare issues, trusts, powers, and guardianship. Each portfolio in the series is written by an elder law expert. The series also includes a table of cases.

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This is the first comprehensive estate-planning guide for those living with a chronic disease or disability. This book is targeted at those planning for the disbursement of their estates, no matter their size.Estate-planning is crucial for those living with a chronic disease or disability: individuals must express their preferences whether to receive long-term care at home rather than in a nursing home in the event that they become more disabled, and it is more important for one who has a chronic illness to name a power of attorney. Estate Planning for People with a Chronic Condition or Disability covers all of those topics plus: How to write your will How to determine how much life insurance your family needs How to figure out whether you need a living trust Learn about powers of attorney When to work with a lawyer, if you need toThe book also includes downloadable sample forms for: Power of Attorney Living Will...

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This book provides state-by-state information on advance directives and living wills. It also touches on other end-of-life planning devices and looks at special problems that may come up when an individual is considering end-of-life planning and executing an advance directive.

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"Public policy responses to escalating medical costs and constrained access pose fundamental challenges to health care law. Profound medical advances also generate many ethical dilemmas. This authoritative discussion considers how law and ethics respond to these driving social, economic, and political forces of innovation, crisis and reform. Topics include health insurance reform, health care finance and delivery structures, treatment relationships, facility and insurance regulation, corporate and tax law, refusal of life support, organ donation, and reproductive technologies." - publisher's description

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"Expert authors present an up-to-date overview of health law as it affects the professionals, institutions, and entities that deliver and finance health care in the United States. Considers the law's response to quality and error through institutional and professional regulation, and malpractice litigation against professionals, hospitals, and managed care organizations. Surveys tax, corporate, and organizational issues. Explores the government's efforts to control costs and expand access through Medicare and Medicaid. Examines government attempts to police anticompetitive activities, fraud, and abuse. And considers the legal and ethical issues involving death, human reproduction, medical treatment decision making, and medical research. The Affordable Care Act, HIPAA, HITECH, and other new statutory and regulatory changes of the past few years are thoroughly incorporated in all aspects of the legal discussion." - publisher's description

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This book by Nolo helps readers find information on long-term medical care and financial planning. Long-Term Care helps readers understand the range of available choices helping them to explore options for home care, assisted living and nursing homes, maximizing Medicare, Medicaid and veterans' programs, and preventing elder fraud.

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"Mental illness and intellectual disability (formerly called mental retardation) impact 20% of Americans, and have enormous personal, legal, and policy implications for patients, families, and society. This Nutshell introduces you to the broad range of criminal and civil issues in mental health law, including diagnosis of mental illness; expert testimony on mental health issues; civil commitment; competence to stand trial; the insanity defense; various competencies; ethical/legal issues facing mental health professionals, including informed consent, confidentiality, privilege, and malpractice; discrimination against persons with mental illness; financial and medical benefits for disabled persons." - publisher's description

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Grasp the latest legal information for gay and lesbian couplesSame-sex relationships are treated differently under each state's laws, and nearly a quarter of the U.S. population lives in a state with some form of legal recognition for same-sex couples.Same Sex Legal Kit For Dummies is a practical, plain-English guide to the legal information and guidance lesbian and gay couples need—from making practical decisions about living together and obtaining domestic partner benefits, to making medical decisions, taking care of each other's finances when one partner is incapacitated, leaving property to each other, having and raising children, and much more.Discusses power of attorney, health directives, and real estate and personal property ownershipCovers considerations for bank accounts, investments, and estate planningThe book's accompanying...The EPUB format of this title may not be compatible for use on all handheld devices.

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A quick and easy guide to problems of aging and how the law and practical advice can make things better.

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"This book provides a concise analysis of areas in which the law has addressed issues in bioethics. Topics include assisted reproductive techniques and family-making, limitations on reproduction (including abortion, contraception and sterilization), the role of ethical and religious beliefs of health care professionals, the definition of death, end-of-life decision-making (including physician assisted death), genetics, research involving human subjects (including issues related to conflicts of interest), stem cell research, organ transplantation, and other emerging topics. The book provides an excellent introduction to the process of ethics decision-making as well as useful support for students." - publisher's description

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Provides answers to questions concerning Medicaid, long-term care planning, healthcare issues, trusts, powers, and guardianship. Each portfolio in the series is written by an elder law expert. The series also includes a table of cases.

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The Anti-Kickback Statute (AKS) was first enacted through the Social Security Amendments of 1972 in order to combat fraud and abuse in the Medicare and Medicaid Programs. The purpose of the AKS is to remove the corrupting effects of kickbacks in health care by, among other things, outlawing behavior designed to game the system through the use of financial incentives intended to direct patient referrals to particular health care providers and away from other providers rendering the same type of care. But not every payment or practice offends the policies underlying the statute. Beginning in 1991, the Office of Inspector General of the U.S. Department of Health and Human Services began promulgating regulatory safe harbors to supplement the statutory exceptions passed by Congress. Safe harbors are designed to protect certain common and salutary commercial arrangements the purpose of which is not to induce referrals in violation of the AKS. The safe harbors place these arrangements beyond …

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When judged by statistics and comparative health data, health care in the United States is exceptional---exceptionally bad. Our nation faces enormous challenges: unsustainable cost increases, uneven access and quality, and the implementation of health care reform. Policymakers and the greater health care community, including consumers of health care, look to technology as a means of overcoming these challenges by increasing efficiency in health administration, delivery of services, and information management. Health Care IT: The Essential Lawyer's Guide to Health Care Information Technology and the Law, introduces lawyers, health care professionals, and members of the general public to the many facets of the use of technology in health care and its federal regulatory framework.

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"Public policy responses to escalating medical costs and constrained access pose fundamental challenges to health care law. Profound medical advances also generate many ethical dilemmas. This authoritative discussion considers how law and ethics respond to these driving social, economic, and political forces of innovation, crisis and reform. Topics include health insurance reform, health care finance and delivery structures, treatment relationships, facility and insurance regulation, corporate and tax law, refusal of life support, organ donation, and reproductive technologies." - publisher's description

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Few industries in the United States have received more attention from the popular press and antitrust authorities than health care. Whether in response to business or legislative and regulatory pressures, health care companies have increasingly looked to transactions as a means to achieve cost savings, quality improvement, and population health management. At the same time, the antitrust agencies have promised robust enforcement in health care markets. The collision of these forces led to many significant legal developments in recent years, and also made producing an up-to-date treatment of these issues challenging. The revised and updated Health Care Mergers and Acquisitions Handbook, Second Edition provides guidance regarding how courts and the U.S. antitrust agencies analyze and review mergers in the health care industry. This handbook addresses the issues that antitrust practitioners and their clients face in planning, executing, and litigating transactions in the health care field…

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"Expert authors present an up-to-date overview of health law as it affects the professionals, institutions, and entities that deliver and finance health care in the United States. Considers the law's response to quality and error through institutional and professional regulation, and malpractice litigation against professionals, hospitals, and managed care organizations. Surveys tax, corporate, and organizational issues. Explores the government's efforts to control costs and expand access through Medicare and Medicaid. Examines government attempts to police anticompetitive activities, fraud, and abuse. And considers the legal and ethical issues involving death, human reproduction, medical treatment decision making, and medical research. The Affordable Care Act, HIPAA, HITECH, and other new statutory and regulatory changes of the past few years are thoroughly incorporated in all aspects of the legal discussion." - publisher's description

