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Health Care Financing  

This research guide provides print and online sources regarding government regulation and administration of methods of financing health care.
Last Updated: Sep 7, 2014 URL: http://libraryguides.cwsl.edu/hcfinance Print Guide RSS Updates
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Scope

SCOPE: This research guide is not all-inclusive. It does, however, present resources available at the CWSL library and online regarding legal issues associated with health care financing. It is designed to provide the researcher with guidance as to the location of materials dealing with this subject. Additional research can be conducted by using the KIM system, legal periodical indexes, and other finding aids.  Access to Lexis, Westlaw, and the Internet is limited to students and faculty at CWSL.  We welcome suggestions for improvements to this and other research guides.  Please consult the Reference Librarian with suggestions and further research questions.  This research guide was originally compiled in August, 1998, and ws most recently revised in June 2010.

A NOTE ON THE INTERNET: Internet site addresses change frequently.  Accordingly, some of the sites noted throughout this research guide may no longer exist under the addresses provided.  To locate changed addresses, search for the page title using an Internet search engine such as Altavista (altavista.com), Google (google.com) or HotBot (hotbot.com).

 

 

Health Insurance

     A. General

           1.  Print Resources

Landmark: The Inside Story of America’s New Health-Care Law and What It Means for Us All.  New York:  Public Affairs, 2010.

LOCATION:  4th Floor
CALL NO.: 
KF3825 .L36 2010

 

Leonard J. Nelson, II, A Tale of Three Systems: A Comparative Overview of Health Care Reform in England, Canada, and the United States, 37 Cumb. L. Rev. 513 (2006).

 

         2.  Internet Resources

Democratic Policy Committee, The Patient Protection and Affordable Care Act (Pub. L. 111-148)  and the Health Care and Education Reconciliation Act (Pub. L. 111-152), at http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm

Kerry Capell, The French Lesson in Health Care: The Nation’s System Isn’t Quite as Superbe as Sicko Maintains, But It’s Pretty Good, Business Week, July 9, 2007, available at http://www.businessweek.com/magazine/content/07_28/b4042070.htm

      B. Fraud Detection and Prevention

          1.  Print Resources

Baumann, Linda A., edHealth Care Fraud and Abuse : Practical Perspectives, 2nd ed.  Washington, D.C. : Bureau of National Affairs, 2007.
LOCATION:  4
th Floor and Reserve (CD-ROM)
CALL NO.:  KF 3605 .H43 2007

Legal issues in health care fraud and abuse : navigating the uncertainties, 3rd ed.  Washington, DC: American Health Lawyers Association, 2006.
LOCATION:  4th Floor
CALL NO.: 
KF9368 .V35 2006

 

              2.  Internet Resources

National Health Care Anti-Fraud Association (NHCAA)
http://www.nhcaa.org/

  • This association was formed to detect and prevent health care fraud. Its web site provides links to information on membership, its officers, fact sheets, annual training conferences, and other training opportunities.

United States Department of Justice Office of the Deputy Attorney General
http://www.justice.gov/

Do a search for “health care fraud” to find articles on various DOJ projects regarding this issue.

 

United State Department of Labor : Employee Benefits Security Administration
http://www.dol.gov/ebsa/hlthcarefraud.html

  • This website includes links to policies, publications and reports from the government agency which enforces ERISA, the Employee Retirement Income Securities Act, which also governs employer-provided health care plans.

      C.  Managed Health Care

        1.  Print Resources

Managed Care Litigation.  Washington, DC:  Bureau of National Affairs, 2005.
LOCATION:  4th Floor (Book) & Reserve (CD-ROM)
CALL NO.: 
KF1184.H4 M348 2005

 

The Challenge of Regulating Managed Care.  Ann Arbor: University of Michigan Press, c2001.
LOCATION:  3rd Floor
CALL NO.: 
RA413 .C45 2001

 

Haas-Wilson, Deborah.  Managed Care and Monopoly Power:  The Anti-Trust Challenge.  Cambridge, Mass.: Harvard University Press, c2003.
LOCATION:  3rd Floor
CALL NO.: 
 RA395.A3 H32 2003

 

2.  Internet Resources


California Department of Managed Health Care
www.dmhc.ca.gov

This California State government department regulates managed health care plans and enforces relevant California laws.

 

Government Programs

    A.  Medicare

        1.  Print resources

Elaine Wong Eakin & David Lipschutz, ABCD’s of Medicare for Low-Income Beneficiaries.  42 Clearinghouse Rev. 569 (2009).

Medicare and Medicaid Fraud and Abuse.  St. Paul, MN:  Thomson/West, c2003.
LOCATION:  4th Floor
CALL NO.: 
KF3608.A4 J67 
[Also available through Westlaw for subscribers.]

