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 choice in health care and includes a new chapter that sets out the principles and tools used in health policy and reform efforts. The book includes extensive coverage of payment systems, including Medicare, Medicaid, managed care, and private insurance and their effect on the organization of the health care delivery system, including treatment of accountable care organizations and other structures joining organizations and professionals in the delivery of care. The book accounts for the current situation affecting the structure and payment for health care services, including the continuing impact of the Affordable Care Act and recent changes. This edition of the book includes up-to-date coverage of fraud and abuse, antitrust enforcement, ERISA, and tax-exempt status requirements. Several chapters examine the legal framework and effectiveness of 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, informal guidance, and other sources.