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This new edition provides step-by-step guidance on dealing with the medical-legal issues involved in litigating a nursing home case for both plaintiffs' and defense lawyers. It also provides guidance to nursing home administrators on how to avoid liability and improve quality through regulatory compliance. Authors James T. O'Reilly and Katharine Van Tassel begin by reviewing the responsibilities and liabilities of management, nurses, and physicians in the second edition of Litigating the Nursing Home Case. This extensive reference then examines liability and regulatory issues from both defense and plaintiffs' perspectives, including specific topics such as drug interaction and polypharmacy concerns, ulcers and infection problems, fall-related injuries, wandering and escape issues, assault and abuse, dehydration, choking, and more. New topics in the second edition have been added, including: - A greatly expanded description of the medical-legal issues facing both plaintiff s' and def…

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"Mental illness and intellectual disability (formerly called mental retardation) impact 20% of Americans, and have enormous personal, legal, and policy implications for patients, families, and society. This Nutshell introduces you to the broad range of criminal and civil issues in mental health law, including diagnosis of mental illness; expert testimony on mental health issues; civil commitment; competence to stand trial; the insanity defense; various competencies; ethical/legal issues facing mental health professionals, including informed consent, confidentiality, privilege, and malpractice; discrimination against persons with mental illness; financial and medical benefits for disabled persons." - publisher's description

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This book represents the cutting edge of physician law. The publication emanates from the American Bar Association Health Law Section's 2018 Physicians Legal Issues Conference. The conference and this book have been produced in conjunction with the Chicago Medical Society and the American Medical Association, tailored to an audience including physicians, lawyers, healthcare administrators and other healthcare business people. The book includes nine peer-reviewed chapters on core physician-centric legal topics: 1.Entrepreneurial Medicine (including fraud and abuse risk areas); 2.Physician-Hospital Contracting; 3.Medical Professional Liability; 4.Telemedicine; 5.HIPAA; 6.Accountable Care Organizations; 7.Doctor's Defense in Medical Staff Hearings and Appeals; 8.Physician Well-Being; and 9.Medicare and Medicaid Contractors. Physicians will especially benefit from the content that addresses a broad range of non-clinical topics that are currently transforming American healthcare. The chapte…

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The business of providing medical care is in the midst of dramatic change. To keep pace with evolving economics and reimbursement practices, the small physician practice, which stood as the standard arrangement for so long, is giving way to larger, more corporate models. These models have led to a highly regulated business environment in the health care services industry, which involves interpreting areas of the law without clear guide rails. The corporate practice of medicine and fee-splitting prohibitions, depending on which state's laws you are interpreting, can be one of those areas of the law that lack those guide rails. Advising clients on compliance with the prohibitions may require more finesse and risk analysis than legal research in some jurisdictions. This primer on the prohibitions provides practitioners with the historical context in which they arose; a concise discussion of each of the prohibitions and how they affect the business of medicine; what they mean for the owner…

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Alternative dispute resolution, or ADR, is the practice of resolving disputes through processes other than litigation. The most common forms of ADR are mediation and arbitration, but many other forms exist in the Health Care arena to address specific types of disputes and their need for tailored processes for unique situations.Some of these include hearing officers for hospital hearings, referees for discovery disputes and early neutral evaluation of cases. Lawyers specializing in the Health Care field are required to utilize many skills, techniques and methods to resolve disputes for their clients. Health Care lawyers must remain up-to-date on regulatory changes, industry trends, the economic climate and changes in the law.

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CHOW is an acronym frequently used by those in the health care industry to describe the regulatory process that often must be followed when a licensed or certified health care provider undergoes a "change of ownership." Many businesses that operate in the health care industry will have at least one and maybe multiple "permits" or "provider numbers" issued by a governmental body. As a result, the CHOW process applicable to most, if not all, health care permits, licenses, certifications, and provider numbers is heavily regulated to ensure that any new owners satisfy the regulatory requirements that the "seller" met when it originally obtained the permit. This book is designed to give practitioners a general understanding of the CHOW process for operating licensure, certificate of need, and Medicare and Medicaid provider numbers. The book describes some general and specific elements of what can be, and in some cases is, required in a change of ownership process in these different contexts…

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In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA). This was done to combat the perceived problem of "patient dumping," where hospital emergency rooms were refusing to treat patients that did not have health insurance. This book covers everything you need to know about EMTALA, from its history and regulatory framework to the requirements it places on hospitals to this day. This includes larger considerations like what constitutes a legitimate emergency medical condition, but also smaller (but still important) ones like signage and proper record keeping. The book also looks at other considerations, like dealing with psychiatric patients, malpractice, and disaster response. What Is...EMTALA? is a must for any attorney working in the field of patient's rights.

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?The term "medical staff" refers to an organized body of licensed physicians, dentists, and other healthcare providers who are authorized by state law and by a hospital to provide medical care to patients within the hospital. A healthcare provider's membership at a hospital must be reviewed for reappointment at least every two years. Such review and reappointment is based upon ongoing monitoring of specific information regarding the healthcare provider's performance, medical judgment, clinical skills and professional behavior. This book covers the different kinds of peer review, as well as the various outcomes they can have. It begins by defining what constitutes a medical staff, and how they are governed. It then examines both the informal and formal peer review process, internal investigations, and disciplinary actions.

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Learn how to analyze and advise on Stark Law issues. The Physician Self-Referral Law, commonly known as the "Stark Law", prohibits a physician from referring Medicare patients for certain services defined as designated health services ("DHS"), to an entity with which the physician or an immediate family member of the physician has a direct or indirect "financial relationship." What is Stark Law? presents a general overview and discussion of the Stark Law. Topics include: -An overview of the statute itself -Regulations, specifically the regulatory exceptions, and the terms of the exceptions -The source of interpretations of the Stark Law, including key cases and advisory opinions -An overview of enforcement mechanisms and consequences for violations of Stark -A list of resources to further assist attorneys as they research and analyze Stark issues This book is a must have for any individual working with healthcare entities needing a general introduction to the statute and regulations go…

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This handy resource provides a broad overview of the telemedicine industry and prepares the reader to better understand and address the technology and patient care aspects of telemedicine, but also the critical policy and legal issues that surround and support—and sometimes impede—its adoption. This book includes examples of companies operating in the telehealth, telemedicine, and mHealth markets and a discussion of how telemedicine is well positioned to address some of the current U.S. health care market failures.

