Regulation of Health Care Business Relationships

Robert I. Field

in Health Care Regulation in America

Published in print October 2006 | ISBN: 9780195159684
Published online September 2009 | e-ISBN: 9780199864423 | DOI:
Regulation of Health Care Business Relationships

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This chapter examines laws and regulations that shape most health care business relationships, including those addressing antitrust, fraud and abuse, tax-exempt status, and data privacy. Antitrust enforcement prohibits conspiracies among competitors and willful acquisition of monopoly power. Fraud and abuse laws, including the Stark Amendments, proscribe false reimbursement claims and payments in return for patient referrals. Tax-exempt status, which applies to most hospitals, requires the provision of charitable care and community commitments. Privacy protections, most notably those imposed by the federal HIPAA law, restrict the dissemination of patient information by providers. The application of these laws remains controversial because of various ways in which health care differs from other kinds of businesses, including information asymmetry between patients and providers, inelasticity of demand for many basic services, and the buffering of consumers from the full cost of services by third party payers, a phenomenon known as moral hazard.

Keywords: antitrust; fraud; abuse; nonprofit; tax-exempt; privacy; medical data; HIPAA; information technology; moral hazard

Chapter.  14588 words. 

Subjects: Public Health and Epidemiology

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