The Law of Health Care Organization and Finance

This book is designed for a specialized health law course focusing on the organization and financing of health care. It is also well-suited for health law courses in health administration, business, or health policy and management programs. The book begins with an introduction to fundamental concepts affecting cost, quality, access, and equity in health care and sets out the economic principles and tools used in health policy and reform efforts. The book includes extensive coverage of payment systems, including Medicare, Medicaid, and private insurance and their effect on the organization of the health care delivery system, including alternative payment models, such as accountable care organizations. The book also surveys the organizational structures and legal relationships in health care enterprises. The book explores legal concerns affecting the payment and delivery of health care, including the continuing impact of the Affordable Care Act, up-to-date coverage of fraud and abuse laws, antitrust enforcement, ERISA, and requirements for tax-exempt entities. Several chapters examine the legal framework for quality control efforts, including professional licensure, institutional licensure and certification, and nondiscrimination requirements. As in previous editions, the authors provide classroom teaching tools including problems that engage students in dealing with legal, policy, and practical issues and a range of materials drawn from judicial opinions, statutes, regulations, agency guidance, and other sources.