Integrated Private Practice
Jordan Saint John and Stephen D . Bittinger unlicensed persons in making these types of decisions , the medical doctor retains ultimate responsibility .
Additionally , the Board prohibits the following types of medical practice ownership and operating structures , deeming them the unlicensed practice of medicine :
• Non-physicians owning or operating a business that offers patient evaluation , diagnosis , care and / or treatment .
• Management service organizations arranging for , advertising , or providing medical services rather than only providing administrative staff and services for a physician ’ s medical practice .
• A physician acting as ‘ medical director ’ for a business providing medical procedures .
Nevertheless , even in states which are widely considered to have robust CPOM laws , such as California , it is possible to set up an integrated practice that will not run afoul of state law .
Additional Legal and Regulatory Requirements
Laws and regulations governing the healthcare arena can apply to any healthcare entity or be specific to certain programs such as Medicare . For example , the Health Insurance Portability and Accountability Act (“ HI- PAA ”) established national standards for electronic health care transactions that apply to nearly every healthcare practice . On the other hand , the federal Physician Self-Referral law applies specifically to Medicare and Medicaid . However , some states have their own versions of such laws that may be even broader than the federal version , such as applying to all healthcare payers rather than just FHPs . The regulatory schemes where an integrated practice would most likely run afoul are briefly discussed below .
Anti-Kickback and Fee-Splitting Statutes
A medical practice operating in collaboration with a non-physician practice implicates both anti-kickback and fee-splitting prohibitions . Anti-kickback laws prohibit any kind of remuneration for referrals . A “ safe harbor ” in the federal anti-kickback statute (" AKS ") is that of referring a patient to a practitioner of another specialty in return for an agreement to refer that patient back , as long as there is no remuneration or splitting of a global fee for the referral other than the compensation each practitioner receives for his / her services 5 . However , states can have their own anti-kickback laws that could be broader than the AKS and not include such a safe harbor .
Meanwhile , fee-splitting is the sharing of fees across professions for services provided to a single healthcare consumer . Fee-splitting is generally prohibited because it raises similar issues to that of CPOM laws , in that financial considerations may run counter to professional judgment . It also raises issues similar to those addressed by anti-kickback laws , in that healthcare referrals may be made for financial reasons , rather than the patient ’ s best interests .
Fee-splitting prohibitions derive from state statutes and professional licensing boards . Therefore , while prohibiting similar behavior , these laws are state specific . In Florida , for example , it is a criminal offense for a healthcare provider or facility to split fees , a practice known there as “ patient brokering .” 6 The prohibition does not apply to a group practice , but a non-physician and physician could not form a group practice in Florida , because , by statutory definition , each member of the group must provide “ substantially the full range of services which the health care provider routinely provides , including medical care , consultation , diagnosis , or treatment .” 7 However , in Florida as elsewhere , integrated practices can operate both legally and compliantly .
5 42 C . F . R . § 1001.952 ( s )
6 Fla . Stat . § 817.505 ( 1 )( a ).
7 Fla . Stat . § 456.053 ( 3 )( h )( 1 ).
TODAY ’ S PRACTICE : CHANGING THE BUSINESS OF MEDICINE 24