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The federal Anti-Kickback Statute (AKS) is one of the best-known federal fraud and abuse statutes, due largely to its wide-ranging effects on business relationships in the health care, pharmaceutical, and medical device sectors. This primer explains how AKS is a criminal statute that prohibits transactions intended to induce or reward referrals for items or services reimbursed by the federal health care programs. It further details the anti-corruption statute and how it is designed to protect federal health care program beneficiaries from the influence of money on referral decisions and thus is intended to guard against overutilization, increased costs, and poor quality services. Chapters include: • Overview of the Anti-Kickback Statute and Its Purpose • Statutory Exceptions and Safe Harbors to the Anti-Kickback • Statute • Fraud and Abuse Waivers • Sources of Guidance • Related Statutes

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This guide provides a detailed overview of the Sunshine Act, transparency initiatives, and related implications associated with increased attention on physician-industry relationships. Section II provides background and the legislative history of the Sunshine Act. Section III provides a detailed summary and analysis of the technical statutory and regulatory requirements manufacturers and group purchasing organizations must abide by to comply with the law. Section IV analyzes the Sunshine Act's regulatory requirements as they may impact other healthcare fraud and abuse and compliance obligations and requirements, including the Anti-Kickback Statute and the False Claims Act. Section IV.C provides an overview of related state transparency laws and gift ban laws, including how such provisions are preempted under the Sunshine Act. Section V offers a brief overview of CMS's first data release on the Open Payments website and discusses potential issues and future concerns for all stakeholders…

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"Public policy responses to escalating medical costs and constrained access pose fundamental challenges to health care law. Profound medical advances also generate many ethical dilemmas. This authoritative discussion considers how law and ethics respond to these driving social, economic, and political forces of innovation, crisis and reform. Topics include health insurance reform, health care finance and delivery structures, treatment relationships, facility and insurance regulation, corporate and tax law, refusal of life support, organ donation, and reproductive technologies." - publisher's description

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"Expert authors present an up-to-date overview of health law as it affects the professionals, institutions, and entities that deliver and finance health care in the United States. Considers the law's response to quality and error through institutional and professional regulation, and malpractice litigation against professionals, hospitals, and managed care organizations. Surveys tax, corporate, and organizational issues. Explores the government's efforts to control costs and expand access through Medicare and Medicaid. Examines government attempts to police anticompetitive activities, fraud, and abuse. And considers the legal and ethical issues involving death, human reproduction, medical treatment decision making, and medical research. The Affordable Care Act, HIPAA, HITECH, and other new statutory and regulatory changes of the past few years are thoroughly incorporated in all aspects of the legal discussion." - publisher's description

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Maintaining cybersecurity in today's technologically driven world is vital to the health of any business. Media outlets continue to report on large-scale data breaches affecting millions of consumers' information and costing companies millions, and sometimes even billions, of dollars to rectify. Organizations, particularly those within or touching the healthcare industry, remain the most attractive of targets for cyber attackers given the higher and lasting value of personal health information. The goal of this book is to help bolster stakeholders' knowledge of cybersecurity in the healthcare industry, with the aim of pinpointing current and impending threats to the industry's data security. The topics to be addressed include types of cybersecurity threats; ransomware in healthcare; how to prepare for and respond to cybersecurity attacks; the cost of inadequate security measures; and managing privacy and cybersecurity risks.

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HIPAA privacy regulations have been the subject of countless hours of study, analysis, and compliance efforts within the health care industry and beyond. Almost two decades later, and more than 15 years after the first edition of this book, the privacy and security requirements of HIPAA are the subject of significant confusion and uncertainty. As the laws and social pressure evolve and tighten the reigns on health care privacy, patients and providers will continue to become more concerned about maintaining the security and privacy of data while rising to the challenge of balancing privacy while promoting patient access and quality care. This revised and updated edition creates a useful guide for those who are new to HIPAA as well as provide updates for seasoned veterans of HIPAA. This book expands on the first edition and includes the Security Rule, the HITECH Act, and the Breach Notification Rule along with extensive discussion about HIPAA's parameters, practical applications, and les…

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This volume provides current instructions on the most recent medical issues. It covers more than 200 medical issues including standards of care, childbirth, patient consent, pre-existing conditions, and allergies. Legal concepts and issues are presented in sample instructions using understandable terms.

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"The Privacy Nutshell briefly reviews the historical roots of privacy, and then examines each of these U.S. privacy statutes and regulations. Virtually all governments and businesses face privacy considerations as technology continues to evolve. Legal issues related to privacy are exploding on the U.S. legal scene. The EU has a long history of a strong regulatory privacy regime. The U. S., however, follows a sectoral approach to privacy, whereby Congress responds to each privacy “crisis” with a new statute and set of regulations. This sectoral approach has resulted in a unique series of privacy rules for different areas of society. The Privacy Nutshell is an excellent introductory guide to the legal privacy world." -publisher's description

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As part of the “What Is” series, the purpose is to provide a preliminary overview of HIPAA and the HITECH Act in relation to correlating international laws in some strategic countries, as well as providing practical guidance for evaluating business associates and executing business associate agreements. Three countries in particular will be highlighted: the U.S., the U.K. and India. This gives a perspective on the U.S. laws in relation to an established market and an emerging market, whose laws and their enforcement vary widely.

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Waiting to address long-term care needs until the point one actually needs care is too late, as it significantly impacts a client's financial situation, quality of life of their loved ones, and their ability to maintain their independence. Incorporating long-term care insurance into the financial plan can ultimately help protect assets reduce the burden of care that would otherwise fall on family members, and enable the client to receive care in the setting they most prefer, including their home. The Advisor's Guide to Long-Term Care looks at the full range of the topic, explaining how to best use it in the estate plan as a prudent risk-management choice. Statistics point to the high probability that people are likely to need extended health care at some point in their life. The Advisor's Guide to Long-Term Care is intended to help estate planners and advisors to address these issues with their clients, establishing the issues and trends for care and covering all relevant issues invol…

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The Elder Law Answer Book offers a thorough guide to aspects of the law that affect senior citizens, including long-term care planning, powers of attorney, trusts, age discrimination, and more.

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This book provides a brief overview of elder law. Topics covered include ethical considerations, health care decision making, Medicaid, SSI, guardianship alternatives, pension plans, and elder abuse and neglect.

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Provides answers to questions concerning Medicaid, long-term care planning, healthcare issues, trusts, powers, and guardianship. Each portfolio in the series is written by an elder law expert. The series also includes a table of cases.

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The Anti-Kickback Statute (AKS) was first enacted through the Social Security Amendments of 1972 in order to combat fraud and abuse in the Medicare and Medicaid Programs. The purpose of the AKS is to remove the corrupting effects of kickbacks in health care by, among other things, outlawing behavior designed to game the system through the use of financial incentives intended to direct patient referrals to particular health care providers and away from other providers rendering the same type of care. But not every payment or practice offends the policies underlying the statute. Beginning in 1991, the Office of Inspector General of the U.S. Department of Health and Human Services began promulgating regulatory safe harbors to supplement the statutory exceptions passed by Congress. Safe harbors are designed to protect certain common and salutary commercial arrangements the purpose of which is not to induce referrals in violation of the AKS. The safe harbors place these arrangements beyond …

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"Public policy responses to escalating medical costs and constrained access pose fundamental challenges to health care law. Profound medical advances also generate many ethical dilemmas. This authoritative discussion considers how law and ethics respond to these driving social, economic, and political forces of innovation, crisis and reform. Topics include health insurance reform, health care finance and delivery structures, treatment relationships, facility and insurance regulation, corporate and tax law, refusal of life support, organ donation, and reproductive technologies." - publisher's description

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"Expert authors present an up-to-date overview of health law as it affects the professionals, institutions, and entities that deliver and finance health care in the United States. Considers the law's response to quality and error through institutional and professional regulation, and malpractice litigation against professionals, hospitals, and managed care organizations. Surveys tax, corporate, and organizational issues. Explores the government's efforts to control costs and expand access through Medicare and Medicaid. Examines government attempts to police anticompetitive activities, fraud, and abuse. And considers the legal and ethical issues involving death, human reproduction, medical treatment decision making, and medical research. The Affordable Care Act, HIPAA, HITECH, and other new statutory and regulatory changes of the past few years are thoroughly incorporated in all aspects of the legal discussion." - publisher's description

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This book is about how to successfully fight for the payment of medically reasonable and necessary services when Medicare erroneously denies payment, or when Medicare erroneously demands a repayment of overpayment. The information in this book will help Medicare providers, Medicare billing companies, and health care attorneys who represent Medicare providers to prepare for Administrative Law Judge (ALJ) hearings—and will help you win those ALJ decisions.

