Current legal challenges facing healthcare

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By paying $35 million, Walgreens settled allegations by pharmacist-whistleblower Bernard Lisitza that it unlawfully defrauded Medicaid by switching prescriptions for ranitidine, the generic form of the brand-name drug Zantac®, and fluoxetine, the generic form of Prozac®. The United States, Puerto Rico, 42 states, and the qui tam relator claimed that Walgreens improperly caused its pharmacies to switch Medicaid patients’ prescriptions from ranitidine tablets to ranitidine capsules, and from fluoxetine capsules to fluoxetine tablets. The alleged Medicaid fraud covered by the settlement lasted for more than four years, from July 16, 2001 through at least December 31, 2005. The complaint was brought in 2003 under the qui tam provisions of federal and state False Claims Acts, after whistleblower relator Bernard Lisitza uncovered the conduct and reported the problem to the government. The investigation and prosecution was led by the Attorneys General Offices in Florida, Illinois, Ohio, Texas and several other states, and by the United States Attorney’s Office in Chicago. Qui tam Relator Lisitza pursued the case with the assistance of his attorneys, Michael I. Behn and Linda Wyetzner, of Behn & Wyetzner, Chartered, in Chicago.

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Problem 17.4 Consider the following financial statements for BestCare HMO, a not-for-profit managed care plan: BestCare HMO Statement of Operations and Change in Net Assets Year Ended June 30, 2011 (in thousands) Revenue: Premiums earned $26,682 Co-insurance 1,689 Interest and other income 242 Total revenue $28,613 Expenses: Salaries and benefits $15,154 Medical supplies and drugs 7,507 Insurance 3,963 Provision for bad debts 19 Depreciation 367 Interest 385 Total expenses $27,395 Net income $1,218 Net assets, beginning of year $900 Net assets, end of year $2,118 BestCare HMO Balance Sheet June 30, 2011 (in thousands) Assets Cash and cash equivalents $ 2,737 Net premiums receivable 821 Supplies 387 Total current assets $3,945 Net property and equipment $5,924 Total assets $9,869 Liabilities and Net Assets Accounts payable–medical services $2,145 Accrued expenses 929 Notes payable 141 Current portion of long-term debt 241 Total current liabilities $3,456 Long-term debt $4,295 Total liabilities $7,751 Net assets (equity) .

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Running Head: ROLE OF EXECUTIVE ORDER IN ACA Role of Executive Order in ACA 2 Role of Executive Order in ACA By: Ameki Lee Dr. White MPA6501 SU01 State and Local Government and Intergovernmental Relations Role of Executive Order in ACA Affordable Act Care has been a significant issue in Texas State for the past seven years. Texas governor, Greg Abbott has been on the frontline in fighting the implementation of the Act in Texas and America. The governor's office claims that the penalties related to avoiding the Act are unconstitutional and not democratic (Toussaint, 2017). Furthermore, the Governor argues that the Affordable Care Act should be put on halt while the cause is being liquidated. However, the governor does not concentrate on improving the policy rather than doing away with it. Greg Abbott believes the pre-existing conditions are the major barriers for the effectiveness of the act. The Affordable Care Act allows people to purchase the policy even with pre-existing conditions. In favor of the governor, the act should limit the purchase of the act during such conditions with the aim of reducing the cost as well as the rates of insurance. Therefore, an appeal can be made based on the governors value since most Americans are complaining about the same issue (Toussaint, 2017). Affordable Act Care was implemented under the executive administrative policy. In America, an executive order is directed by the president on the managers of various federal governments with the aim of forcing policy to law. In 2013, former president of America Barack Hussein Obama issued a directive on the implementation of the Affordable Care Act (Rovner, 2018). The current President, Donald Trump began fighting the Act by attacking the executive committee and even dismantling it. An executive order is written, signed and published by the president's office and directed to various federal departments. The Executive order directed all agencies responsible under the Affordable Care Act provision that will provide a regulatory and fiscal burden on entities that will be reluctant on adopting a policy. Also, the Executive Order directs the same agencies to offer greater flexibilities and collaboration on implementing such healthcare policies. Since the implementation of the Affordable Care Act in 2010, the policy has suffered various criticisms in its debate. For those who believed that the primary goal of the Act was to make insurance more affordable didn’t achieve their purpose. However, the policy has caused more Americans to have access to medical insurance hence fostering a healthy nation. Since the Act is applicable in improving the public health of all Americans, it includes various resources in healthcare like materials, funds, personnel and other things that can be utilized in the provision of healthcare service. The act is also responsible for ensuring all medical care institutions have the necessary resource for effective operations (Ba.

