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Tables of Contents for Health Law and Policy
Chapter/Section Title
Page #
Page Count
About the Author
xi
Contributor
xiii
Preface
xv
I TRADITIONAL LEGAL MEDICINE
1
72
Concepts of Law
3
12
Structure
3
1
Types of Law
4
3
The Structure of a Civil Lawsuit
7
3
Notes on Concepts of Law
10
1
Further Reading
11
2
Web Sites
13
2
Medical Malpractice
15
14
General Considerations
15
2
Notes on Medical Malpractice
17
7
Res Ipsa Loquitur: Changing the Burden of Proof
24
1
Notes on Res Ipsa Loquitur
25
1
Further Reading
26
1
Web Sites
27
2
Informed Consent
29
16
General Considerations
29
1
Notes on Informed Consent
30
10
Emergency Treatment Exception to Informed Consent
40
1
Notes on the Emergency Treatment Exception
40
3
Further Reading
43
1
Web Sites
43
2
Medical Information, Records, and Confidentiallity
45
18
Confidentiality of Medical Records and Information
46
1
Notes on Confidentially of Medical Records
47
5
Allowable Disclosures
52
3
Notes on Allowable Disclosures
55
6
Further Reading
61
1
Web Sites
62
1
The Provider--Patient Relationship and the Obligation to Treat Provider--Patient Relationship
63
10
Notes on the Provider--Patient Relationship
64
3
Severing the Provider--Patient Relationship and Patient Abandonment
67
2
Notes on Severing the Provider--Patient Relationship and Patient Abandonment
69
3
Further Reading
72
1
Web Sites
72
1
II THE HEALTH CARE INSURANCE STRUCTURE
73
60
Private Insurance
75
18
Out of Pocket
75
1
Private Insurance
75
1
Federal Regulation: ERISA
76
7
COBRA and HIPAA
83
3
Other Statutes
86
2
States
88
1
Further Reading
88
2
Web Sites
90
3
Public Insurance: Medicare
93
12
Enrollment
93
1
Coverage
94
1
Beneficiary Cost Sharing
95
1
Medicare Exclusions from Payment
95
1
Provider Participation Requirements
96
1
Part A Payment
96
2
Part B Payment
98
1
Assignment
99
1
Appeals in Medicare
100
1
Medigap Insurance
101
1
Further Reading
102
1
Web Sites
103
2
Public Insurance: Medicaid
105
10
Covered Groups and Eligibility
105
2
Services
107
1
Payment
107
1
Appeals
108
1
Medicaid and Medicare
109
1
Waivers
109
1
Spending Down for Nursing Home Care
110
2
Further Reading
112
2
Web Sites
114
1
Managed Care
115
18
Managed Care Delivery Forms
115
2
Other Managed Care Forms
117
1
Payment Methodologies
118
1
Regulatory Structure
119
1
Liability
120
2
ERISA and Managed Care
122
2
Medicaid and Managed Care
124
1
Medicare and Managed Care
125
1
Other Federal Programs
126
1
Accreditation
126
1
Further Reading
127
4
Web Sites
131
2
III MODERN DELIVERY CONSIDERATIONS
133
138
Physician Contracting and Employee Considerations
135
14
Independent Contractors
135
4
Employees
139
3
Other Statutes
142
5
Further Reading
147
1
Web Sites
148
1
Licensure and Practice Regulation
149
20
State Licensure and Revocation
149
4
Notes on State Licensure and Revocation
153
2
Staff and Clinical Privileges
155
3
Notes on Staff and Clinical Privileges
158
4
Covenants Not to Compete
162
3
Further Reading
165
2
Web Sites
167
2
Fraud and Abuse
169
48
False Claims Act
169
4
Antikickback statute
173
18
Stark Laws
191
6
Sanctions
197
5
Notes on Fraud and Abuse
202
2
The Emergency Medical Treatment and Active Labor Act (EMTALA)
204
4
Notes on EMTALA
208
2
Further Reading
210
4
Web Sites
214
3
Antitrust Law
217
40
Sherman Act
217
2
Clayton Act
219
1
Federal Trade Commission Act
220
1
Enforcement and Penalties
220
1
Antitrust Enforcement Policies
221
5
Business Review and Advisory Opinions
226
9
Notes on Antitrust
235
5
Appendix: FTC and DOJ Guideline Examples
240
13
Further Reading
253
2
Web Sites
255
2
Alternative Dispute Resolution
257
14
Formal Adjudication
257
1
Mediation
257
1
Arbitration
258
1
Hybrid Methods
259
1
ADR and Medical Malpractice Claims
260
1
Other Medical Disputes
261
6
Notes on ADR
267
1
Further Reading
268
1
Web Sites
269
2
IV END-OF-LIFE CONSIDERATIONS
271
30
Advance Directives
273
14
Living Will
273
1
Durable Power of Attorney
274
1
Patient Self-Determination Act
274
1
Oral Directives
275
1
Potential Reasons for Limited Advance Directive Use
276
2
Objections to the Use of Advance Directives
278
1
Wrongful Living and Other Causes of Action Involving Advance Directives
278
1
Notes on Advance Directives
279
5
Further Reading
284
1
Web Sites
285
2
Definitions of Death
287
14
Anna V. Schlotzhauer
Bryan A. Liang
Cardiopulmonary Death
287
1
Whole Brain Death
288
2
Higher Brain Death
290
1
Patient-Determined Definition of Death
291
1
Anencephalic Infants
292
1
Organ Donation
293
1
Financial Considerations
294
1
Notes on Definitions of Death
295
3
Further Reading
298
1
Web Sites
299
2
Index
301