Health Policy, Law, and Regulation
Core concepts
Master the statutory backbone: Medicare (Title XVIII), Medicaid (Title XIX), EMTALA, HIPAA, Stark (physician self-referral), the Anti-Kickback Statute, the False Claims Act, and the Affordable Care Act. Know the difference between civil and criminal exposure and between strict liability (Stark) and intent-based standards (Anti-Kickback). Understand licensure (state) versus certification (CMS Conditions of Participation) versus accreditation (Joint Commission, DNV). Know malpractice elements - duty, breach, causation, damages - and the role of peer review and credentialing protections.
Traps
Stark and Anti-Kickback are frequently confused. Stark is a strict-liability civil statute limited to designated health services and Medicare/Medicaid referrals; the Anti-Kickback Statute is a criminal statute covering any federal health care program and requires intent. EMTALA applies to anyone presenting to an emergency department for examination or treatment regardless of ability to pay - not just emergencies. HIPAA privacy and security are separate rules; the Security Rule covers electronic PHI only.
Worked example / rule of thumb
A physician owns a lab and refers Medicare patients to it. Even without proof of intent, this implicates Stark because lab services are designated health services and the referral is to an entity with a financial relationship - unless a safe harbor/exception applies. Rule of thumb: Stark = strict liability + designated services; AKS = intent + any federal program. When a question offers "intent" as a required element, it is almost always the Anti-Kickback Statute.