25 Frequently Asked Questions About Health Law and Regulations

Patients’ Rights

What is HIPAA, and why is it important?

The Health Insurance Portability and Accountability Act (HIPAA) protects the confidentiality and security of patient health information.

Can patients access their medical records?

Yes, under HIPAA, patients have the right to access, review, and obtain copies of their medical records.

Also read:

What is informed consent in healthcare?

Patients must be informed about treatment options, risks, and benefits and must voluntarily agree before procedures are performed.

What is the EMTALA?

EMTALA mandates that hospitals treat patients with emergency conditions without regard to source of payment.

How do patients have rights to refuse treatment?

Any competent adult has the right to refuse medical intervention, even if refusal could lead to his or her death.

Roles of Providers

What is standard of care in healthcare?

The level of care a reasonably competent provider would provide under similar circumstances.

What is medical malpractice?

When a healthcare provider’s negligence causes harm to a patient, such as misdiagnosis or surgical errors.

What are providers’ obligations under HIPAA?

Providers must safeguard patient information, share it only when necessary, and report breaches promptly.

What is the duty to report in healthcare?

Providers are obligated to report certain conditions or incidents, such as infectious diseases, abuse, or threats of harm.

What are advance directives, and how do they affect care?

Legal documents (e.g., living wills, DNR orders) that specify a patient’s desires for medical treatment if they cannot communicate.

Health Insurance and Billing

What does the Affordable Care Act (ACA) protect?

The ACA protects against pre-existing conditions, requires essential health benefits, and permits young adults to remain on parents’ plans until age 26.

What is balance billing?

Billing patients for the difference between a provider’s charge and the insurance payment, which is sometimes illegal.

What are a patient’s options when an insurance claim is denied?

Patients can appeal through their insurer’s process and can escalate to external review or litigation if necessary.

What is medical necessity in the context of an insurance claim?

Insurers require that treatments be deemed medically necessary before coverage applies.

What are surprise medical bills?

Unexpected bills from out-of-network providers, which are addressed by federal laws, such as the No Surprises Act.

Privacy and Security

What is a healthcare data breach?

Unauthorized access or disclosure of PHI, in violation of HIPAA and patient trust.

What are the telehealth privacy rules?

Telehealth services must be covered under HIPAA, and protected platforms for data.

Can providers share patient data without consent?

Only in specific cases, for example, reporting public health, statutory requirements, or in case of emergencies.

Ethical Legal Issues

What is False Claims Act?

A legislation that addresses healthcare frauds including ones being overcharged and unjustified government programs charges.

What does healthcare whistleblower protection entail?

Laws that safeguard reportees of fraudulent activities from retaliatory action.

What does an ethics committee do in the hospital?

To guide in complex medical decisions and to solve conflicts over the care of a patient.

Laws on prescribing controlled substances

Providers must abide by DEA rules, which would ensure proper documentation and monitoring in order to avoid misuse.

What is the Stark Law?

A federal law that bars physicians from referring patients to any entity in which they or an immediate family member has a financial interest.

Public Health and Safety

What are public health laws?

Laws that help prevent disease, disability, and death.

Public health laws deal with concerns such as preventing diseases, compulsory vaccination, and emergency response policies.

What are mandatory reporting laws in healthcare?

Providers are to report suspected abuse, infectious diseases, or any other condition mandated by state and federal law.

These FAQs address core aspects of health law and regulation.