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This new edition provides step-by-step guidance on dealing with the medical-legal issues involved in litigating a nursing home case for both plaintiffs' and defense lawyers. It also provides guidance to nursing home administrators on how to avoid liability and improve quality through regulatory compliance. Authors James T. O'Reilly and Katharine Van Tassel begin by reviewing the responsibilities and liabilities of management, nurses, and physicians in the second edition of Litigating the Nursing Home Case. This extensive reference then examines liability and regulatory issues from both defense and plaintiffs' perspectives, including specific topics such as drug interaction and polypharmacy concerns, ulcers and infection problems, fall-related injuries, wandering and escape issues, assault and abuse, dehydration, choking, and more. New topics in the second edition have been added, including: - A greatly expanded description of the medical-legal issues facing both plaintiff s' and def…

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This book by Nolo helps readers find information on long-term medical care and financial planning. Long-Term Care helps readers understand the range of available choices helping them to explore options for home care, assisted living and nursing homes, maximizing Medicare, Medicaid and veterans' programs, and preventing elder fraud.

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A quick and easy guide to problems of aging and how the law and practical advice can make things better.

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"The Social Security and Medicare Answer Book is designed to be a comprehensive and accessible resource for attorneys, accountants, estate planners, financial planners, insurance agents, and others who counsel either older Americans or their younger counterparts who are planning for future retirement." from the preface

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Learn about Medicare coverage, including Part D prescription drug coverage, and understand medigap insurance and Medicare managed care and what makes the most sense for you. And if you are denied for any medical treatment or benefits, this book teaches you how to file an appeal with Medicare, Social Security, or your state's Medicaid agency. Also learn how to claim disability benefits, veterans benefits, and federal retirement benefits.

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What Are...Medicare and Medicaid Secondary Payer Laws? is an addition to the Health Law Section's popular "What Is?" Series. As with other books in the series, this book provides the reader background information. Medicare was established in 1965 to provide federally funded health insurance for people age 65 and older. Prior to the Medicare Secondary Payer Act (MSP Act), Medicare was the primary payer (i.e., Medicare paid first) for its beneficiaries' claims with limited exceptions—such as situations where claims were covered by workers' compensation. As you read this book you will see how Medicare and Medicaid laws have evolved over the past several decades. The majority of the book explains Medicare's secondary payer recovery rights under Medicare Parts A and B, "traditional Medicare." However, did you know the program is comprised of four separate parts: Part A, Part B, Part C and Part D? This book serves as an introductory source as well as an intermediate resource for anyone…

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A complete overview of the Medicare FFS audit and Medicare appeals environment. The vast majority of Medicare claims are processed without undergoing claims review, creating vulnerability for the Medicare Trust Funds. Through various legislative actions, CMS has contracted with claims review entities to perform post-payment and pre-payment claims review, and audits of Medicare FFS claims have increased exponentially over the past decade. The book presents an overview of the various CMS contractors performing claims review (including post-payment and pre-payment auditing activities). Additionally, the uniform Medicare Part A and Part B appeals process is covered in great detail. Appeal strategies are set forth along with legal challenges applicable to Part A and Part B unfavorable claims determinations, with which attorneys should familiarize themselves when representing a health care entities subject to audit. A helpful list of resources and references is included to further aid the re…

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Learn how to analyze and advise on Stark Law issues. The Physician Self-Referral Law, commonly known as the "Stark Law", prohibits a physician from referring Medicare patients for certain services defined as designated health services ("DHS"), to an entity with which the physician or an immediate family member of the physician has a direct or indirect "financial relationship." What is Stark Law? presents a general overview and discussion of the Stark Law. Topics include: -An overview of the statute itself -Regulations, specifically the regulatory exceptions, and the terms of the exceptions -The source of interpretations of the Stark Law, including key cases and advisory opinions -An overview of enforcement mechanisms and consequences for violations of Stark -A list of resources to further assist attorneys as they research and analyze Stark issues This book is a must have for any individual working with healthcare entities needing a general introduction to the statute and regulations go…

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This book describes and applies the practical four-step PLAN Model, based in caselaw and professional psychology's literature to help lawyers organize, critique, and use psychological materials and testimony when examining experts and framing legal arguments.

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"Oh no, what are we going to do?" Experts say that every 65 seconds someone is diagnosed with Alzheimer's disease or some other form of dementia. When someone you love gets that diagnosis, you need answers. The authors, Kerry Peck and Rick Law, are two nationally renowned elder law attorneys who can help you make wise decisions in the midst of a post-diagnosis whirlwind of confusion. Avoid common missteps such as : Giving away assets to qualify for nursing home benefits Believing that Medicare will pay for your long-term care Waiting until the last minute before seeking expert legal advice Assuming that nursing home Medicaid is a do-it-yourself project Thinking that a revocable living trust provides asset protection And many more

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This book is intended to assist both mental health professionals and attorneys in working together on family law cases to improve their understanding of each other's respective roles. The purpose of Part I is to provide some definition and clarification about the roles of mental health professionals in family law settings and to identify how those roles are used by attorneys in litigating their cases. The purpose of Part II is to offer some insight and understanding about the underlying "rules" for conducting a parenting evaluation. The purpose of Part III is to help family law attorneys better understand the goals of the PE at each step of the process. In Part IV, we explore some of the "consulting" roles that a mental health professional might perform to assist family law attorneys.

