Healthcare Law Terms

Regulatory & Compliance

Stark Law Federal law (42 U.S.C. § 1395nn) that prohibits physicians from referring Medicare and Medicaid patients to entities in which they have a financial interest for certain designated health services.

Anti-Kickback Statute Federal criminal law (42 U.S.C. § 1320a-7b) prohibiting remuneration to induce referrals for federally covered healthcare services.

HIPAA Health Insurance Portability and Accountability Act establishing national standards for protecting patient health information.

HITECH Act Law strengthening HIPAA privacy and security protections and expanding enforcement.

False Claims Act Federal law imposing liability for defrauding government programs, including whistleblower provisions.

OIG Compliance Program Guidelines Framework for preventing fraud and abuse in healthcare organizations.

Safe Harbor Regulation Rules protecting certain financial arrangements from Anti-Kickback violations if compliant.

Corporate Practice of Medicine Doctrine prohibiting corporations from practicing medicine or employing physicians in certain states.

Fee Splitting Prohibited sharing of professional fees with unlicensed individuals.

Physician Self-Referral Referrals to entities where physicians have a financial interest.

Healthcare Fraud Intentional deception in billing or services for unauthorized benefit.

Medicare Fraud Fraud targeting the Medicare program.

Medicaid Fraud Fraud targeting state Medicaid programs.

Prior Authorization Requirement for insurer approval before certain services.

Fair Market Value (Healthcare) Standard ensuring compensation reflects legitimate market value.

Healthcare Business & Transactions

MSO (Management Services Organization) Entity providing administrative services to healthcare providers.

ASC (Ambulatory Surgery Center) Facility for outpatient surgical procedures.

FQHC (Federally Qualified Health Center) Federally funded community healthcare providers in underserved areas.

Hospital-Physician Integration Business arrangements aligning hospitals and physicians.

Medical Cannabis License State authorization for medical cannabis activities.

Telehealth Regulation Laws governing remote healthcare delivery.

Certificate of Need Requirement for approval before expanding healthcare services.

Healthcare Joint Venture Collaborative business arrangement between healthcare entities.

Physician Employment Agreement Contract outlining physician employment terms.

Medical Staff Bylaws Rules governing hospital medical staff.

Call Coverage Agreement Arrangement ensuring emergency physician availability.

Non-Compete Agreement (Healthcare) Restriction on physician practice post-employment.

Medical Practice Valuation Process of determining practice value.

EMTALA Law requiring emergency treatment regardless of ability to pay.

Qui Tam Action Lawsuit brought by whistleblowers on behalf of the government.

Health Information & Technology

PHI (Protected Health Information) Individually identifiable health data protected by law.

Business Associate Agreement Contract governing PHI use by third parties.

Health Information Exchange Electronic sharing of patient information.

AI in Healthcare Use of artificial intelligence in medical settings.

Telemedicine Platform Technology enabling remote healthcare services.

Electronic Health Records (EHR) Digital patient records.

Healthcare Data Breach Unauthorized access to protected health information.

Medical Device Regulation FDA oversight of medical devices.

Clinical Decision Support Technology aiding clinical decisions.

Patient Portal Secure online access to patient health information.

Trial Litigation Terms

Pre-Trial & Discovery

Discovery Pre-trial exchange of evidence.

Deposition Sworn out-of-court testimony.

Interrogatories Written questions answered under oath.

Request for Production Request for documents or evidence.

Summary Judgment Decision without trial when facts are undisputed.

Motion to Dismiss Request to terminate a case early.

Class Action Lawsuit representing a group with similar claims.

Venue Proper location for trial.

Statute of Limitations Time limit to file a claim.

Burden of Proof Obligation to prove claims.

Expert Witness Specialist providing opinion testimony.

Daubert Standard Rule governing admissibility of expert testimony.

Trial Procedures

Jury Selection (Voir Dire) Process of selecting jurors.

Opening Statement Initial case outline to jury.

Direct Examination Questioning of one’s own witness.

Cross-Examination Questioning opposing witness.

Redirect Examination Follow-up questioning after cross.

Closing Argument Final argument summarizing case.

Jury Instructions Judge’s explanation of applicable law.

Verdict Jury’s decision.

Judgment Final court ruling.

Appeal Request for higher court review.

Mistrial Trial terminated before conclusion.

