When Sanford V. Teplitzky joined the federal government as a lawyer in 1975, his boss asked if he'd be interested in health law. "Sure," he responded, "What's that?"
After all, the only course remotely connected to health in law school in the early 1970s at Tulane University was titled, "Psychiatry and the Law," taught -- he swears -- by a Professor Couch.
Back then, a lawyer couldn't make a living representing health-care clients. Today, a law firm is often the first stop for hospitals, doctors, insurance companies, medical laboratories and others who want to introduce new products in one of the most heavily regulated industries.
"Unfortunately, it is a fact of life," Mr. Teplitzky said in a recent interview.
This month, Mr. Teplitzky, 43, a partner in the Baltimore law firm of Ober, Kaler, Grimes & Shriver, was elected president of the National Health Lawyers Association. The group, whose membership has doubled to 6,500 over the last five years, is composed of lawyers who advise doctors and other care providers in business matters -- which can get pretty complicated with five federal agencies and a phalanx of state and local officials trying to regulate them.
The role of health care lawyers is particularly important today, as national health care reforms are debated, because they interpret and carry out ever-changing national health care rules and regulations.
"We are the people who implement the president's or Maryland's health care reforms. We are the ones who are going to do the corporate work to implement whatever is done," said Marilou M. King, executive vice president of the Washington-based association.
For instance, she said, the group's members would appear before the new Maryland commission on physician fees in Maryland during rate-setting hearings. Nationally, they would help decide how changes in health care affect federal labor laws.
Of Maryland lawyers, 260 are members of the national lawyers group, the ninth-largest membership of any state. The reason is a large regulatory practice before the federal Medicare program.
"Firms in Baltimore have been leaders in representing clients before the Health Care Financing Administration," Ms. King said. HCFA administers the federal government's $146 billion health insurance program for the elderly and disabled. Medicaid, largely run by the states, accounts for another $80 billion annually.
No one knows the size of the health-law business, but Mr. Teplitzky's career and the development of his firm's national law practice is indicative of its growth.
As a government lawyer for the former Department of Health, Education and Welfare, he wrote the regulations for the 1977 Medicare and Medicaid anti-fraud amendments. Commonly known as the anti-kickback law, it made it a felony for a health care provider to profit from a referral.
When two years later he joined Ober Kaler, Mr. Teplitzky took up a specialty in Medicare and Medicaid fraud and abuse. About 40 percent of his practice is advising clients under investigation. But the rest is what he calls preventive law -- essentially advising health care providers on how to compete in the marketplace -- offer quality care at reduced cost -- without violating the law.
Right now, for instance, the trend in Maryland and around the country is for health care providers -- doctors, hospitals, companies that manage care, and others -- to set up networks or joint ventures with each other in a bid to supply care to corporations and businesses.
But these networks and joint ventures, each containing a full complement of services to care for people from birth to death, are raising questions from federal agencies charged with policing fraud, maintaining a free market and collecting taxes.
For instance, the Inspector General's Office of the Department of Health and Human Services is raising questions about whether such practices violate the anti-kickback law; the Internal Revenue Service wants to know whether they mesh with the nonprofit status enjoyed by many of the players; the Federal Trade Commission is looking at whether these are anti-competitive; the Justice Department and HCFA, too, are asking questions.
"These agencies are saying, 'OK let's see how they really operate," Mr. Teplitzky said.
He said the public perception of doctors profiting from such networks is skewed.
Such systems "can be very effective in delivering high-quality care at a reduced price," he said.
"The issue is, how you go about it. Are there bad apples? Absolutely. But I've seen over the years that patients can benefit from lower cost and better care."
Even the "good actors," or providers who want to play by the rules, he says, have to be concerned about the very detailed rules and regulations of government. And often they succeed in bringing new services to a community.
He helps providers, for instance, such as a hospital in a rural setting that attracts an obstetrician to the community with a $10,000 bonus and gets penalized when the doctor refers patients to the hospital's new obstetrics wing.
Mr. Teplitzky was attracted to the specialty of health law precisely because it is always in a state of flux and, as a result, he can be creative and original in an area of importance to millions of people. There is little case law and "no cookie-cutter approach," he said.
Where other lawyers research the law, health care lawyers create it. "It's a more vibrant area of law. Much of what I do is being done for the first or second time," he said.
When he joined Ober Kaler in late 1979, Mr. Teplitzky was the fourth member to specialize in health care full time. Today the firm's health care practice accounts for 18 of its 130 attorneys and nearly 20 percent of its revenues.
The health care practice is three times as big as any other Baltimore firms with such specialties, Mr. Teplitzky said.
It was started by and is still largely run by another partner, Leonard C. Homer, who served as president of the national health lawyers group a decade ago.
Mr. Teplitzky said he joined Ober Kaler because of Mr. Homer's reputation and the firm's commitment of resources to health law more than a decade ago.
Last year he helped reshape the lawyers' group by making it focus on educating lawyers about their clients' industry and needs. This year, he wants to start programs to do that.
Lawyers who represent health care providers even 50 percent of the time need to know far more than corporate law, Mr. Teplitzky said. They "need to understand health care issues."