Guide to Medicare Decision-Making and Appeals.  Chicago: American Bar Association, Section of Administrative and Regulatory Practice, c2002.
LOCATION:  4th Floor
CALL NO.: 
KF3608.A4 G85 2002  

           2.  Internet Resources  

Medicare
http://www.medicare.gov/

  • “The Official U.S. Government Website for People with Medicare.”  Information about coverage, billing, appeals, supplemental insurance plans and prescription drug coverage.

Healthcare spending and the Medicare program. Available through our catalog at
http://kim.cwsl.edu/record=b1165118.

  • A 2004 report from the Medicare Payment Advisory Commission.

U.S. Department of Health and Human Services: Centers for Medicare and Medicaid Services.
http://www.cms.hhs.gov/

  • This federal agency is responsible for administering Medicare, Medicaid, and Child Health Insurance Programs. Its homepage provides links to information on Medicare, Medicaid, publications, statistics, and laws and regulations.

National Library of Medicine – Medline Plus
http://www.nlm.nih.gov/medlineplus/medicare.html

  • Medline/PubMed’s links to recent articles published on PubMed dealing with Medicare.

       B.  Medicaid

         1.  Print Resources

Medicare and Medicaid Fraud and Abuse.  St. Paul, MN:  Thomson/West, c2003.
LOCATION:  4th Floor
CALL NO.: 
KF3608.A4 J67 
[Also available through Westlaw for subscribers.]

Leighton Ku & Fouad Pervez, Documenting citizenship in Medicaid: the struggle between ideology and evidence, 35 Journal of Health Politics, Policy and Law 5 (2010)
LOCATION:  3rd Floor Periodicals

              2.  Internet Resources

Medi-Cal
http://www.medi-cal.ca.gov/

  • This site provides links to the Family P.A.C.T. (Planning, Access, Care and Treatment) program, provider and billing information, news releases and Medi-Cal Publications.

U.S. Department of Health and Human Services: Centers for Medicare and Medicaid Services.
http://www.cms.hhs.gov/

  • This federal agency is responsible for administering Medicare, Medicaid, and Child Health Insurance Programs. Its homepage provides various links including links to information on Medicare, Medicaid, publications, statistics, and laws and regulations.

U.S. Government Accountability Office, Transfers of assets by elderly individuals to obtain long-term care coverage : report to congressional requesters (2005), at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=gao&docid=f:d05968.pdf

 

Health Savings Accounts

     A.  Print Resources

Adam Larson, The Promises and Pitfalls of Health Savings Accounts, 18 Annals of Health Law 119 (2009)
LOCATION:  4th Floor
CALL NO.: 
KF3821.A15 A56 

 

Rubin, Beth L.  HIPAA and employer group health plans : nothing is simple.  Washington, D.C. : American Health Lawyers Association, c2003.
LOCATION:  4
TH Floor
CALL NO.: KF3515.3.Z9 R83 2003

 

       B.  Internet Resources

 

United States Department of Labor Bureau of Labor Statistics
http://www.bls.gov/opub/cwc/cm20031022ar01p1.htm

  • This site provides an explanation of various employer-provided health spending account programs, as well as a table of the laws creating each.

 

Council for Affordable Health Insurance, Answering Your Questions About Health Savings Accounts (2004), at http://www.cahi.org/cahi_contents/resources/pdf/n125HSAQuestions.pdf

 

Lexis-Nexis & Westlaw

These resources are available only to CWSL students and faculty.  Both services are quite extensive, but a few databases and files that are especially relevant to this area have been noted below.  Please consult the directories for these services, available at the Reference Desk or online, for more complete information regarding coverage.  If you have questions about accessing these services, please see a Reference Librarian.

A.  Lexis-Nexis

Relevant files on Lexis-Nexis include:

  • Federal and state cases, codes and administrative regulations dealing with health and health care.
  • Managed Care Business Week

·         BNA Medicare Report

·         Medicare Monthly

·         Medicaid Monthly

·         Health & Human Services Departmental Appeals Board Decisions

·         Managed Care Liability:  Mealey’s Litigation Report

·         Consumer Reports on Health

·         Inside CMS

·         Healthcare Financial Management

·         Social Security Cases and Court Rulings

      B.  Westlaw

Westlaw has a number of useful Health Care Financing resources, many of which are also carried by Lexis.  Westlaw resources include:

  • Federal and state cases, codes and administrative regulations dealing with health and health care.
  • Health and Human Services decisions [FHTH-HHS]
  • Health Care Financing Administration rulings [FHTH-HCFA]
  • Journal of Health Care Law and Policy [JHTHCLP]
  • Yale Journal of Health Policy, Law and Ethics [YJHPLETH]
  • Health Care Fraud [HTHCRFRD]
  • Health Industry Today [HEINDTDY]
  • New England Journal of Medicine [NEWENGJMED]
  • Social Security Bulletin [SSBULL]
  • Social Security Claims and Procedure [SSCLP]
  • Social Security Disability Practice [SSDISP]

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