Commonalties in Criminal and Administrative Law
Whereas this section deals with criminal law, it is important to understand the parallels between criminal and administrative law, especially because in health law most of the criminal prosecutions arise from administrative law problems. Both are related in that both are actions between the state and an individual or corporation. In criminal law, the state brings and prosecutes the case in the name of the people against the defendant. (A few states still allow private individuals to bring criminal prosecutions, but these are very infrequent and involve unusual facts.) Only criminal law proceedings can result in imprisonment as a punishment for crime. Administrative law proceedings may be initiated by the state or by an individual. An example would be a hospital petitioning a local zoning board for permission to rezone land so that it could be used for a clinic. Administrative proceeding can result in fines, various remedies such as injunctions, but cannot result in imprisonment. If an administrative agency such as the Health Care Financing Administration uncovers criminal behavior, it must take it to a prosecutor who will determine whether a criminal action will be brought.
At the federal level, criminal prosecutions are brought by the Department of Justice (DOJ). Structurally, DOJ is an executive branch agency no different from the Department of Health and Human Services (DHHS) or the other cabinet- level departments. It is headed by the Attorney General, who is a political appointee of the president, confirmed by the Senate. It is subject to the same political pressures as other agencies and it shifts its enforcement priorities with the political winds. Except for its unique powers to bring criminal charges, it operates much as DHHS, and the two interact as independent agencies. DHHS brings its own civil investigations through the Office of the Inspector General (OIG) and can demand millions of dollars in reimbursement if it finds improper claims practices. It can also refer the matter to DOJ for further investigation as a criminal matter. DOJ can bring its own investigation of the same matters, either involving OIG or not. From the perspective of a medical care practitioner, these federal investigations seem to be a seamless blend of administrative and criminal proceedings.
At the state level, criminal justice is much more fragmented. Each state has an Office of the Attorney General, which functions much like DOJ, except in many states the Attorney General is an independently elected office that is not under the control of the governor. In addition, counties have district attorneys and courts and cities have municipal courts, all of which, depending on the jurisdiction, can bring criminal charges. State administrative agencies are similarly fragmented. Some health functions, such as licensing professionals, are reserved to a state agency. Others, such as public health matters, may be divided between a state Department of Health, and city and county health agencies. There is usually limited effective cooperation between the state and the local agencies, and between the local agencies, whether administrative or criminal. In some situations, such as Medicaid—a state- administered program with substantial federal funding and oversight—investigations will involve both state, local, and federal authorities.