Hm300 week 2

1. © 2017 American Health Information Management Association© 2017 American Health Information Management Association
Chapter 3: The Legal System
in the United States
Fundamentals of Law for Health
Informatics and Information
Management, Third Edition

2. © 2017 American Health Information Management Association
US Legal System—Public vs.
Private Law
• How are laws classified?
– Public law
• Involves the federal, state, or local government and its
relationship to individuals and business organizations
• Criminal law: Government is a party prosecuting an accused
who has been charged with violating a criminal statute or
criminally violating a regulation
• Civil law: Regulatory activities for which non-compliance is
non-criminal in nature
– Private law
• Concerns the rules and principles that define rights and
duties among people and among private businesses (a
government is not a party)

3. © 2017 American Health Information Management Association
US Legal System—Sources of
Law
• Constitutional law
– Body of law that deals with the amount and
types of power and authority that
governments are given
– US Constitution
• Legislative branch
• Executive branch
• Judicial branch

4. © 2017 American Health Information Management Association
US Legal System—Sources of
Law (continued)
• Statutory law
– Statutes are enacted by a legislative body
• US Code (USC): Compilation of all federal statutes
• Administrative law
– Executive branch enforces laws enacted by
legislative body through development of rules
and regulations
• US Code of Federal Regulation (CFR)

5. © 2017 American Health Information Management Association
US Legal System—Sources of
Law (continued)
• Common law: Judicial law or case law
(decisions)
– Based on court resolutions of disputes
• Outcomes vary from state to state and from federal
court system to another
– Stare decisis (let the decision stand) and
precedent
• Lower courts in a court system are bound to apply
decisions of higher courts in the same court system
when determining the outcome of the case, if the fact
pattern of the case in the higher court was similar to of
the current case.

6. © 2017 American Health Information Management Association
US Legal System—Conflicts of
Laws
• Occurs when there is an inconsistency
between laws of different states arising
from a legal action that involves more than
one jurisdiction
– State vs. state
– Federal vs. state
• Supremacy clause

7. © 2017 American Health Information Management Association
US Legal System—Government
Organization
• Executive branch
– Enforces laws through creation and issuance
of rules and regulations by administrative
agencies
– Example: Federal regulation of healthcare
– Health and Human Services oversees Medicare,
Medicaid, Indian Health Service, and other entities.
– Example: State regulation of healthcare
– Numerous agencies deal with disbursement of Medicaid
funds, mental health, public health, etc.

8. © 2017 American Health Information Management Association
US Legal System—Government
Organization (continued)
• Legislative branch
– Enacts laws in the form of statutes
– Bicameral (two-chamber) model consisting of
the Senate and the House of Representatives

9. © 2017 American Health Information Management Association
US Legal System—Government
Organization (continued)
• Judicial branch
– Interprets laws and adjudicates disputes,
creating common law
– Federal and state course apply res judicata
(“a matter already judged”)

10. © 2017 American Health Information Management Association
US Legal System—Government
Organization (continued)
• Separation of powers
– Limits the authority of each and inhibits any
one branch of government from becoming
autocratic

11. © 2017 American Health Information Management Association
US Legal System—Judicial
System
• State court system
– Trial courts (lowest tier)
• General jurisdiction: Hear more serious criminal
cases or civil cases dealing with large sums
• Limited jurisdiction: Hear cases related to of
particular subject matter or lesser severity crimes
(e.g., small claims, domestic relations, landlord–
tenant)

12. © 2017 American Health Information Management Association
US Legal System—Judicial
System (continued)
• State court system
– Appellate courts (middle tier)
• Hear appeals on final judgments of the state trial
courts
– State supreme court (highest tier)
• Hears appeals from the appellate courts (or from
trial courts if no appellate court)

13. © 2017 American Health Information Management Association
US Legal System—Judicial
System (continued)
• Federal court system
– District courts (trial courts located throughout the
US)
– Circuit courts (appellate courts located throughout
the US)
• Nationally divided into geographic circuits
– US Supreme Court (final decision-maker)
• Petition for writ of certiorari : Process by which a party
submits a request for the Supreme Court to hear a
case
• Only hears cases by granting certiorari

14. © 2017 American Health Information Management Association
US Legal System—Federal
Court Jurisdiction
• Jurisdiction: Legal authority that a body possesses
to make decisions
• Federal courts can hear cases based on two types
of jurisdiction:
– Subject matter jurisdiction (content or substantive
area of case being brought must be related to federal
law or the US Constitution
– Diversity jurisdiction (parties from different states
engage in a lawsuit in federal court)
• No plaintiff can be from the same state as any of the
defendants.
• The amount in controversy must be at least $75,000

15. © 2017 American Health Information Management Association
US Legal System—
Requirements of Non-Legal
Entities
• Are voluntary and do not have legal authority
• May nonetheless be powerful and influential,
such as accrediting bodies including:
– Joint Commission
– Healthcare Facilities Accreditation Program
– DNV GL Healthcare
– Center for Improvement in Healthcare Quality
(CIHQ)

16. © 2017 American Health Information Management Association
US Legal System—Alternative
Dispute Resolution
• Alternative dispute resolution provides a less
costly and less time-consuming mechanism
outside of the court system for resolving
conflicts
– Arbitration
• Dispute is submitted to and decided by a third party
outside the court system
– Mediation
• Occurs by agreement of the parties, as facilitated by a
mediator