Healthcare law is a complex field that is only getting more complicated as new procedures and capabilities become available and as the American medical insurance industry evolves.
Regulated at the state and federal levels, the healthcare industry has a lot of compliance issues to deal with, and where there are compliance issues, there are paralegals. Their expertise in reviewing and translating regulations into actual practices form the backbone of insurance policies and coverage limits, not to mention laying the groundwork for creating healthcare provider policy.
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Healthcare is a massive industry, totaling almost $3 trillion in expenditures in 2015 alone and amounting to 17 percent of the U.S. economy according to Becker’s Hospital Review. With that much money flowing around, any disputes can turn into high-dollar lawsuits pretty quickly. Medical malpractice insurance companies and law firms employ many paralegals to deal with these incidents – from both sides.
Because the industry is so expansive and healthcare touches on so many aspects of modern life, there are plenty of niche areas within healthcare where paralegals can find work. These niche areas can range considerably …
- From roles that involve a lot of direct patient interaction, such as those found in medical-legal partnerships (MLP) in which legal teams actually work within a healthcare facility
- To work that is almost entirely conducted in back offices reviewing documentation, as is the case with paralegal policy analysts working for insurance companies
Paralegals Working for Hospitals, Insurers and the Law Firms That Represent Them
Health care law paralegals typically find themselves working for hospitals, insurers, or at law firms specializing in medical malpractice lawsuits or defense. They may also find themselves working for the government, in social services or for regulatory agencies like the Food and Drug Administration (FDA), or at departments such as the Centers for Disease Control and Prevention. The pharmaceutical industry also employs large numbers of paralegals, and various non-profit social services agencies have paralegals on staff to help clients with insurance and healthcare industry issues.
Even outside of court cases, paralegals in healthcare find themselves handling a lot of paperwork. Among other duties, healthcare paralegals may be responsible for:
- Reviewing insurance policy language or drafting suggested language for policies
- Working on position papers and hospital policies regarding operating procedures or patient relations, particularly regarding HIPAA regulations
- Reviewing medical records and case files
- Reviewing advertising language and marketing claims for defensibility
- Write or review employment contracts and agreements for medical staff
- Assist with contract negotiations with unions or vendors working with hospitals
- Oversee regulatory compliance matters
- Manage the legal aspects of experimental drug trials and the approval process
HIPAA, the Health Insurance Portability and Accountability Act of 1996, has also introduce a degree of complexity into the industry that demands constant legal review and input. Paralegals may not offer legal advice, but they are capable of drafting policy and reviewing practices regarding medical files and are employed to do so in many healthcare organizations and at insurance companies.
Medical Malpractice Cases
Medicine is a complex practice and it can be difficult to determine what is genuine negligence and what is simply an unfortunate but genuine mistake. According to the Civil Justice Resource Group (CJRG), the average number of deaths each year that result from medical accidents and negligence ranges somewhere between 65,000 and 200,000.
The vast difference between those two numbers tells the story of why there are so many malpractice lawsuits—when even expert analysts cannot agree on whether or not a death is attributable to accident, let alone negligence, then you know there is considerable grounds for a lawsuit.
According to Medscape, the average malpractice lawsuit settlement is $425,000. The average jury award in such cases is $1 million. The cases can take between three and five years to litigate. And in extreme cases some of the numbers are eye-popping: in 2016, a jury awarded $53 million to a woman whose son ended up with cerebral palsy as a result of mistakes made during childbirth while under the care of doctors and nurses at the University of Chicago Medical Center.
And with such a wide spread in the best estimate for the number of deaths attributable to accidents and negligence, you can bet that there are plenty of disputes and discrepancies when it comes to tracking injuries as well. For this reason, it’s no wonder that 90 percent of malpractice cases are settled without ever seeing the inside of a courtroom. When you add the risks of a large settlement to the additional costs of defense, there is a significant motivation for medical facilities – and the companies that insure them – to settle instead of trying to litigate the case in court.
