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Legal Issues in Healthcare Administration

Healthcare administrators manage the business side of medical organizations — hospitals, doctor groups and nursing homes, to name a few. To be successful, these professionals must have a wide range of skills as well as an understanding of how to deal with legal issues that can affect healthcare providers and patients. Failure to protect a patient’s medical records under the Health Insurance Portability and Accountability Act (HIPPA), for example, could result in fines or costly legal battles.

Following legal and ethical guidelines is not simply a practical means of avoiding costly lawsuits. The laws that govern healthcare in the United States ensure that patients receive the care they need in a timely manner. Following the laws that govern healthcare can quite literally save lives.

These are reasons why the University of North Carolina at Pembroke’s online Master of Business Administration in Healthcare Administration offers a course on legal and ethical issues. The online class explores the legal, policy and ethical issues encountered by healthcare professionals and patients in the healthcare system.

Common Legal Issues Faced by Healthcare Administrators

Healthcare administrators face numerous legal issues, and they must have the educational background to handle them in a manner that protects patients, providers and the facilities they manage. Here are just a few of those issues.

Data Breaches: Cybercrimes affect every major industry in the United States, including healthcare. Medical practices are required to take steps to protect the private patient information under HIPAA. The United States Department of Health and Human Services can levy fines on hospitals and medical practices that fail to comply with HIPAA requirements. In 2011, Maryland-based Cignet Health was fined $4.3 million for a regulatory compliance issue and for failure to cooperate with the subsequent Health and Human Services investigation.

False Claims Act: The False Claims Act allows individuals or healthcare providers to be prosecuted for defrauding government healthcare programs. Potential reasons for prosecution include knowingly presenting a fraudulent claim to the federal government, knowingly using a false statement to have a claim paid and conspiring to obtain a fraudulent claim paid by the federal government. The act covers claims made through Medicare or Medicaid.

Compliance for Tax-Exempt Hospitals: Hospitals that wish to maintain their charity status must provide certain services that add to the general welfare of the communities they serve. These services include limits on charges to patients, annual community needs assessments and emergency care policies, among others.

Laws That Affect Healthcare Providers

Here are some of the most important regulations that apply to the U.S. healthcare system.

HIPAA: This act protects patient privacy with regard to medical treatments and records. It also aims to reduce healthcare fraud and includes guidelines for how patients can retain health insurance coverage in certain situations, among other provisions.

Stark Law: The Stark Law includes provisions to prevent healthcare fraud in the area of physician referrals.

Anti-Kickback Law: This federal law prohibits the exchange of anything of value for referrals for services payable by a federal program. Individuals who violate the law may face criminal penalties.

Learn About Important Legal Issues With an MBA from UNCP

UNCP’s online MBA program in Healthcare Administration includes a course on legal and ethical issues faced by healthcare providers. Taught by UNCP faculty, the course explores legal, policy and ethical issues encountered by healthcare professionals. Further topics include government regulations, patient consent, human reproductive issues, fraud and abuse. 

The healthcare industry is continually evolving, and new laws that regulate healthcare are passed each year at the federal, state and local levels. An online healthcare-focused MBA from UNCP is one way to equip yourself with the skills and know-how to adapt to the changing legal landscape.

Learn more about UNCP’s online MBA program in Healthcare Administration.


HealthLeaders: Cignet Health Fined $4.3M for HIPAA Violations

Becker’s Hospital Review: 13 Legal Issues for Hospitals and Health Systems

Becker’s Hospital Review: 4 of the Most Pressing Healthcare Legal Issues

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