Hung Jury Jury unable to reach a decision.

Damages & Remedies

Compensatory Damages Payment for actual losses.

Punitive Damages Damages to punish wrongdoing.

Economic Damages Quantifiable financial losses.

Non-Economic Damages Intangible losses like pain and suffering.

Lost Wages Compensation for lost income.

Medical Expenses Healthcare-related costs.

Future Damages Compensation for future losses.

Injunctive Relief Court order to act or refrain from acting.

Settlement Agreement resolving dispute without trial.

Structured Settlement Payments made over time.

Contingency Fee Attorney paid based on case outcome.

Insurance Law Terms

Coverage & Claims

Bad Faith Insurance Improper denial or handling of claims.

Subrogation Insurer’s right to recover from responsible parties.

Policy Limits Maximum payout under policy.

Deductible Amount paid before coverage applies.

Coverage Denial Refusal to pay a claim.

Exclusion Policy provision removing coverage.

Pre-Existing Condition Condition existing before coverage.

Claim Investigation Review of claim validity.

Reservation of Rights Insurer preserves right to deny later.

Duty to Defend Obligation to provide legal defense.

Healthcare Insurance

Prior Authorization Approval required before services.

Network Provider In-network contracted provider.

Out-of-Network Provider without insurance contract.

Medical Necessity Requirement services be appropriate.

Utilization Review Evaluation of service necessity.

Appeals Process Challenging claim denials.

Explanation of Benefits (EOB) Statement of coverage/payment.

Coordination of Benefits Determines primary payer.

COBRA Continuation of coverage after job loss.

Self-Funded Plan Employer-funded health coverage.

Employment Law Terms

Employment Relationships

At-Will Employment Employment terminable at any time.

Wrongful Termination Illegal firing.

Employment Contract Agreement defining employment terms.

Non-Disclosure Agreement (NDA) Protects confidential information.

Non-Compete Agreement Restricts post-employment competition.

Severance Package Compensation after termination.

Employee Handbook Workplace policies document.

Performance Improvement Plan (PIP) Process to address performance issues.

Constructive Dismissal Forced resignation due to conditions.

Independent Contractor Non-employee service provider.

Discrimination & Harassment

Title VII Law prohibiting employment discrimination.

Sexual Harassment Unwelcome sexual conduct at work.

Hostile Work Environment Abusive workplace conditions.

Quid Pro Quo Benefits conditioned on conduct.

Protected Class Group protected from discrimination.

Disparate Impact Neutral policy with unequal effects.

Reasonable Accommodation Adjustments for disabilities.

ADA (Americans with Disabilities Act) Disability discrimination law.

FMLA (Family and Medical Leave Act) Job-protected leave law.

Retaliation Punishment for protected activity.

Wage & Hour

Overtime Pay Pay for hours over 40/week.

Minimum Wage Legal minimum pay.

Exempt Employee Not eligible for overtime.

Wage Theft Failure to pay proper wages.

Equal Pay Act Equal pay regardless of sex.

Business & Commercial Law Terms

Business Formation

LLC (Limited Liability Company) Hybrid entity with liability protection.

Corporation Separate legal entity with shareholders.

Partnership Shared ownership business.

Articles of Incorporation Document forming a corporation.

Operating Agreement LLC governance document.

Shareholder Agreement Agreement among shareholders.

Buy-Sell Agreement Ownership transfer plan.

Professional Corporation Entity for licensed professionals.

Contracts & Transactions

Breach of Contract Failure to perform agreement.

Force Majeure Excuse for uncontrollable events.

Liquidated Damages Pre-set damages for breach.

Specific Performance Court-ordered contract fulfillment.

Material Breach Fundamental contract failure.

Due Diligence Pre-transaction investigation.

Letter of Intent Preliminary agreement.

Purchase Agreement Contract for sale.

Escrow Third-party holding arrangement.

Indemnification Compensation for losses.

Merger Combination of companies.

Acquisition Purchase of a company.

General Legal Terms

Jurisdiction Court’s authority.

Standing Right to bring a lawsuit.

Plaintiff Party bringing a case.

Defendant Party being sued.

Cause of Action Legal basis for claim.

Statute of Limitations Filing deadline.

Res Judicata Claim preclusion doctrine.

Precedent Prior decisions guiding courts.

Due Process Right to fair procedures.

Damages Monetary compensation for harm.