Top legal challenges in the healthcare system

healthcare system

Over the past few years, technology has revolutionized the healthcare system. Doctors are working more efficiently, and patient outcomes are improving. Healthcare information technology has transformed various processes within the healthcare industry. With AR and robotic applications, the future of healthcare is shaping in front of our eyes. However, technology also has its share of challenges. As doctors work on a unique treatment, they also face new legal challenges. 

A balancing act

Medical professionals have to balance private rights with medical decision-making. While patient autonomy is a tenet of healthcare, physicians can limit this right to fulfill their fiduciary duties. The issue becomes even more problematic when doctors are facing a healthcare crisis. Take the COVID-19 pandemic as an example. There have been several reports of patients refusing invasive mandatory testing of the virus. However, their refusal is not only endangering them, but it is also putting the general public at risk of transmission. Despite this, the patients have to respect the autonomy of the patient. 

The situation becomes even more complex in financial compensation cases for exposure to hazardous substances. In some cases, doctors do not have enough research to help patients with their claims. For example, in mesothelioma cases, the fundamental issue is that doctors do not know much about the disease. While they can diagnose a patient with mesothelioma, they cannot say when asbestos exposure occurred. Such patients have to rely on the skills of a mesothelioma attorney and hope for compensation and justice.

The modern healthcare system is a minefield of legal and ethical issues. The fundamental legal issues in healthcare relate to medical negligence, patient confidentiality, and consent. Doctors and nurses have to remain vigilant to avoid medical malpractice suits. We will consider some of these legal challenges in detail.

Antitrust issues and ACO:

Accountable Care Organizations are a conglomerate of hospitals and healthcare providers who coordinate care and deliver it at the correct time. The Medicare shared Savings Program envisions a collaborative approach towards healthcare. Ideally, this will reduce costs and improve quality. But, collaboration amongst competitors may raise antitrust issues. If ACO collaboration increases prices and lowers the quality of care, then the situation may become risky. Therefore, Antitrust Agencies have been actively enforcing antitrust laws against healthcare providers. Healthcare providers have to tread carefully or risk penalties under competition law.

False Claims Act and Whistle-blower suits: 

The False Claims Act prohibits the knowing and improper retention of overpayment of government funds. Every day, healthcare providers submit millions of claims to government healthcare bodies. However, the government cannot scrutinize them. Fortunately, whistle-blowers cases have helped to govern bodies crack down on fraud. A Louisiana sports physician got a 37-month prison sentence in a health care fraud case. However, some experts believe that the requirement to prove should be more stringent. According to them, a physician fulfills the “knowing” requirement even if they act in ignorance of the circumstances. 

HIPAA Violations: 

A patient-doctor relationship is confidential. Confidentiality helps develop trust, and patients feel more comfortable sharing their history. However, the doctor can only disclose patient information to other healthcare personnel under necessity. The Health Insurance Portability and Accountability Act (HIPAA) protects patient data and privacy. When a healthcare worker discloses patient data to third parties, the patient can file a lawsuit against them. A HIPAA violation can result in a fine of $50,000 per violation or up to 10 years in jail. In a recent case, medical informatics engineering had to pay a fine of $900,000 after a massive data breach. HIPAA also states that providers have to notify the patient about a data breach because of an online attack. Failure to do so is a HIPAA violation. Implementing HIPAA audit controls is crucial for meeting the business and technical demands of modern healthcare providers looking to establish regulatory compliance and information security. 

Informed Consent:

Healthcare providers must inform the patient about the risk, benefits, and alternatives of proposed treatment. Furthermore, the information should be clear and understandable. The patient should decide whether they want to opt for a procedure or not. This principle of informed consent is also about patient autonomy. A patient could file a lawsuit if their doctor did not obtain informed consent before proceeding with a procedure. Traditionally, parental consent is sufficient for the treatment of minors. However, the situation is complicated when doctors have to treat an unaccompanied minor. Sometimes, a healthcare professional has to weigh the ethics of beneficence with autonomy or ask a judge to rule on the matter.

Medical Malpractice:

A doctor has to uphold standards of care when they treat a patient. So they have to provide the best treatment and take necessary action to help their patient get better. Medical malpractice occurs when doctors fail to do this. According to the Medical Malpractice Centre, Americans file 15,000 malpractice suits every year. Healthcare providers can limit their liability by training the workforce and improving the standards of care.


The healthcare sector is stumbling. Rising costs and a shortage of competent healthcare professionals will undermine the quality of care. Amidst this chaos, professionals are scrambling to improve patient outcomes. Every day, healthcare professionals face several challenges. They have to follow ethical and legal standards in treatment, management, and aftercare. And as the healthcare system faces new dilemmas, the situation will worsen unless healthcare managers mitigate the risks.


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