The conundrum of legal issue in healthcare in the US

According to the Commonwealth Fund, the US spends more on healthcare than any other OECD country yet has the lowest life expectancy rate among all of them. This says a lot about how much there is to fix and a lot of it comes from the legal issue in healthcare. There are many instances in the whole ordeal that can cause legal issues for the medical staff or the person applying for healthcare.

America does not have universal healthcare, meaning any care/preventive measures/benefits you need for your health; you have to pay for. In majority of the cases, either you pay for your own medical expenses or your health insurance provider takes care of it for you. But a large number of cases are not covered by insurance companies. Who will pay for the healthcare treatment of a patient, who is eligible to get the benefits are few of the questions that arise due to legal issues in healthcare. There’s no one legal issue in healthcare that is prominent here, but we have filtered out a few top ones for you.

False claims act

We have many laws in place to protect the patients and medical service providers from any illegal activity, but there is also an act to protect the government from such. The False Claims Act is a law to make sure there is no misuse of government resources. In terms of healthcare services, when someone claims Medicaid payments based on fabricated data, The False Claims Act helps identify fraud.

This Act is holistic in its nature and covers all aspects of fraud committed against the government. And this does not just include patients claiming false payments but also healthcare businesses such as pharmaceutical companies committing similar fraud. Since the commercialization aspect of medicine has been brought to mainstream attention, we have witnessed some troubling data. More and more data shows how pharma companies abuse their role in the provision of medical equipment and other products. Even if their acts are not explicitly illegal, they do use their power and influence to act against public benefit.

The connection between medical practitioners who commit malpractice and pharma who misuse their position is also a concerning point. All these matters and any other unethical activity that harms the government can get severely punished under this Act.

Telemedicine law

Telemedicine is one of those concepts that seem like an obvious public win but it has its own set of issues. We have witnessed and taken advantage of the incredible innovations that technology has brought to healthcare. The amount of help biotech has provided to the overall healthcare sector is immense. From equipment and research to experimentation, all of it has brought the medicine field years ahead. And while it may have brought new ways to treat and diagnose patients, there’s more to it than that.

Telemedicine is one of those chapters that is bringing much-needed widespread access to medicine, but also many legal issues with it. Many of us have used it and are not aware that it has its own different name and category in medicine. Accessing or getting medical assistance over the internet/electronic device, such as phone accounts is known as telemedicine.

While we do realize how that is revolutionizing the medicine industry, it has a lot that needs resolving. The distance between a professional providing medical assistance and a patient gets completely eradicated with the use of this remote access to healthcare. The problem, however, arises due to various reasons. The location of the doctor and the patient, the insurance coverage, and licensing are all different matters that can cause complications in the process. Apart from general technical issues, this can also get problematic if the doctor gives inaccurate advice or is negligent about the prescription over telemedicine. Some insurance policies cover damage in the case of telemedicine but not all. As a patient, you need to make sure you thoroughly check your policy plan. The laws regarding telemedicine are also different in different states. Some laws require an in-person meeting between the doctor and patient for the approval of telemedicine services in the future.


Many people are not aware of the Health Insurance Portability and Accountability Act (HIPAA) but as conscious consumers, you should be. Healthcare systems have some of the most confidential data about their patients. Protecting the data of your customers is very important regardless of your business type. Even small businesses these days have access to confidential bank details about their customers that need to stay confidential. Healthcare is a huge industry with a lot of sensitive data, which is why they need to implement strict measures to protect that information.

The HIPAA helps the governing bodies keep healthcare businesses in check regarding their customers’ data protection policies. The healthcare records, history, and private information that hospitals have cannot be accessed by any unauthorized body. The act makes sure they follow through with that regulation.

Previously, the only issue that occurred with data protection was the business’ integrity regarding keeping the sensitive data confidential. But ever since technology’s takeover, a lot of that data is recorded online, in systems that store and safekeep it accordingly. Even though the ease and innovation that technology has brought into healthcare cannot be disregarded, the threat of data breach cannot be either. Online systems of recording and storing data have left the patients’ data horribly exposed to any hackers that breach systems online.

Unintentionally, the healthcare industry is more compromised here than they realize. Even though the threat of cyber-attacks is unwarranted and not the business’s fault, the HIPAA requires companies to follow strict measures to protect the data. And in case you are a victim of an attack, you can simultaneously be in legal problems when you don’t take strict enough measures to ensure that does not happen.

As a medical service provider/business, you need to stay on top of your security just as you do with other technological advancements in the medical field. Make sure you have a capable IT department covering everything regarding online security, keeping all cyberattacks away, and protecting the patients’ data. And in case of an attack, have a plan/strategy that enables your staff to recover and secure the system from as much damage as much as you can.

Medical malpractice

In the healthcare industry, professionals are continuously working with whatever resources you have to improve and save lives. As such an uncompromising field of work, it can get complicated when legal forces are involved on either side. Both as a healthcare provider and as a patient (caretaker of a patient) you can get in trouble if you commit fraud in terms of healthcare laws here.

Even if the general overall scenario when medical malpractice is committed is not concerned with any legal issue, you can get into serious trouble as a medical service provider. There are so many regulations to make sure patients are treated with the best possible care. The recent political debates and battles over providing universal health care are bringing fresh challenges to the system. As both a business and service provider in the healthcare sector, it is important to make sure you are aware of and following all the necessary regulations of the legal system.

Even though all doctors and medical practitioners take an oath, known as the Hippocratic oath, to be completely ethical while performing their job there’s no stopping malpractice in any field. We occasionally see people committing unethical acts in their jobs, sometimes as critical as the courtrooms and hospitals. Therefore, even though they are under oath to make their patients’ lives better, they intentionally commit irresponsible acts that harm their patients. In this case of negligence, the service providers can get themselves tangled in a lawsuit.

The penalties in case the medical staff member ends up being guilty can vary and can go as far as their license being suspended. If the situation is rather severe, the business providing the care can also be closed down. Therefore, it is important to not only follow the laws strictly but also ensure they are faithfully practiced by your staff too.

Whether you are a practitioner, patient, or a business, a legal issue in healthcare can work in your favor and against you too. Make sure you are informed, educated, and up-to-date about the laws and regulations in your state. This will help you not only fulfill your responsibility in the matter but also understand your rights in the matter.

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