UNIVERSITY OF SOUTHERN CALIFORNIA

Sol Price School of Public Policy

SYLLABUS | Fall 2012

PPD-513: / LEGAL ISSUES IN HEALTH CARE DELIVERY
Section: / 51349D
Day and Time: / Tuesdays – 6:00pm to 9:20pm
Start/End Dates: / Tuesday October 23rd through Tuesday December 4th
Class Location: / WPH – 102
Required Text
/ Health Law: Cases, Materials and Problems
West Publishing (6th Ed. 2008), Furrow, Barry R., et al.
ISBN: 978-0-314-18474-0
Adjunct Instructor: / Ralph Oyaga, Esq., MBA
Telephone: / 661-313-4869 (cell)
213-438-5631 (office)
E-Mail: /
Office Hours: / By Appointment
Course Description

Virtually every professional engaged in the delivery, organization, or coverage of health care needs at least a basic knowledge of health law to facilitate sound clinical and business decision making, as well as to avoid potentially costly violations. To facilitate appreciation of health law as it is developing, we will consider cutting-edge issues of interest to health care providers and health care institutions alike. This course develops your leadership in the organization and delivery of health care by developing your understanding of the fundamental principles of law that affect everyone and every organization in the health care enterprise.

The course will consist of lectures, readings, presentations, and discussions. Class discussions will be based primarily on materials distributed by the Instructor, required readings and that which is presented during lecture.

It is expected that all students will actively participate in class discussions. Students are expected to read and analyze materials assigned in advance of each lecture and be prepared to discuss them. Students will be evaluated on their ability to identify and discuss legal problems and their relationship to health care management, delivery and policy.

Course Notes:

Additional resources may be provided on Blackboard, by email, or during class. As with any graduate class, in response to questions and discussion, the schedule may be modified. Your participation in email discussion well in advance of the first module will enable us to support your learning in those areas of health law that are of particular interest.

Learning Objectives
  • Gain an executive or managerial level appreciation of and comfort with the unsettled, dynamic nature of much health law and ability to use the law to facilitate positive change.
  • Identify and deal effectively with legal issues in your current and future positions in health care leadership.
  • Develop skills to analyze a health related contract from a legal perspective.
  • Develop an in-depth, working knowledge of one significant area of health law that applies to your current or intended responsibilities or interests.
Performance Evaluation

