Midterm Flashcards
Administrative Law
Subset of statues; regulatory; government agency will administer (ex: DRROA, CO Department Health); Administrative agencies 1- pass rules 2- ajudicatory process (enforce violations of rules)
Due Process of Law
Fundamental principle in fairness of legal matters, particularly in courts (civil and criminal); 1- Notice 2- Opportunity to be heard 3- Impartial Tribunal
Dred Scott Decision, 1857
Congress does not have the right to pass anti-slavery statues
Henry II
Consolidated ecclesiastical law, set up King’s courts, Court of Equity with deeds, set up Lord Chancellor of England; merged with court of law in England; merged early 1800s in US courts
Jurisdiction
Area over which they preside
Starry Decisis
Let it stand; established precedent
In rein vs personenum
jurisdiction over individuals; jurisdiction over the thing/property in their area
Subject matter jurisdiction
Arises from statutes; state vs federal
Court Rules
Rules of procedure; rules for discovery (facts/evidence; deposition0 exam under oath; issue requests for admission
Spoliation of evidence
if you destroy evidenced in pending case before disclosing to other side, you will be sanctioned (ex: email)
Alternative dispute resolutions for contracted, binding agreements
Arbitration (quicker), mediation (not binding, someone facilitates)
Affordable Care Act and the Supreme Court
SC ruled that Obamacare went too far regarding the commerce clause with the individual mandate; The commerce clause prohibits, but can it mandate/force?
MLR under ACA
MLR must be at least 80%; for Medicare, 97% MLR
ACA Goals: Obama & Pelosi
1- Slow growth rate of health care expenses; 2- improve quality and access to care (by expanding coverage, including young and healthies); this act expanded Medicaid payments; eliminated coverage denials 2/2 pre-existing conditions and gender/sex differences; expanded coverage of parents’ plan til age 26; strengthened HC fraud provisions; encouraged ACOs; passsed “individual mandate (controversial)- everyone must obtain insurance; employee mandate- if 50+ employees, required to purchase HC (44% US population)
ACA criticisms Case 1
1 National Federation of Independent Businesses vs Sebelius (HHS Secretary); does the individual mandate exceed the reach of the commerce clause? Ruled that is was too far, can prohibit but not mandate; Necessary & Proper Clause- in Constitution- Congress can doe whatever necessary and proper to enhance other powers of Congress/Constitution- mandate is necessary and proper; Roberts majority opinion of Republican court- individual mandate NOT supported by commerce clause, but supported by taxation; pay alternative to insurance requirement statue constitutional under tax, upheld the individual mandate
ACA Criticisms Case 2
Opponents found ACA clause suggesting only state-wide exchanges; SC didn’t answer, but said Act supports expantion of state & federal exchange
ACA Criticisms Case 3
11th Circuit (deep South) sued to reduce individual mandate to $0 by Republican legislation; so the act says you have to opt in, but you weren’t penalized if you didn’t do it; conflicts with in-good-conscious healthcare purchase undue burden. TX vs US Azar case- sued HHS self- Supreme Court says you can’t create a standing to sue creating counter, challenge thrown out- self-inflicted injuries cannot establish standing to sue; ACA still stands without individual mandate
Social Security Act of 1965
Lyndon Johnson; Established Medicaid for poor and Medicare for elderly; diability; baseline illegal alien coverage
HMO Act of 1973
organizations compensated based on capitation per head; ex: Kaiser; benefit financially if people stay healthy
PPO Preferred Provider Org
physician group similar to HMO with capitation per head, goals of keeping people healthy
Medicaid Parts A, B, C, D
A: hospitalization/inpatient coverage 65+, B: Self-funded insurance (social security) outpatient/medical coverage; C: Medicare Advantage: Private insurance services funded by Medicare; D Prescription coverage
Employee Retirement Income Security Act 1993 (ERISA)
Use ERISA to sue government funded insurance that fails to provide sufficient coverage (NOT private employer-funded insurance, which usually holds up better in court); will only reimburse coverage amount
Health Planning & Resource Development Act of 1974
Established “certificate of need” at state level to review/approve new technologies in attempt to control costs; widely unpopular, including in CO; bureaucratic, expensive, conflict of interests/politics; no longer federally mandated, but present in 34 states
TEFRA Tax Equity & Financial Responsibility Act of 1984
Introduced DRGs, standardized costs for diagnosis instead of costs
COBRA Consolidate Omnibus Budget Reconciliation Act 1985
Used 10% of people; health insurance from employer still available for set period of time at same price
EMTALA Emergency Medical Treatment Act & Active Labor Act of 1985