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Review pages 109–110 of Essentials of Health Policy and Law as well as the following legislation: Examination and Treatment for Emergency Medical Conditions and Women in Labor You are a consultant specializing in policy analysis. Based on theExamination and Treatment for Emergency Medical Conditions and Women in Labor legislation, as well as the situation that follows, you will complete a policy analysis with 3–5 options for your client, Congresswoman Moody, to consider. Congresswoman Moody represents a state that borders Mexico. She is up for re election next year, and she will seek another term in office. There are many undocumented workers that reside in her district. Congresswoman Moody is vocal about the need to provide health care to all that need it, but she also believes in fiscal restraint and does not support bail-outs for private facilities. She is well aware that her state’s Medicaid budget is almost exhausted for this year, and the state’s unemployment rate remains stubbornly high. Apart from the voters, other affected constituents include three private regional medical centers trauma units that receive referrals from five or more small facilities that have emergency departments with lesser trauma status. Also, the largest health care corporation that owns two of the three medical centers in her catchment area, and which supported her in her last bid for election with campaign funds at the allowable limit, is threatening to refuse Medicare and Medicaid patients to ensure survival in the bad economy. An increase in unfunded mandates for urgent care may push this corporation into private payer only, and Congresswoman Moody is aware that there are enough affluent families in the area to support two facilities providing only designer medicine and concierge services. All options must: · Be within the power of Congresswoman Moody to do · Be consistent with Congresswoman Moody’s values, and · Address the issue identified in the problem statement You will: 1. Identify 3–5 options for Congresswoman Moody’s consideration 2. Identify criteria that will be used to evaluate the options 3. Identify pros and cons for each option 4. Use a side-by-side table (MS® Excel® would be appropriate for this) to assist in analyzing the options. Submitting Your Assignment Prepare your written Assignment in a Word and/or Excel document and save it in a location and with a name you will remember, using the following naming convention: username-assignment-unit#.doc. Page number 109 In terms of national constitutions, a 2004 survey reported that some two-thirds of constitutions worldwide address health or health care, and that almost all of these do so in universal terms, rather than being limited to certain populations.13 For example, consider the health-related constitutional aspects of four politically and culturally diverse countries—Italy, the Netherlands, South Africa, and Poland—that have some type of “right to health”: Italy’s Constitution guarantees a ...

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HHP 4600 Law and Public Health Module 3 Power Point questions on Privacy 1. Where in the U.S. Constitution is the explicit provision recognizing the right to privacy? 2. How has the Supreme Court recognized the right to privacy? 3. Roe v Wade recognizes the privacy of women’s right to choose to reproduce or not. How does the decision to abort a fetus legally avoid clashing with the right to life of a child? Does Roe v Wade require every state to permit abortions? Why is it more difficult to have an abortion in some states than others? 4. What fundamental right is common in cases involving abortion, guardianship, right to refuse treatment, and sex between consenting adults? 5. What did the courts decide in Bowers v Hardwick? Was a fundamental right actually involved? Did the opinion of Justice White recognize that fundamental right? How was this different from Roe? 6. Karen Quinlan 1. What was decided in the case of Karen Quinlan? 2. What fundamental right do Quinlan and Cruzan have in common with abortion and contraceptive cases? 3. What prevalent practice became almost standard procedure by the public after the Quinlan and Cruzan decisions? 7. What did the court rule in 1. Bouvia? 2. Cruzan? 8. Has the Supreme Court decided we have a right to refuse treatment even if it leads to one’s death? 9. Has the Supreme Court decided we have a right to determine the timing and manner of our death, i.e. commit suicide? Teitelbaum and Wilensky Chapter 6 Individual Rights in Health Care 1. Does having a license to practice medicine legally obligate you to provide healthcare to those who need it? 2. What is meant by the no duty principle? 3. Does the Constitution confer to Americans the right to education and health? 4. Did the passage of the Affordable Care Act of 2010 alter Americans right to health care? 5. How might the idea of having a free market health care system and a negative view of government be a barrier to single payer universal healthcare? 6. To what does EMTALA entitle a person? 7. What does the Canterbury case demonstrate? 8. How might Jacobson v Massachusetts be a legal precedent today in resolving cases where some people contest states or cities require wearing protective masks or social distancing or closing some businesses during a pandemic? 9. Why is it important to recognize the courts’ interpretation of the Tenth Amendment or police powers as empowering, but not obligating government to act? 10. If one believes the federal government has not done enough to protect citizens during a Pandemic, could one successfully sue to make the government take better care of its citizens? 11. What is meant by a negative constitution? 12. What do the cases of DeShaney and Town of Castle Rock cases demonstrate? Updated 7/9/20 Government Power and Privacy Module 3 PrivacyMaking individual decisions without government interferenceTorts or violations of civil liberties, but privacy not explicit in U.S. Cons ...