Class Preparation and Participation10%

Case Briefs20%

Contract Analysis 30%

Final Paper 40%

Course Requirements
  1. General requirements:
  2. All students are required to have email capability and should consult Blackboard and their email regularly for up-to-date information.
  3. Each written assignment is to be in 12-point Times New Roman double spaced, both margins justified, in Word format.
  4. Each assignment is to be submitted electronically in Word format to no later than the start of class on the Due date, as noted in each assignment.
  5. Each student must have a copy (electronic or hardcopy) available during class to facilitate active participation in class discussion.
  1. Initial Information – Upon registering or as soon thereafter as practicable, please email the following information to the Instructor at . Using bullet points briefly describe your own specific learning objectives for the course. Describe your career goals, and attach a resume (scheduling a 15 minute phone introductory call is highly recommended).
  1. Class Preparation and Participation (10%) – Cogent, insightful, succinct, and active class participation based on careful preparation and relevant professional experience should focus on the assigned cases (whether or not briefed) and readings, legal reasoning, health policy, and the impact of health law on the administration, delivery, and financing of care. Please share your special knowledge and experience with the class as appropriate. Note: Throughout the assigned Text, skip (i.e. do notreview or prepare) “Review Problems” unless assigned via Blackboard, by email, or in class. For Team assignments, ALL Team members must participate in assigned chapter discussion and be prepared to answer questions from classmates and instructor.
  2. Case Briefs (20%)
  3. Purpose: Briefs (1) facilitate comprehension and appreciation of case law, (2) develop skill in identifying and framing issues, (3)promote precise, self-disciplined reasoning and drafting, and (4) enable you to effectively lead class legal discussions and defend your views. Students who have prepared a brief on a particular case should be prepared to lead the class discussion of the case and its policy ramifications (along with anyone else who has prepared a brief on the same case).
  4. Due Dates – Each student is to draft four(4) case briefs of one to two pages each. Each case brief is worth 5% of your grade.
  5. Brief #1: Due Day 1. Case: Katskee v. Blue Cross/Blue Shield of Nebraska
  6. Briefs #2 and #3: Due as specified by Team assignment (see Weekly Course Schedule). Each student is to draft two case briefs analyzing two cases selected from the assigned reading materials for their Team.
  7. Brief #4: Due Day 7. Case: Self Assigned (must be different from above)
  8. Directions for Format of Case Briefs: Each brief should identify the case name and citation, e.g., Hall v. Hilbun, 466 So.2d 856 (Miss. 1985), should be divided into six parts, and should include at least the following information:
  9. Facts: A statement of the procedural facts, followed by a brief summary of the relevant evidentiary facts of the case that gave rise to the litigation.
  10. Issue: A statement clearly identifying the issue or question presented. (Is the question a question of fact or a question of law, or a mixed question of fact and law?)
  11. Rule (of Law): Succinct statement of the rule of law (common law, statutory law, or constitutional law) that expressly or impliedly governs the case. Include all the elements of the rule, ideally in your own words. If known, briefly state the reason or policy behind the rule.
  12. Analysis: Application of (all elements of) the rule of law to the facts of the case;
  13. Conclusion: Succinct statement of the conclusion, decision, or holding. Who prevailed in the litigation and what occurred procedurally as a result? Did the holding modify or extend the existing rule? Are there any significant dicta (statements of the court that are not essential to the holding)?
  14. Public Policy: Is the case wisely decided? Does the decision uphold or extend a sound health policy or public policy? Why or why not? What are the legal and policy ramifications?
  1. Recommendation: Very valuable information on legal reasoning, a discussion of the case method, directions on how to draft a brief, and a sample brief can be found in the first three steps of a free online workshop at Reviewing this information in detail prior to briefing any case will enable you to draft cogent, useful briefs and will save you a great deal of time.
  1. Contract Analysis (30%) – Due Day 5. Each student is to draft and present a paper of not less than threeand not more than seven pages analyzing a health care contract assigned by Instructor.
  2. Purpose -- The purpose of this assignment is to familiarize the student with the fundamental elements of contracts generally and with health care contracts specifically, and the basic principles of contract analysis.
  3. Details – The student should identify the contract’s parties (or type of healthcare entity) and should briefly describe the contract’s subject matter, purpose, consideration (what is being paid and what is being received for that payment), which state’s law governs the contract, and any provision regarding dispute resolution such as use of a lawsuit, arbitration or mediation. Any provisions raising a significant health policy concern may also be noted. Each student should be prepared to discusstheir analysis in class.
  1. Final Paper (40%) – Due Day 7. Each student is to draft a final paper of not less than seven pages and not more than 10 pages on a topic of significant interest to the student or the student’s employer, demonstrating an in-depth knowledge of the particular area of health law (including applicable federal and state statutory, regulatory, and case law) as well as related health policy and ethical considerations. Reference material will be recommended on an individual basis based on the topic of each student’s final paper.
  2. Law - For issues arising under federal law, special attention should be given to applicable federal statutes, regulations, and administrative interpretations, and to decisions of the U.S. Supreme Court and the 9th Circuit Court. For issues arising under state laws, those planning to pursue their careers in California should focus primarily on any California statutes, regulations, and administrative interpretations and any California cases addressing the issue, while anyone planning a career in another state may also consider any relevant authorities in that state. If appropriate the paper may compare and contrast the applicable authorities in multiple states.
  3. Topic - Topics and research materials for the final paper should be discussed in advance with the Instructor. Please propose a topic (no later than Day 3) that interests you and will be of maximum value for your present or future responsibilities. Be sure to discuss your proposed topic with Instructorin advance to assure selection of a topic that will return maximum value for your investment of time in view of your specific learning objectives for this course and your career goals.
  1. Makeup Work – Due Day 7. Due to the condensed nature of the course, absence from class is highly discouraged and should be limited to emergency situations. In such cases, student is responsible for notifying Instructor and arranging for makeup assignment. At the discretion of Instructor, make up work will be assigned.

