WASHINGTON _ For lawyers who specialize in health care and
related issues, business is booming, largely as a result of the
wholesale restructuring of the health care industry.
Doctors, hospitals, insurance companies, clinics, laboratories
and drug manufacturers are repositioning themselves to make money
in a brave new world of joint ventures and managed care that
continues to evolve amid the ashes of national health care
The new business arrangements and transactions all require
lawyers: experts who understand antitrust law, tax law, insurance
law, medical malpractice, bioethics and patients' rights,
securities law, the regulation of employee benefits and
reimbursement under Medicare and Medicaid, including laws that
prohibit kickbacks, false claims and self-dealing by doctors.
"We're in the midst of one of the largest industrial
reorganizations in history, and it's a viciously competitive
environment," said Gerald Peters, a health care lawyer at Latham
Watkins in San Francisco.
Lawyers often serve as police officers, telling clients what
they can and cannot legally do, Peters said.
In the health care field, lawyers also help minimize the
financial risks and the potential for civil and criminal
liability as investigators from the Department of Health and
Human Services, the Justice Department, the Federal Trade
Commission and the IRS train their sights on this trillion-dollar
Nonprofit hospitals, for example, are often tempted to offer
lavish bonuses, gifts, interest-free loans and other incentives
to doctors whom they are trying to recruit or retain. The doctors
generate business, but if the IRS concludes that the incentives
are excessive, it may revoke a hospital's tax-exempt status, a
severe penalty. The hospital may also be legally unable to issue
tax-exempt bonds to pay for construction and for new high-tech
This is a far cry from what health law once was, said Lynn
Shapiro Snyder, a lawyer at the Washington office of Epstein,
Becker Green, whose clients include doctors and hospitals,
ambulance companies, kidney dialysis centers and retail
"Fifteen years ago, when I started in this field," she said,
"I would tell people I was a health lawyer. They would say, `You
must do malpractice.' I said, `I do everything but malpractice.'
They would say, `What else is there?' I would explain that I help
create HMOs. And I had to spell out health maintenance
organizations. But now, with all the talk about health care
reform, my friends and relatives and neighbors have a little more
understanding of what I do for a living."
President Clinton and his wife, Hillary, both have law degrees
and understood the complexities of federal-state health programs,
like Medicaid, for the poor. But the health plan devised for them
by Ira Magaziner, the coordinator of the President's Task Force
on National Health Care Reform, did not mesh with the edifice of
health care laws built over the last century.
That edifice includes the English common law of trusts, which
defined the concept of charity; the Social Security Act, passed
in 1935 and amended 30 years later to create Medicare and
Medicaid, and the Employee Retirement Income Security Act of
1974, which regulates benefits provided to employees by
The lawyers who drafted Clinton's health bill had difficulty
translating his bold, abstract concepts into the concrete
specifics needed for laws and legislation. …