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Chapter 3 Due Process, Equal Protection, and Civil Rights Those who deny freedom to others deserve it not for themselves. Abraham Lincoln CHAPTER OBJECTIVES After studying this chapter you should better understand: · • The standards applied for determining whether a procedure satisfies the constitutional due process requirements · • The manner in which the restrictions on federal government action in the Bill of Rights have been incorporated into the due process guaranty that applies to state actions · • The U.S. Supreme Court’s approach to determining whether classifications violate the constitutional equal protection requirements · • The classifications to which “strict scrutiny” is applied in the equal protection analysis · • The basic remedies available for civil rights violations At the heart of the rule of law lie the ideals that everyone should be treated fairly and equally before the law. Toward this end the U.S. Constitution protects individual rights by constraining government. But fairness and equality cannot be reduced to prohibitions. To reach more broadly the Constitution also includes fundamental guaranties. Many important court decisions and legislative acts addressing individual rights have been based on the two most fundamental general guaranties: the Due Process Clause and the Equal Protection Clause. A Due Process Clause was part of the Fifth Amendment in the original Bill of Rights and it was aimed at the federal government. It provides that no person shall be “deprived of life, liberty, or property, without due process.” The original Bill of Rights did not mention equal protection of the laws in a general sense. The Fourteenth Amendment, added after the Civil War and aimed at former slave states, included the same due process provisions as the Fifth Amendment. The Fourteenth Amendment also included the Equal Protection Clause. It provides that no state shall “deny to any person within its jurisdiction the equal protection of the laws.” Although nothing in the text said that equal protection applied to the federal government as well as to the states, the U.S. Supreme Court eventually held that it did. In 1954 in Bolling v. Sharpe the Court said that “the concepts of equal protection and due process, both stemming from our American ideal of fairness, are not mutually exclusive. The ‘equal protection of the laws’ is a more explicit safeguard of prohibited unfairness than ‘due process of law,’ and, therefore, we do not imply that the two are always interchangeable phrases. But, as this Court has recognized, discrimination may be so unjustifiable as to be violative of due process.”1 Consequently due process and equal protection apply to both federal and state laws. The Due Process and Equal Protection Clauses address government action. They require that laws and legal procedures be fair. As discussed in the final section of this chapter, other constitutional provisions or laws may directly address unfair or discriminato ...