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This comprehensive book addresses the increasingly important role of forensic psychologists in consulting and in expert witness testimony in child custody litigation. Authors Robert A. Simon and Philip M. Stahl, forensic psychology consultants with more than 60 years of combined experience, provide practical advice on understanding the critical psychological dynamics frequently encountered in child custody cases as well as guidance for how to effectively use your own forensic consultant and testifying expert in litigation. Using case examples where critical issues such as the developmental need of children, relocation, domestic violence, and the alienated child are involved, the authors explain a logical process to critique the evaluation reports of others and help you analyze the strengths and weaknesses of your case. Among the topics covered are: Forensic vs. clinical approach in child custody evaluations A method for critiquing the work of the neutral court-appointed custody evaluat…

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Designed as a quick and accessible reference, this book helps lawyers understand and address the array of mental health expert issues they will encounter in their cases. Written by John A. Zervopoulos, who is both an attorney and psychologist, each issue in the book is examined through the dual prism of Daubert-Frye principles (the legal perspective) and of professional psychology s expertise and literature (the psychological perspective). This information provides the tools necessary to develop clear direct examinations, sharpen cross examinations, and compose effective, compelling arguments to the court. These lessons are also useful to attorneys who litigate cases outside of family law. Each chapter in How to Examine Mental Health Experts considers one particular issue commonly encountered in litigation, such as when experts rely on experts, managing experienced-based testimony, or the purpose of evaluation reports, and consider three aspects to help lawyers understand and effectiv…

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This book is about the intersection of mental health institutions and the criminal justice system. It explains how the meshing of institutional imperatives, professional ideologies, budgetary considerations, and time constraints create the “politics of mental health.”

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"Mental illness and intellectual disability (formerly called mental retardation) impact 20% of Americans, and have enormous personal, legal, and policy implications for patients, families, and society. This Nutshell introduces you to the broad range of criminal and civil issues in mental health law, including diagnosis of mental illness; expert testimony on mental health issues; civil commitment; competence to stand trial; the insanity defense; various competencies; ethical/legal issues facing mental health professionals, including informed consent, confidentiality, privilege, and malpractice; discrimination against persons with mental illness; financial and medical benefits for disabled persons." - publisher's description

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"This book provides a concise analysis of areas in which the law has addressed issues in bioethics. Topics include assisted reproductive techniques and family-making, limitations on reproduction (including abortion, contraception and sterilization), the role of ethical and religious beliefs of health care professionals, the definition of death, end-of-life decision-making (including physician assisted death), genetics, research involving human subjects (including issues related to conflicts of interest), stem cell research, organ transplantation, and other emerging topics. The book provides an excellent introduction to the process of ethics decision-making as well as useful support for students." - publisher's description

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The evolution of law to respond to a societal need is a recurring theme for scholars and legislators alike. No challenge is too big for the rhetorical strength of the legal system: "Show us a wrong and we'll create a prohibition or incentive to solve it!" Infectious disease does not follow that path. It mutates, its diagnosis is muddied, its DNA may adapt, and its host animals or humans will migrate, spreading the illness. Law may be an art form, but the science of pathogenic microbes is definitely more technical and less artistic. So the lawyer must know that the power of persuasive oratory has never moved a single virus. It is the consequences of infection that law can address: workers' compensation systems for hospital employees, disability determinations for patients severely impacted by infection, rejection of delivery for commercial shipments of goods that may have been carrying a harmful pathogen, or lawsuits against surgeons who were careless during or after surgical operations…

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Modern technology offers new tools to better understand, track, and explain viral and bacterial spread in humans. In 2020, as COVID-19 overwhelmed governments and significant segments of the population and paralyzed many courts, we became painfully aware of the magnitude of risk carried around in tiny bacteria and viruses. COVID-19 has shown us that developing standards of care, treatments, and vaccines for emerging viruses and bacteria can take substantial time and resources. The rise in superbugs and drug-resistant bacteria, and the difficulty of treating these infections, have raised new questions about the balance between public health and global commerce. More than ever, practitioners need to think like scientists—following the facts and science to build a case. Like science, the law has not remained stagnant. Products, premises, and food outbreak liability law—all applicable to this type of litigation—have evolved through legislative acts, regulatory rulemaking,…

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This book provides an assessment of the critical role of law in American society to protect the community’s health discussing topics such as legal authority, preventing and treating diseases, social distancing measures and emergency preparedness.

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A quick and easy guide to problems of aging and how the law and practical advice can make things better.

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"This book provides a concise analysis of areas in which the law has addressed issues in bioethics. Topics include assisted reproductive techniques and family-making, limitations on reproduction (including abortion, contraception and sterilization), the role of ethical and religious beliefs of health care professionals, the definition of death, end-of-life decision-making (including physician assisted death), genetics, research involving human subjects (including issues related to conflicts of interest), stem cell research, organ transplantation, and other emerging topics. The book provides an excellent introduction to the process of ethics decision-making as well as useful support for students." - publisher's description

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This book describes and applies the practical four-step PLAN Model, based in caselaw and professional psychology's literature to help lawyers organize, critique, and use psychological materials and testimony when examining experts and framing legal arguments.

URL: http://lexisdl.com/library/txsll/title/2592712

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"Oh no, what are we going to do?" Experts say that every 65 seconds someone is diagnosed with Alzheimer's disease or some other form of dementia. When someone you love gets that diagnosis, you need answers. The authors, Kerry Peck and Rick Law, are two nationally renowned elder law attorneys who can help you make wise decisions in the midst of a post-diagnosis whirlwind of confusion. Avoid common missteps such as : Giving away assets to qualify for nursing home benefits Believing that Medicare will pay for your long-term care Waiting until the last minute before seeking expert legal advice Assuming that nursing home Medicaid is a do-it-yourself project Thinking that a revocable living trust provides asset protection And many more

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The Elder Law Answer Book offers a thorough guide to aspects of the law that affect senior citizens, including long-term care planning, powers of attorney, trusts, age discrimination, and more.

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This practice manual contains more than 100 forms and documents. Each form includes commentary explaining when and how each form should be used. The manual is organized into five parts: managing the elder law practice; estate and long-term care planning; powers of attorney, medical directives and wills; trusts; and miscellaneous topics.

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This book provides a brief overview of elder law. Topics covered include ethical considerations, health care decision making, Medicaid, SSI, guardianship alternatives, pension plans, and elder abuse and neglect.

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This is the first comprehensive estate-planning guide for those living with a chronic disease or disability. This book is targeted at those planning for the disbursement of their estates, no matter their size.Estate-planning is crucial for those living with a chronic disease or disability: individuals must express their preferences whether to receive long-term care at home rather than in a nursing home in the event that they become more disabled, and it is more important for one who has a chronic illness to name a power of attorney. Estate Planning for People with a Chronic Condition or Disability covers all of those topics plus: How to write your will How to determine how much life insurance your family needs How to figure out whether you need a living trust Learn about powers of attorney When to work with a lawyer, if you need toThe book also includes downloadable sample forms for: Power of Attorney Living Will...

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This book is intended to assist both mental health professionals and attorneys in working together on family law cases to improve their understanding of each other's respective roles. The purpose of Part I is to provide some definition and clarification about the roles of mental health professionals in family law settings and to identify how those roles are used by attorneys in litigating their cases. The purpose of Part II is to offer some insight and understanding about the underlying "rules" for conducting a parenting evaluation. The purpose of Part III is to help family law attorneys better understand the goals of the PE at each step of the process. In Part IV, we explore some of the "consulting" roles that a mental health professional might perform to assist family law attorneys.