Anti-dumping statue; hospitals with an ED can’t dump patients/send elsewhere (e.g., community hospital) for care; 1 must be examined 2 must be stabilized (regardless of ability to pay)
Health Care Quality Improvement Act of 1986 HCQIA
offers broad immunity against damages for health care entities & individuals conducting peer review activities; national practitioner databank in MD- receives complaints/info re: physicians w/ malpractice complaints, suspended privileges over 30 days- must recertify every 2 years; POC, women, foreign or MDs not involved in political structure most likely to have complaints
HCQIA 1986 HC Quality Improvement Act Immunity for reporting if (x4)
1 act in reasonable belief for quality of patient care; 2 reasonable effort to obtain facts; 3 adequate notice of procedures provided to practitioner; 4 action warranted by reasonable belief given facts (*in practice, limited due process of law and easy to report)
STARK Statute 1988
prohibits self-referrals; covers most medical procedures EXCEPT kidney-failure tx; huge penalties if violated, consideration when setting up physician hospital contracts
HIPPA Health Insurance Portability & Accountability Act 1996
Protects PHI; nondisclosure provisions with government sanctions; increases patient access to medical records and patients can disagree (medical records as basis for liability claims)
Patient Self-Determination Act of 1990
Mandates advanced healthcare directives upon admission (e.g., living will)
CHIPS Children’s Health Insurance Program 1997
Provides increased healthcare funding for children living in poverty
HITECH Act 2009 Health Information Technology for Economic & Clinical Health Act
Provides some funding and standards/guidelines for EHR
Colorado Reve Stat 8-2-113
Non-compete; can’t intimidate people from working elsewhere before they start employment
Emmanuel Kant system for ethics (process to approach ethical problem)
1 ID & clarify the problem; 2 Gather info 3 Evaluate evidence 4 consider evidence 5 choose and implement best alternative
Emmanuel Kant System for Ethics based upon
1 autonomy 2 beneficence 3 non-malefice 4 justice (5 confidentiality 6 role fidelity 7 veracity)
Types of business organizations (4)
1 sole proprietor (1 person doing business on their own) 2 Partnerships (2+ people doing business- share profits/risks and operate together; mutual agents for each other; only taxed once); 3 LLC- members are their own managers, state level LL act; 4 corporations- legally a person but not an individual or citizen; has 1st amendment right (for campaign donations) but not 5th amendment rights (corporations CAN incriminate themselves); could be C corp (taxed separately from owners, go public), S corp (smaller, 100 shareholders max, only taxes on profits received)
Fiduciary relationship/duty
top execs, employees, shareholders OWED fiduciary duties by board members, bankers, lawyers; to work in interests of your clients/organization loyalty, responsibility, reasonable care; obligation to act in good faith and not be diverted by outside interests
Business judgement rule
If decision made in good faith with reasonable evidence in best interest of organization, can’t be sued by shareholders (protects Board of Directors from complaints)
A trust
Controls other corporations; amasses more power
Corporations
created for liability purposes (e.g., not personal liability); longevity- exist externally as entity; Can double taxation (corporate & shareholders); Separates management (Board of Directors) from people who own the business
Major hospitals as corporations (x3)
1 general shareholders; 2 c-corp- tax benefit flows to individual members, less than 100, operation as a partnership; non-profit/501c3- tax exemption/revenue code for charitable purposes; profits back to operations, not to shareholders
inurement
“benefit” can’t overpay reasonable/market value, espeically in 501c3
estoppel
principle of law; party estopped from asserting something that contradicts what they previously established or did
Independent contractor
Assigned actions/duties; can perform in their own way
Employees
Services at direction/whim of employer
Corporate Practice of Medicine
Prohibits private ownership of clinics; active in CO, many states; outsiders/nonprofessionals cannot have corporate ownership of clinicians; so hospitals (eg. not a doctor) hire MDs as IC as a result; MSO as corporate owner
Respondeat superior
employer is responsible for actions of employees; principle (employer) is liable; if employee commits crime, employer can still be liable if they knew or reasonably should have known (EXCEPT in CO- Captain of the Ship- MD as IC controlling their unit team, taking on liability)
How to terminate agency (of employee?)
fire them; frustration of purpose for which hired; impossibility performance (e.g., unprecedented/impossible circumstances); material breach contract
Uniform Partnership Act 1997
Establishes partnership as a separate legal entity, no aggregate of individual partners
