The Medical Law System
We often forget how much risk those in the medical field take in their daily jobs. Physicians, surgeons, and nurses, to name a few, hold the lives of their patients in balance every day. But what happens when something goes wrong, or someone makes a mistake? When such a mistake happens in the healthcare industry, it can have terrible consequences for all parties involved: the patient, the worker, and the hospital. As a result, to properly judge the issues, the medical law system was created. Today, we’ll explore how this system and its two branches, civil law (medical malpractice) and criminal law (medical fraud), work to regulate the problems of the healthcare field.
Although not as known, “medical malpractice lawsuits are a relatively common occurrence in the United States” (Bal ‘09). Medical malpractice cases can involve a wide range of issues, including misdiagnosis, surgical errors, medication errors, and birth injuries. In civil cases, patients or their families file lawsuits seeking compensation for damages caused by the malpractice. The burden of proof typically rests on the plaintiff to demonstrate that the healthcare provider's actions or omissions constituted negligence. However, the punishment for each mistake varies depending on the severity and responsibility of the worker who is charged. As a result, “medical malpractice can be a criminal act [...] depending on the healthcare practitioner’s level of negligence” (WKW ‘24). In most cases, “courts hearing medical malpractice cases will determine money damages to compensate the injured patient,” and punitive damages are rare. In fact, in 2022 alone, New York paid $551 million in medical malpractice payments.
The more dangerous issue, medical fraud, often creates different implications. Medical fraud involves deliberate deception for financial gain within the healthcare system. This could include billing for services not provided, submitting false claims, or even prescribing unnecessary treatments or medications. The FBI writes that healthcare fraud “affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year.” As a result, medical fraud can lead to significant losses for insurers, governments, and taxpayers. This comes with dangerous consequences; in Texas, “a defendant guilty of healthcare fraud will be ordered to not more than 10 years imprisonment per count, a term of supervised release, criminal fines, asset forfeiture, and a mandatory special assessment.” Regardless, it can come with lengthy jail time, more in other states.
For those going into the medical field, it is important to know the risks of what the work is. While in other industries a mistake may get you reprimanded or at the very worst fired, malpractice and fraud in the healthcare industry can hold the life of a patient in balance.
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“Oberheiden, P.C.” Federal Lawyer, 21 Dec. 2018, federal-lawyer.com/healthcare/texas/medicare/penalties/#:~:text=Pursuant%20to%20Title%2018%20of,and%20a%20mandatory%20special%20assessment. Accessed 12 June 2024.
Bieber, Christy. “Medical Malpractice Statistics of 2024.” Forbes, 10 June 2024, www.forbes.com/advisor/legal/personal-injury/medical-malpractice-statistics/#medical_malpractice_statistics_by_state_section. Accessed 12 June 2024.
Wilson Kehoe Winingham. “Criminal Medical Negligence Examples: Criminal Malpractice Cases.” WKW, 22 May 2017, www.wkw.com/indianapolis-medical-malpractice-lawyers/blog/medical-malpractice-become-criminal/#:~:text=Medical%20malpractice%20can%20be%20a,be%20charged%20with%20a%20crime. Accessed 12 June 2024.
Bal, Sonny B. “An Introduction to Medical Malpractice in the United States.” Clinical Orthopaedics and Related Research, vol. 467, no. 2, 1 Feb. 2009, pp. 339–347, www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/, https://doi.org/10.1007/s11999-008-0636-2. Accessed 12 June 2024.
“Health Care Fraud | Federal Bureau of Investigation.” Federal Bureau of Investigation, 2016, www.fbi.gov/investigate/white-collar-crime/health-care-fraud. Accessed 12 June 2024.