Course Schedule: A Weekly Breakdown

Week 1 (Day 1): Tuesday October 23

Due: Brief #1: All students must brief Katskee v. Blue Cross/Blue Shield of Nebraska

Introduction to Course

Self introductions and sharing of learning objectives

Expectations and overview of syllabus

Contract Analysis Assignment

Briefs #2and #3- Team Assignments

Team Exercise: Organizational Analysis -Discussion and Report (see Appendix A)

Introduction to Health Law and Policy

Text -- Chapter 1: Introduction to Health Law and Policy -- Review and discussion of the introduction and following sections (only):

Section I. Defining Sickness

Section II. Quality in Health Care

Section III. The Problem of Medical Error

Section IV. Distributive Justice and Allocation of Health Care Resources

Section V. Public Health

Discussion:

Katskee v. Blue Cross/Blue Shield of Nebraska (there will be a general discussion on Brief drafting)

Affordable Care Act –Class discussion

Week 2 (Day 2): Tuesday October 30

Due: Brief #2 and Brief #3 for Team A

Team A / Arora, Geeta /
Chen, Kuan-Chen /
Junnarkar, Jasmine /
Meehan, Andrew, Joseph /
Quintalino, Catherine, Ann /
Tilleskjor, Sara, Ann /

Regulation of Health Care Professionals and Institutions

Text – Chapter 2: Licensing and Regulation of Health Care Professionals -- Review and discussion of the introduction and following sections (only):

Section I. Discipline

Section II. Complementary and Alternative Medicine

Section IV. Scope of Practice Regulation

Text – Chapter 3: Licensing and Regulation of Health Care Institutions – Review and discussion of the introduction and following sections (only):

Section I. New Health Care Service Configurations

Section II. Regulatory Systems (Hospitals, Nursing Homes)

Section III. Private Accreditation of Health Care Facilities

Week 3 (Day 3): Tuesday November 6

Due: Brief #2 and Brief #3 for Team B

Team B / Berg, Jeffrey, Kent /
Chu, Henry, Hao /
Kadakia, Vidhi, Nimish /
Mendoza, Eduardo, Jose /
Stein, Hilary, Beth /
Zwers, Andrew, Orion /

+ Topic for Final Paper should be selected and discussed with Instructor by today.

Health Care Costs and Access, the Emergency Medical Treatment and Labor Act (EMTALA) and The ADA

Text – Chapter 7: Health Care Cost and Access: The Policy Context – Review and discussion of the introduction and following sections (only)

Section 1. The Problem(s) (skim)

Section II. Approaches to Expanding access and Controlling Costs (skim) (discussion of legal issues presented in health care reform)

Text – Chapter 8: Access to Health Care: The Obligation to Provide Care – Review and discussion of the introduction and following sections (only)

Section 1. Common Law Approaches (introduction, only)

Section II (A). Statutory Exemptions to the Common Law – Emergency Medical Treatment and Labor Act (EMTALA)

Section II (B). Statutory Exemptions to the Common Law – ADA

Week 4 (Day 4): Tuesday November 13

Due: Brief #2 and Brief #3 for Team C

Team C / Cardona, Phillip /
Evero, Oghoghoreva, Akpezi /
Kakwani, Sahra /
Oganyan, Arpine /
Stewart, Carly, Brandt /

Due: Contract Analyses are due at the beginning of class today.

Managed Health Care – State Regulation

Text – Chapter 9: Private Health Insurance and Managed Care: State Regulation and Liability – Review and discussion of the Introduction and the following sections (only)

Section I. Insurance and Managed Care: Some Basic Concepts

Section II. Contract Liability of Private Insurers and Managed Care Organizations

Section IV. Regulation of Private Health Insurance Under State Law

Section V. State Regulation of Managed Care (Instead of Massachusetts Law, analyze using California Law) (Subsections A through D, only).

Section VII. Consumer-Directed Health Care

Managed Health Care – The Federal Role

Text – Chapter 10: Regulation of Insurance and Managed Care: The Federal Role – Review and discussion of the introduction and the following sections (only)

Section I. Introduction

Section II. The Employee Retirement Income Security Act of 1974 (ERISA) (A through E, only).

Section III. Federal Initiatives to Expand Private Ins. Coverage: HIPAA, COBRA, and ADA.