But a skilled paralegal on the defendant’s side knows that settling out of court doesn’t necessarily mean making a payout. By lining up solid expert witnesses and preparing a formidable defense, malpractice defense attorneys can encourage a settlement on other terms that do not require a huge payout. Paralegals are a vital part of preparing cases like this and locating and preparing those witnesses.
Because medicine is so specialized and complex, most cases hinge on expert witness testimony. The side that has the more convincing experts will often prevail, so paralegals become skilled at assessing and coaching experts to provide effective testimony in their cases.
Like paralegals in other specialty fields, healthcare paralegals are the official keepers of the files in most cases. They are responsible for organizing, documenting, and maintaining the massive amount of paperwork involved in medical malpractice cases. Because these cases often involve working with sensitive patient information, they also need to be particularly concerned with security.
They are also typically responsible for watching case calendars to ensure that filings and responses happen within the court-mandated timelines.
Medical-Legal Partnerships Are The Next Frontier For Healthcare Paralegals
Another interesting employment opportunity for healthcare paralegals comes in the form of a recent innovation called the medical-legal partnership (MLP). Modern healthcare has become inextricably linked with state and federal laws to the point that obtaining proper care is often a matter of exerting legal rights, or taking care of legal issues to clear the way for receiving benefits.
For example, a doctor may diagnose a patient with anemia, and prescribe the usual course of treatments for that disease. But it may be that the anemia itself results from a dietary deficiency that comes from malnutrition, because the patient cannot afford a balanced diet.
In such cases, the doctor could refer the patient to the legal side of the partnership. A paralegal might work with the client to help them enroll in the federal Supplemental Nutrition Assistance Program (SNAP) to allow them to improve their diet to address the underlying issue.
Medical-legal partnership paralegals can also work with patients on issues like:
- Insurance enrollment and filing claims
- Medicare/Medicaid enrollment
- Estate planning
- Advanced directives for medical decisions (living wills)
- Facilitating giving family members power of attorney for some medical decisions
Paralegals in MLPs can also work closely with medical staff to help them recognize legal impediments to effective treatment plans. In many cases, patients may not recognize or may attempt to minimize their legal or financial difficulties. This can have a significant impact on a patient’s ability to access certain treatments. For example, studies have found that 40 percent of patients struggle to absorb the financial impact of cancer treatment, causing almost 10 percent to forgo certain types of treatment altogether.
Since patients and doctors aren’t usually familiar with assistance programs or legal options that may be available, paralegals can actually step in to provide a vital service by educating patients and effectively expanding the treatment options available to them.
Preparing For a Position as a Paralegal in Healthcare and Malpractice Law
Some paralegal training programs have a focus or specialization available in healthcare, but there are no industry-standard certifications specific to healthcare.
There are, however, a number of specialized certification options available to practicing paralegals which may touch on health care or malpractice topics.
The National Association of Legal Assistants (NALA) has a comprehensive slate of Personal Injury certifications in 8 different practice areas. Three of these are of special interest in the malpractice field:
- Entity Medical Liability
- Individual Medical Liability
- Wrongful Death
And NALS, the association for legal professionals, has specialty certification programs for personal injury, civil litigation, and insurance, each of which could touch on various health care and malpractice cases.
The direction you plan to take within the healthcare industry may dictate how you decide to prepare for your paralegal career. Medical malpractice work is very similar to other types of trial work, so finding work at a law office that specializes in litigation of any sort can help hone your skills for managing large malpractice cases.
On the other hand, if you plan to look for work with insurers or on staff at healthcare providers, a background in healthcare policy and a familiarity with industry regulations will be more helpful. Also with respect to insurance industry positions, a strong actuarial background or some familiarity with actuarial and risk calculations may be important.
Healthcare is likely to remain a booming industry for years to come and one where a paralegal can find work that will make a legitimate difference in people’s lives.