URL: http://lexisdl.com/library/txsll/title/5234388

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This comprehensive book addresses the increasingly important role of forensic psychologists in consulting and in expert witness testimony in child custody litigation. Authors Robert A. Simon and Philip M. Stahl, forensic psychology consultants with more than 60 years of combined experience, provide practical advice on understanding the critical psychological dynamics frequently encountered in child custody cases as well as guidance for how to effectively use your own forensic consultant and testifying expert in litigation. Using case examples where critical issues such as the developmental need of children, relocation, domestic violence, and the alienated child are involved, the authors explain a logical process to critique the evaluation reports of others and help you analyze the strengths and weaknesses of your case. Among the topics covered are: Forensic vs. clinical approach in child custody evaluations A method for critiquing the work of the neutral court-appointed custody evaluat…

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This book provides state-by-state information on advance directives and living wills. It also touches on other end-of-life planning devices and looks at special problems that may come up when an individual is considering end-of-life planning and executing an advance directive.

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When judged by statistics and comparative health data, health care in the United States is exceptional---exceptionally bad. Our nation faces enormous challenges: unsustainable cost increases, uneven access and quality, and the implementation of health care reform. Policymakers and the greater health care community, including consumers of health care, look to technology as a means of overcoming these challenges by increasing efficiency in health administration, delivery of services, and information management. Health Care IT: The Essential Lawyer's Guide to Health Care Information Technology and the Law, introduces lawyers, health care professionals, and members of the general public to the many facets of the use of technology in health care and its federal regulatory framework.

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"Public policy responses to escalating medical costs and constrained access pose fundamental challenges to health care law. Profound medical advances also generate many ethical dilemmas. This authoritative discussion considers how law and ethics respond to these driving social, economic, and political forces of innovation, crisis and reform. Topics include health insurance reform, health care finance and delivery structures, treatment relationships, facility and insurance regulation, corporate and tax law, refusal of life support, organ donation, and reproductive technologies." - publisher's description

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Few industries in the United States have received more attention from the popular press and antitrust authorities than health care. Whether in response to business or legislative and regulatory pressures, health care companies have increasingly looked to transactions as a means to achieve cost savings, quality improvement, and population health management. At the same time, the antitrust agencies have promised robust enforcement in health care markets. The collision of these forces led to many significant legal developments in recent years, and also made producing an up-to-date treatment of these issues challenging. The revised and updated Health Care Mergers and Acquisitions Handbook, Second Edition provides guidance regarding how courts and the U.S. antitrust agencies analyze and review mergers in the health care industry. This handbook addresses the issues that antitrust practitioners and their clients face in planning, executing, and litigating transactions in the health care field…

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"Expert authors present an up-to-date overview of health law as it affects the professionals, institutions, and entities that deliver and finance health care in the United States. Considers the law's response to quality and error through institutional and professional regulation, and malpractice litigation against professionals, hospitals, and managed care organizations. Surveys tax, corporate, and organizational issues. Explores the government's efforts to control costs and expand access through Medicare and Medicaid. Examines government attempts to police anticompetitive activities, fraud, and abuse. And considers the legal and ethical issues involving death, human reproduction, medical treatment decision making, and medical research. The Affordable Care Act, HIPAA, HITECH, and other new statutory and regulatory changes of the past few years are thoroughly incorporated in all aspects of the legal discussion." - publisher's description

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Maintaining cybersecurity in today's technologically driven world is vital to the health of any business. Media outlets continue to report on large-scale data breaches affecting millions of consumers' information and costing companies millions, and sometimes even billions, of dollars to rectify. Organizations, particularly those within or touching the healthcare industry, remain the most attractive of targets for cyber attackers given the higher and lasting value of personal health information. The goal of this book is to help bolster stakeholders' knowledge of cybersecurity in the healthcare industry, with the aim of pinpointing current and impending threats to the industry's data security. The topics to be addressed include types of cybersecurity threats; ransomware in healthcare; how to prepare for and respond to cybersecurity attacks; the cost of inadequate security measures; and managing privacy and cybersecurity risks.

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HIPAA privacy regulations have been the subject of countless hours of study, analysis, and compliance efforts within the health care industry and beyond. Almost two decades later, and more than 15 years after the first edition of this book, the privacy and security requirements of HIPAA are the subject of significant confusion and uncertainty. As the laws and social pressure evolve and tighten the reigns on health care privacy, patients and providers will continue to become more concerned about maintaining the security and privacy of data while rising to the challenge of balancing privacy while promoting patient access and quality care. This revised and updated edition creates a useful guide for those who are new to HIPAA as well as provide updates for seasoned veterans of HIPAA. This book expands on the first edition and includes the Security Rule, the HITECH Act, and the Breach Notification Rule along with extensive discussion about HIPAA's parameters, practical applications, and les…

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Designed as a quick and accessible reference, this book helps lawyers understand and address the array of mental health expert issues they will encounter in their cases. Written by John A. Zervopoulos, who is both an attorney and psychologist, each issue in the book is examined through the dual prism of Daubert-Frye principles (the legal perspective) and of professional psychology s expertise and literature (the psychological perspective). This information provides the tools necessary to develop clear direct examinations, sharpen cross examinations, and compose effective, compelling arguments to the court. These lessons are also useful to attorneys who litigate cases outside of family law. Each chapter in How to Examine Mental Health Experts considers one particular issue commonly encountered in litigation, such as when experts rely on experts, managing experienced-based testimony, or the purpose of evaluation reports, and consider three aspects to help lawyers understand and effectiv…

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This book is about how to successfully fight for the payment of medically reasonable and necessary services when Medicare erroneously denies payment, or when Medicare erroneously demands a repayment of overpayment. The information in this book will help Medicare providers, Medicare billing companies, and health care attorneys who represent Medicare providers to prepare for Administrative Law Judge (ALJ) hearings—and will help you win those ALJ decisions.

URL: http://lexisdl.com/library/txsll/title/5408027

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The evolution of law to respond to a societal need is a recurring theme for scholars and legislators alike. No challenge is too big for the rhetorical strength of the legal system: "Show us a wrong and we'll create a prohibition or incentive to solve it!" Infectious disease does not follow that path. It mutates, its diagnosis is muddied, its DNA may adapt, and its host animals or humans will migrate, spreading the illness. Law may be an art form, but the science of pathogenic microbes is definitely more technical and less artistic. So the lawyer must know that the power of persuasive oratory has never moved a single virus. It is the consequences of infection that law can address: workers' compensation systems for hospital employees, disability determinations for patients severely impacted by infection, rejection of delivery for commercial shipments of goods that may have been carrying a harmful pathogen, or lawsuits against surgeons who were careless during or after surgical operations…

URL: http://lexisdl.com/library/txsll/title/2883717

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Modern technology offers new tools to better understand, track, and explain viral and bacterial spread in humans. In 2020, as COVID-19 overwhelmed governments and significant segments of the population and paralyzed many courts, we became painfully aware of the magnitude of risk carried around in tiny bacteria and viruses. COVID-19 has shown us that developing standards of care, treatments, and vaccines for emerging viruses and bacteria can take substantial time and resources. The rise in superbugs and drug-resistant bacteria, and the difficulty of treating these infections, have raised new questions about the balance between public health and global commerce. More than ever, practitioners need to think like scientists—following the facts and science to build a case. Like science, the law has not remained stagnant. Products, premises, and food outbreak liability law—all applicable to this type of litigation—have evolved through legislative acts, regulatory rulemaking,…

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This volume provides current instructions on the most recent medical issues. It covers more than 200 medical issues including standards of care, childbirth, patient consent, pre-existing conditions, and allergies. Legal concepts and issues are presented in sample instructions using understandable terms.