Week 5 (Day 5): Tuesday November 20

Due: Brief #2 and Brief #3 for Team D

Team D / Chadalavada, Sridhar, Choudary /
Holzner, Sandra E. /
Kashiwagi, Courtney, Kiyomi /
Oganyan, Narine /
Tailor, Ankoor, Ramesh /

Professional Relationships in the Health Care Enterprise

Text -- Chapter 12: Professional Relationships in Health Care Enterprises -- Review and discussion of the introduction and the following sections (only)

Section I. Staff Privileges and Hospital-Physician Contracts

Section II. Managed Care Contracts

Section III. Labor and Employment (Subsections A and B.1, only)

Section IV. Discrimination Law

Structure of the Health Care Enterprise

Text -- Chapter 13: The Structure of the Health Care Enterprise -- Review and discussion of the introduction and the following sections (only)

Section I. Introduction

Section II. Forms of Business Enterprises and Their Legal Consequences (This Section includes the Corporate Practice of Medicine Doctrine.)

Section III. Integration and New Organizational Structures (Subsection A, only)

Section IV. Tax-Exempt Health Care Organizations (Subsections A through C, only)

Week 6 (Day 6): Tuesday November 27

Due: Brief #2 and Brief #3 for Team E

Team E / Chang, Katherine, Hwei-Tsyr /
Ioannou, Kira /
Lowry, Scott, Clegg /
Pfendler, Shawn, Wright /
Taratikhumporn, Phanthira /

Fraud and Abuse

Text – Chapter 14: Fraud and Abuse -- Review and discussion of the introduction and the following sections (only)

Section I. A. False Claims -- Government Enforcement

Section 1.B. False Claims – Qui Tam Actions

[U.S. ex rel. Sanders v. Allison Engine Co., Inc., Case No. 1:99cv970

Us Dist. Ct. So Dist of Ohio, Western Division at Dayton]

Medicare and Medicaid Fraud and Abuse

Text – Chapter 14: Fraud and Abuse (Continued) -- Review and discussion of the introduction and the following sections (only)

Section II. Medicare and Medicaid Fraud and Abuse

Section III. The Stark Law: A Transactional Approach to Self-Referrals

[Section IV. California Business and Professions Code Sections 650, 650.1 and 650.2]

Antitrust

Text -- Chapter 15. Antitrust – Review and discussion of the introduction and the following sections (only)

Section I. Cartels and Professionalism (Subsections A and B. 1 through “Note: Physician Staff Privileges”)

Section II. Health Care Enterprises, Integration and Financing

Week 7 (Day 7): Tuesday December 4

Due: Final Paper

Public Programs: Medicare, Medicaid and S-CHIP

Text – Chapter 11: Public Health Care Financing Programs: Medicare and Medicaid -- Review and discussion of the introduction and the following sections (only)

Section 1. Introduction

Section II. Medicare

Section III. Medicaid

Section IV. State Children’s Health Insurance Program (S-CHIP)

Legal, Social and Ethical Issues

Text – Chapter 17: Legal, Social and Ethical Issues in Human Genetics -- Review and discussion of the introduction and the following sections (only)

Section I. Introduction

Section II. Legal Responses (Subsections A, B. l., C. and D., only)

Text – Chapter 18: Defining Death -- Review and discussion of the introduction and the following sections (only)

Section I. Introduction

Section III. The “Dead Donor” Rule, etc. (Beginning at p. 1398)

Section IV. Individual Choice in the Determination of Death

Summary of Class and Discussion

Health Law Reflects Diverse and Often Conflicting Perspectives:

  • Physician Perspectives
  • Hospital Perspectives
  • Payer Perspectives
  • Patient Perspectives

What is your perspective? What is your forward direction? What is next? What will you achieve?

Statement for Students with Disabilities

Any student requesting academic accommodations based on a disability is required to register with Disability Services and Programs (DSP) each semester. A letter of verification for approved accommodations can be obtained from DSP. Please be sure the letter is delivered to me (or to TA) as early in the semester as possible. DSP is located in STU 301 and is open 8:30 a.m.–5:00 p.m., Monday through Friday. Website and contact information for DSP: (213) 740-0776 (Phone), (213) 740-6948 (TDD only), (213) 740-8216 (FAX) .

Statement on Academic Integrity

USC seeks to maintain an optimal learning environment. General principles of academic honesty include the concept of respect for the intellectual property of others, the expectation that individual work will be submitted unless otherwise allowed by an instructor, and the obligations both to protect one’s own academic work from misuse by others as well as to avoid using another’s work as one’s own. All students are expected to understand and abide by these principles. SCampus, the Student Guidebook, ( or contains the University Student Conduct Code (see University Governance, Section 11.00), while the recommended sanctions are located in Appendix A.