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Health Care Regulation in AmericaComplexity, Confrontation, and Compromise$
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Robert I. Field

Print publication date: 2006

Print ISBN-13: 9780195159684

Published to Oxford Scholarship Online: September 2009

DOI: 10.1093/acprof:oso/9780195159684.001.0001

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Regulation of Health Care Business Relationships

Regulation of Health Care Business Relationships

(p.173) 7 Regulation of Health Care Business Relationships
Health Care Regulation in America

Robert I. Field

Oxford University Press

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

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