ABSTRACT
Contents Objectives .............................................................................................................................. 200 Introduction ........................................................................................................................... 200 Administrative Health Law ..................................................................................................... 200 Centers for Medicare and Medicaid ......................................................................................... 201
Medicare ........................................................................................................................ 201 Medicaid ........................................................................................................................ 202
Fraud and Abuse .................................................................................................................... 203 Food and Drug Administration ............................................................................................... 204 Trends ..................................................................................................................................... 204 Revenue Audit Contractors ..................................................................................................... 204 Medicare Administrative Contractors and Comprehensive Error Rate
Testing Contractors ........................................................................................................ 205 Quality .................................................................................................................................... 205 Roles and Practice Settings ...................................................................................................... 207 Conclusion .............................................................................................................................. 207 References ............................................................................................................................... 208 Resources ................................................................................................................................ 208 Test Questions ......................................................................................................................... 209
Objectives Th e intent of this chapter is to assure that the legal nurse consultant can confi dently manage activities and cases in which an understanding of bureaucratic agencies, regulations, codes, and laws is fundamental. Th e legal nurse consultant will be able to
Provide a defi nition of administrative health law ◾ List the primary administrative agencies impacting healthcare ◾ Highlight auditing and quality initiatives and resulting opportunities for legal nurse ◾ consultants
Introduction Modern American health care is a precarious balance between the private and public sectors. Many aspects of health care are a matter of public policy and largely funded through tax revenue. Federal, state, and local governments regulate the provision of health care and countless healthcare-related private sector activities.