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This book is about the intersection of mental health institutions and the criminal justice system. It explains how the meshing of institutional imperatives, professional ideologies, budgetary considerations, and time constraints create the “politics of mental health.”

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This new edition provides step-by-step guidance on dealing with the medical-legal issues involved in litigating a nursing home case for both plaintiffs' and defense lawyers. It also provides guidance to nursing home administrators on how to avoid liability and improve quality through regulatory compliance. Authors James T. O'Reilly and Katharine Van Tassel begin by reviewing the responsibilities and liabilities of management, nurses, and physicians in the second edition of Litigating the Nursing Home Case. This extensive reference then examines liability and regulatory issues from both defense and plaintiffs' perspectives, including specific topics such as drug interaction and polypharmacy concerns, ulcers and infection problems, fall-related injuries, wandering and escape issues, assault and abuse, dehydration, choking, and more. New topics in the second edition have been added, including: - A greatly expanded description of the medical-legal issues facing both plaintiff s' and def…

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This book by Nolo helps readers find information on long-term medical care and financial planning. Long-Term Care helps readers understand the range of available choices helping them to explore options for home care, assisted living and nursing homes, maximizing Medicare, Medicaid and veterans' programs, and preventing elder fraud.

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"Written by experts in the field, this Nutshell offers insight on establishing professional relationships and examines negligence-based claims, intentional torts, causation, damages, affirmative defenses, limitations, immunities, and liabilities. It also provides an overview of medical care liability issues affecting hospitals and managed care organizations." - publisher's description

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"Mental illness and intellectual disability (formerly called mental retardation) impact 20% of Americans, and have enormous personal, legal, and policy implications for patients, families, and society. This Nutshell introduces you to the broad range of criminal and civil issues in mental health law, including diagnosis of mental illness; expert testimony on mental health issues; civil commitment; competence to stand trial; the insanity defense; various competencies; ethical/legal issues facing mental health professionals, including informed consent, confidentiality, privilege, and malpractice; discrimination against persons with mental illness; financial and medical benefits for disabled persons." - publisher's description

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This book represents the cutting edge of physician law. The publication emanates from the American Bar Association Health Law Section's 2018 Physicians Legal Issues Conference. The conference and this book have been produced in conjunction with the Chicago Medical Society and the American Medical Association, tailored to an audience including physicians, lawyers, healthcare administrators and other healthcare business people. The book includes nine peer-reviewed chapters on core physician-centric legal topics: 1.Entrepreneurial Medicine (including fraud and abuse risk areas); 2.Physician-Hospital Contracting; 3.Medical Professional Liability; 4.Telemedicine; 5.HIPAA; 6.Accountable Care Organizations; 7.Doctor's Defense in Medical Staff Hearings and Appeals; 8.Physician Well-Being; and 9.Medicare and Medicaid Contractors. Physicians will especially benefit from the content that addresses a broad range of non-clinical topics that are currently transforming American healthcare. The chapte…

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"The Privacy Nutshell briefly reviews the historical roots of privacy, and then examines each of these U.S. privacy statutes and regulations. Virtually all governments and businesses face privacy considerations as technology continues to evolve. Legal issues related to privacy are exploding on the U.S. legal scene. The EU has a long history of a strong regulatory privacy regime. The U. S., however, follows a sectoral approach to privacy, whereby Congress responds to each privacy “crisis” with a new statute and set of regulations. This sectoral approach has resulted in a unique series of privacy rules for different areas of society. The Privacy Nutshell is an excellent introductory guide to the legal privacy world." -publisher's description

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This book provides an assessment of the critical role of law in American society to protect the community’s health discussing topics such as legal authority, preventing and treating diseases, social distancing measures and emergency preparedness.

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Grasp the latest legal information for gay and lesbian couplesSame-sex relationships are treated differently under each state's laws, and nearly a quarter of the U.S. population lives in a state with some form of legal recognition for same-sex couples.Same Sex Legal Kit For Dummies is a practical, plain-English guide to the legal information and guidance lesbian and gay couples need—from making practical decisions about living together and obtaining domestic partner benefits, to making medical decisions, taking care of each other's finances when one partner is incapacitated, leaving property to each other, having and raising children, and much more.Discusses power of attorney, health directives, and real estate and personal property ownershipCovers considerations for bank accounts, investments, and estate planningThe book's accompanying...The EPUB format of this title may not be compatible for use on all handheld devices.

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"The Social Security and Medicare Answer Book is designed to be a comprehensive and accessible resource for attorneys, accountants, estate planners, financial planners, insurance agents, and others who counsel either older Americans or their younger counterparts who are planning for future retirement." from the preface

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Learn about Medicare coverage, including Part D prescription drug coverage, and understand medigap insurance and Medicare managed care and what makes the most sense for you. And if you are denied for any medical treatment or benefits, this book teaches you how to file an appeal with Medicare, Social Security, or your state's Medicaid agency. Also learn how to claim disability benefits, veterans benefits, and federal retirement benefits.

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Waiting to address long-term care needs until the point one actually needs care is too late, as it significantly impacts a client's financial situation, quality of life of their loved ones, and their ability to maintain their independence. Incorporating long-term care insurance into the financial plan can ultimately help protect assets reduce the burden of care that would otherwise fall on family members, and enable the client to receive care in the setting they most prefer, including their home. The Advisor's Guide to Long-Term Care looks at the full range of the topic, explaining how to best use it in the estate plan as a prudent risk-management choice. Statistics point to the high probability that people are likely to need extended health care at some point in their life. The Advisor's Guide to Long-Term Care is intended to help estate planners and advisors to address these issues with their clients, establishing the issues and trends for care and covering all relevant issues invol…

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Provides answers to questions concerning Medicaid, long-term care planning, healthcare issues, trusts, powers, and guardianship. Each portfolio in the series is written by an elder law expert. The series also includes a table of cases.

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The Anti-Kickback Statute (AKS) was first enacted through the Social Security Amendments of 1972 in order to combat fraud and abuse in the Medicare and Medicaid Programs. The purpose of the AKS is to remove the corrupting effects of kickbacks in health care by, among other things, outlawing behavior designed to game the system through the use of financial incentives intended to direct patient referrals to particular health care providers and away from other providers rendering the same type of care. But not every payment or practice offends the policies underlying the statute. Beginning in 1991, the Office of Inspector General of the U.S. Department of Health and Human Services began promulgating regulatory safe harbors to supplement the statutory exceptions passed by Congress. Safe harbors are designed to protect certain common and salutary commercial arrangements the purpose of which is not to induce referrals in violation of the AKS. The safe harbors place these arrangements beyond …

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As part of the “What Is” series, the purpose is to provide a preliminary overview of HIPAA and the HITECH Act in relation to correlating international laws in some strategic countries, as well as providing practical guidance for evaluating business associates and executing business associate agreements. Three countries in particular will be highlighted: the U.S., the U.K. and India. This gives a perspective on the U.S. laws in relation to an established market and an emerging market, whose laws and their enforcement vary widely.