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Judson, K., & Harrison, C. (20 16). Law and ethics for the health professions. (7th ed. ). New York: McGraw- Hill. Law&Et cs FOR HEALTH PROFESSIONS KAREN JUDSON CARLENE HARRISON Key Terms 204 Privacy, Security, and Fraud LEARNING OUTCOMES After studying this chapter, you should be able to: LO 8. I Discuss U.S. constitutional amendments and privacy laws that pertain to health care. LO 8.2 Explain HIPAA's special requirements for disclosing protected health information. LO 8.3 Discuss laws implemented to protect the security of health care information as health records are converted from paper to electronic form. LO 8.4 Discuss the federal laws that cover fraud and abuse within the health care business environment and the role of the Office of the Inspector General in finding billing fraud. LO 8.5 Discuss patient rights as defined by HIPAA, the Patient Protection and Affordable Care Act, and other health care entities. FROM THE PERSPECTIVE OF . .. ANN, AN R.N. IN A TEXAS HOSPITAL FOR NEARLY 25 YEARS, remembers when patients' names were posted on the doors to their rooms. She and her colleagues once freely informed telephone call- ers and visitors how patients were progressing. Now, Ann remarks, because of federal legislation to protect the privacy and security of health care information, times have changed. "We have to be so care- ful about releasing any information that when my father's dear friend was admitted to my floor in the hospital where I work, I couldn't tell him that his friend had been admitted." From Ann's perspective, because she cares about her patients, she would like to be able to talk more freely with family members or friends who also care about her patients. But she is duty-bound to follow the law, and she knows the benefits to patients for laws that guard their privacy. From the perspective of friends and family members who call for information about a patient, the law is harsh and hard to understand. They are often angry when they cannot learn the status of a friend or loved one. From the perspective of some patients, the law sometimes feels over- protective and unnecessarily intrusive, but for others-such as the patient who has tried to commit suicide and failed, who doesn't want anyone to know he is in the hospital, or the battered spouse who doesn't want her abusive husband to find her-it's a safety net they can depend on. The United States Constitution and Federal Privacy Laws Contrary to popular belief, the term privacy (freedom from unauthor- ized intrusion) does not appear in the U.S. Constitution or the Bill of Rights. However, the United States Supreme Court has derived the right to privacy from the First, Third, Fourth, Fifth, Ninth, and Fourteenth Amendments to the Constitution. LO 8.1 Discuss U.S. constitutional amendments and privacy laws that pertain to health care. privacy Freedom from unaut horized int rusion. LANDMA ...

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INDIVIDUAL RIGHTS AND THE HEALTHCARE SYSTEM The “global perspective” you just read was brief for two reasons. First, a full treatment of international and foreign health rights is well beyond the scope of this chapter, and second, historically speaking, international law has played a limited role in influencing this nation’s domestic legal principles. As one author commented, “Historically the United States has been uniquely averse to accepting international human rights standards and conforming national laws to meet them.”15(p1156) This fact is no less true in the area of health rights than in any other major area of law. As described earlier in this chapter, universal rights to health care are virtually nonexistent in the United States, even though this stance renders it almost solitary among industrialized nations of the world. This is not to say that this country has not contemplated health care as a universal, basic right. For instance, in 1952, a presidential commission stated that “access to the means for attainment and preservation of health is a basic human right.”16(p4) Medicaid and Medicare were the fruits of a nationwide debate about universal healthcare coverage. And during the 1960s and 1970s, the claim that health care was not a matter of privilege, but rather of right, was “so widely acknowledged as almost to be uncontroversial.”17(p389) Nor is it to say that certain populations do not enjoy healthcare rights beyond those of the general public. Prisoners and others under the control of state governments have a right to minimal health care,18 some state constitutions expressly recognize a right to health or healthcare benefits (for example, Montana includes an affirmative right to health in its constitution’s section on inalienable rights), and individuals covered by Medicaid have unique legal entitlements. Finally, it would be inaccurate in describing healthcare rights to only cover rights to obtain health care in the first instance, because many important healthcare rights attach to individuals once they manage to gain access to needed healthcare services. The remainder of this section describes more fully the various types of individual rights associated with the healthcare system. We categorize these rights as follows: · 1. Rights related to receiving services explicitly provided under healthcare, health financing, or health insurance laws; for example, the Examination and Treatment for Emergency Medical Conditions and Women in Labor Act, Medicaid, and the Affordable Care Act. · 2. Rights concerning freedom of choice and freedom from government interference when making healthcare decisions; for example, choosing to have an abortion. · 3. The right to be free from unlawful discrimination when accessing or receiving health care; for example, Title VI of the federal Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin by entities that receive federal funding.12(p12),19 Right.

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