What Exactly Is Healthcare Litigation?
One of the biggest aspects of healthcare delivery is the regulatory environment within which a healthcare provider must operate. A small business owner needs a business license and must abide by a code of ethics put out by the Small Business Administration, but otherwise can control much of their business activity. In healthcare, however, there are several regulatory guidelines with which a medical provider must comply or else they lose their license to practice/provide health service.
One such guideline is issued by the state association which applies to that provider’s line of healthcare. The second regulatory guideline is issued by state agencies such as the Division of Medicaid in a particular state, the state health department, the Department of Human Services, or a combination of others including the attorney general’s office. In addition, there are federal regulatory requirements, which are generally encompassed by Health and Human Services (HHS) or the Center for Medicare and Medicaid Services (CMS).
An investigation will be launched if there is any indication that a provider is not in compliance with the regulations. Many times, litigation comes up with regard to agencies, whether it be the professional agency, the state health agencies, or the federal agencies. This is one reason healthcare providers spend a lot of time, energy, and money on making sure they’re operating within those regulatory guidelines. This is something for which an attorney is recommended. If there is any question as to whether an employee or provider is in compliance, it is important through advice of your attorney to immediately contact the agency and notify them of this. If the agency sees that the provider has attempted to report potential noncompliance and operate in a professional manner, then issues are likely to be resolved short of litigation, violations, and negative findings in audits.
In the healthcare setting, a myriad of disagreements can arise with regard to the services being provided, the kind of equipment being used, the purchase or lease agreements, definitions of employees versus independent contractors, etc. These matters must be negotiated and reduced to agreements that make sense, set out the manner in which operations should proceed, and provide for dispute resolution if there is a disagreement.
What Are Some Of The Alternative Resolution Methods To Healthcare Litigation Matters?
Many times, resolutions are achieved with the agencies. If there is any doubt as to whether there has been a violation of the regulatory guidelines associated with an agency, that agency through advice of your attorney should immediately be contacted and notified of this so that a means of rectifying and resolving the issue can be discussed. This is an alternative means for a resolution outside of litigation that will build and maintain a reputation of honesty and professionalism, which will only help prevent future full-scale litigation.
Other methods of alternative resolution include mediation and arbitration. There are also administrative processes specific to the Division of Medicaid and/or to Medicare which fall somewhere in between mediation and litigation. While somewhat expensive, these methods are certainly less expensive than full-scale litigation.
Is It Best To Have A Healthcare Litigation And Transactional Attorney On Retainer Or Should We Hire One As Needed?
It is best to have a trustworthy lawyer who knows and understands healthcare and the various governmental agencies which regulate them while on retainer. Oftentimes, clients call me to ask questions or discuss a certain action they are thinking about taking, and I will immediately raise two or three red flags for them to consider. Having a lawyer to guide thinking processes with regard to certain issues is essential in the healthcare world. Most healthcare providers—whether big or small—have a healthcare lawyer on retainer…Read More
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