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What Are...Medicare and Medicaid Secondary Payer Laws? is an addition to the Health Law Section's popular "What Is?" Series. As with other books in the series, this book provides the reader background information. Medicare was established in 1965 to provide federally funded health insurance for people age 65 and older. Prior to the Medicare Secondary Payer Act (MSP Act), Medicare was the primary payer (i.e., Medicare paid first) for its beneficiaries' claims with limited exceptions—such as situations where claims were covered by workers' compensation. As you read this book you will see how Medicare and Medicaid laws have evolved over the past several decades. The majority of the book explains Medicare's secondary payer recovery rights under Medicare Parts A and B, "traditional Medicare." However, did you know the program is comprised of four separate parts: Part A, Part B, Part C and Part D? This book serves as an introductory source as well as an intermediate resource for anyone…

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A complete overview of the Medicare FFS audit and Medicare appeals environment. The vast majority of Medicare claims are processed without undergoing claims review, creating vulnerability for the Medicare Trust Funds. Through various legislative actions, CMS has contracted with claims review entities to perform post-payment and pre-payment claims review, and audits of Medicare FFS claims have increased exponentially over the past decade. The book presents an overview of the various CMS contractors performing claims review (including post-payment and pre-payment auditing activities). Additionally, the uniform Medicare Part A and Part B appeals process is covered in great detail. Appeal strategies are set forth along with legal challenges applicable to Part A and Part B unfavorable claims determinations, with which attorneys should familiarize themselves when representing a health care entities subject to audit. A helpful list of resources and references is included to further aid the re…

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The business of providing medical care is in the midst of dramatic change. To keep pace with evolving economics and reimbursement practices, the small physician practice, which stood as the standard arrangement for so long, is giving way to larger, more corporate models. These models have led to a highly regulated business environment in the health care services industry, which involves interpreting areas of the law without clear guide rails. The corporate practice of medicine and fee-splitting prohibitions, depending on which state's laws you are interpreting, can be one of those areas of the law that lack those guide rails. Advising clients on compliance with the prohibitions may require more finesse and risk analysis than legal research in some jurisdictions. This primer on the prohibitions provides practitioners with the historical context in which they arose; a concise discussion of each of the prohibitions and how they affect the business of medicine; what they mean for the owner…

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Alternative dispute resolution, or ADR, is the practice of resolving disputes through processes other than litigation. The most common forms of ADR are mediation and arbitration, but many other forms exist in the Health Care arena to address specific types of disputes and their need for tailored processes for unique situations.Some of these include hearing officers for hospital hearings, referees for discovery disputes and early neutral evaluation of cases. Lawyers specializing in the Health Care field are required to utilize many skills, techniques and methods to resolve disputes for their clients. Health Care lawyers must remain up-to-date on regulatory changes, industry trends, the economic climate and changes in the law.

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CHOW is an acronym frequently used by those in the health care industry to describe the regulatory process that often must be followed when a licensed or certified health care provider undergoes a "change of ownership." Many businesses that operate in the health care industry will have at least one and maybe multiple "permits" or "provider numbers" issued by a governmental body. As a result, the CHOW process applicable to most, if not all, health care permits, licenses, certifications, and provider numbers is heavily regulated to ensure that any new owners satisfy the regulatory requirements that the "seller" met when it originally obtained the permit. This book is designed to give practitioners a general understanding of the CHOW process for operating licensure, certificate of need, and Medicare and Medicaid provider numbers. The book describes some general and specific elements of what can be, and in some cases is, required in a change of ownership process in these different contexts…

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In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA). This was done to combat the perceived problem of "patient dumping," where hospital emergency rooms were refusing to treat patients that did not have health insurance. This book covers everything you need to know about EMTALA, from its history and regulatory framework to the requirements it places on hospitals to this day. This includes larger considerations like what constitutes a legitimate emergency medical condition, but also smaller (but still important) ones like signage and proper record keeping. The book also looks at other considerations, like dealing with psychiatric patients, malpractice, and disaster response. What Is...EMTALA? is a must for any attorney working in the field of patient's rights.

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?The term "medical staff" refers to an organized body of licensed physicians, dentists, and other healthcare providers who are authorized by state law and by a hospital to provide medical care to patients within the hospital. A healthcare provider's membership at a hospital must be reviewed for reappointment at least every two years. Such review and reappointment is based upon ongoing monitoring of specific information regarding the healthcare provider's performance, medical judgment, clinical skills and professional behavior. This book covers the different kinds of peer review, as well as the various outcomes they can have. It begins by defining what constitutes a medical staff, and how they are governed. It then examines both the informal and formal peer review process, internal investigations, and disciplinary actions.

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Learn how to analyze and advise on Stark Law issues. The Physician Self-Referral Law, commonly known as the "Stark Law", prohibits a physician from referring Medicare patients for certain services defined as designated health services ("DHS"), to an entity with which the physician or an immediate family member of the physician has a direct or indirect "financial relationship." What is Stark Law? presents a general overview and discussion of the Stark Law. Topics include: -An overview of the statute itself -Regulations, specifically the regulatory exceptions, and the terms of the exceptions -The source of interpretations of the Stark Law, including key cases and advisory opinions -An overview of enforcement mechanisms and consequences for violations of Stark -A list of resources to further assist attorneys as they research and analyze Stark issues This book is a must have for any individual working with healthcare entities needing a general introduction to the statute and regulations go…

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This handy resource provides a broad overview of the telemedicine industry and prepares the reader to better understand and address the technology and patient care aspects of telemedicine, but also the critical policy and legal issues that surround and support—and sometimes impede—its adoption. This book includes examples of companies operating in the telehealth, telemedicine, and mHealth markets and a discussion of how telemedicine is well positioned to address some of the current U.S. health care market failures.

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The federal Anti-Kickback Statute (AKS) is one of the best-known federal fraud and abuse statutes, due largely to its wide-ranging effects on business relationships in the health care, pharmaceutical, and medical device sectors. This primer explains how AKS is a criminal statute that prohibits transactions intended to induce or reward referrals for items or services reimbursed by the federal health care programs. It further details the anti-corruption statute and how it is designed to protect federal health care program beneficiaries from the influence of money on referral decisions and thus is intended to guard against overutilization, increased costs, and poor quality services. Chapters include: • Overview of the Anti-Kickback Statute and Its Purpose • Statutory Exceptions and Safe Harbors to the Anti-Kickback • Statute • Fraud and Abuse Waivers • Sources of Guidance • Related Statutes

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This guide provides a detailed overview of the Sunshine Act, transparency initiatives, and related implications associated with increased attention on physician-industry relationships. Section II provides background and the legislative history of the Sunshine Act. Section III provides a detailed summary and analysis of the technical statutory and regulatory requirements manufacturers and group purchasing organizations must abide by to comply with the law. Section IV analyzes the Sunshine Act's regulatory requirements as they may impact other healthcare fraud and abuse and compliance obligations and requirements, including the Anti-Kickback Statute and the False Claims Act. Section IV.C provides an overview of related state transparency laws and gift ban laws, including how such provisions are preempted under the Sunshine Act. Section V offers a brief overview of CMS's first data release on the Open Payments website and discusses potential issues and future concerns for all stakeholders…

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