Discussion:

“Contracts and Antitrust Protocols Based on the Criminal Aspects of Health Care” Please respond to the following:

• * From the scenario, differentiate between the concepts of criminal law, antitrust, and health care as they apply to U.S. health law in the 21st Century. Conceptualize the primary ways in which these laws apply to U.S. health care administrators.
• Analyze the general transition of U.S. health laws based on criminal misconduct in health care to the creation of contract laws, as predicated within the Sherman Antitrust Act. Evaluate the efficacy of the measures that the new contracts in question afford, and rationalize whether or not these improvements have provided optimal solutions to today’s complex concerns of integrity in health care performance.

Response Sirlin:

From the scenario, differentiate between the concepts of criminal law, antitrust, and health care as they apply to U.S. health law in the 21st Century. Conceptualize the primary ways in which these laws apply to U.S. health care administrators.

The distinction between criminal law and antitrust laws are as follows; criminal law is the system of law that establishes or is concerned with the punishment of those who commit crimes. Criminal law is basically broken down into two parts, misdemeanors and felonies. Misdemeanors are crimes punishable by imprisonment for up to 364 days and / or a fine. A felony is a crime punishable for one year (365 days) or more.

When it comes to antitrust laws the Sherman Antitrust Act of 1890 that regulates competition among enterprises. When King an subsidiary of Pfizer and marketed by Mylan raised the costs of its EpiPen product, which is a necessary life saving product, by over well over 1000% they were found to be in violation of the Sherman Antitrust Act because they held the patent for this product and they not only raised the price for profit but to give their CEO at the time a $90+ raise. The price increase in this product made the product impossible for most people to afford. Holding the patent made sure that no other company could compete by making a similar product and put many people’s lives at steak. The Department of Justice ended up fining Mylar approximately $480 million and allowing other companies to compete to make a similar product.

U.S. healthcare administrators must be very aware to not violate any antitrust laws by limiting the competitiveness of any provider by taking kickbacks or any type of exchange of services for referrals. This, combined with intent, could and probably would also be charged as a criminal act and the administration could be held liable.

• Analyze the general transition of U.S. health laws based on criminal misconduct in health care to the creation of contract laws, as predicated within the Sherman Antitrust Act. Evaluate the efficacy of the measures that the new contracts in question afford, and rationalize whether or not these improvements have provided optimal solutions to today’s complex concerns of integrity in health care performance.

As stated above the Sherman Antitrust Act of 1890 is a U.S. regulatory act that was put in place in order to regulate competition between organizations. U.S. healthcare misconduct laws were created to provide standards that providers and organizations must follow in order serve the public fairly. Contractual laws were also put in place in order to protect the public from unfair or misconduct by the provider or organization. Contractual law protects both sides against any type of breach of contract or violation of the contractual terms and conditions. There are two types of corporate contracts. They are express and implied contracts. Implied contracts are those that are governed by pre-existing laws and regulations. Express contracts are those that may be taken into account through verbal or non-verbal gestures such as a handshake.

Providers and organizations also have contractual agreements through their bylaws. The bylaws of a healthcare organizations are the rules and regulations that govern not only what the organization can and cannot do, but they also set up the protocols for the hierarchy of the organization or organizational tree as well as what the providers that work for the organization can or cannot do.

The evolution from healthcare law to contract law and antitrust laws have greatly improved the healthcare industry as it protects the public as well as the organizations from unfair acts as well as keeps competition going. Competition is what also helps protect as well as educates the public who need to use the healthcare system.

Response Trotter:

From the scenario, differentiate between the concepts of criminal law, antitrust, and health care as they apply to U.S. health law in the 21st Century. Conceptualize the primary ways in which these laws apply to U.S. health care administrators.

The concept of criminal law is defined in the scenario and course text as “society’s expression of the limits of acceptable human and institutional behavior”.The criminal law process starts with the crime, an arrest, an arraignment, an indictment, a conference and then the criminal trial.Criminal law applies to U.S. Health care in the 21st century as it’s existence helps people that are in vulnerable position to be protected as criminal law acts as a deterrent or the possibility for criminal accountability in the event of wrong doing.This also helps facilitate the reporting of wrong doing and in regards to healthcare negligence.The antitrust laws exist to promote free competition within the health care setting which in turn acts as a benefit to the patient/consumer group as health care organizations will work to compete for consumers through quality services and competitive pricing.Health Care Administration would want to be particularly in tune with criminal laws and antitrust in order to avoid violations of these laws which could result in legal ramifications.Additionally, Health Care Administration would want time to provide the appropriate education for their staff to avoid future violations and ensure that all areas within the health care hierarchy are knowledgeable about their role in regards to compliance with these laws.

• Analyze the general transition of U.S. health laws based on criminal misconduct in health care to the creation of contract laws, as predicated within the Sherman Antitrust Act. Evaluate the efficacy of the measures that the new contracts in question afford, and rationalize whether or not these improvements have provided optimal solutions to today’s complex concerns of integrity in health care performance.

I think like with most items an issue helps evaluate a better way of conduct and accountability with criminal misconduct within the health care setting being no different.Misconduct whether it be direct abuse/neglect of a patient by a health care professional or antitrust violations such as price fixing or an exclusive contract have assisted with the creation of contracts to avoid violations of criminal law and Sherman Antitrust Act to establish a better way to evaluate and enforce the misconduct that can exist with in the health care profession.Contracts when legally obtained through an offer, consideration and acceptance can help maintain a clear picture of expectation.This can assist with keeping an environment that promotes integrity.There are many ways that contracts can assist with improvements but may also have the potential to impede certain areas.As stated by the American Medical Association, “These changes with contract implementation are intended to enhance quality, efficiency, and safety in health care, they can also put at risk physicians’ ability to uphold professional ethical standards of informed consent and fidelity to patients and can impede physicians’ freedom to exercise independent professional judgment and tailor care to meet the needs of individual patients”.I think the further we delve into the establishment of contract and the laws that follow there may alway be the potential that one party may not be represented equitably.

Pozgar. (2018). Legal Aspects of Health Care Administration (12th ed.). Burlington, MD: Jones & Bartlett Learning.

Contracts to Deliver Health Care Services | American Medical Association. (2018). Retrieved from https://www.ama-assn.org/delivering-care/contracts…