KFF is an endowed nonprofit organization providing information on health issues to the nation. Broadly speaking, the Corporate Practice doctrine provides that a non-licensed person (or company) should not own or control a professional practice (such as a physician or dental practice), while fee-splitting laws prohibit professionals from sharing or dividing their fees with a non-professional in return for a referral of patients or customers. Professions and Occupations 12-36-134. Florida Statute 463.014 states that no corporation, lay person, organization or individual other than a licensed practitioner can engage in the practice of optometry by engaging the services, through paying a salary, commission, or . McDermott health lawyers contributed to the second edition of AHLA's Corporate Practice of Medicine: A 50 State Survey. Terms of Use, Disclaimer, and Privacy Policy, Strong form corporate practice of medicine doctrine. 610-701-4416. 610-701-4402. Telemedicine Ventures. In Californiaas one example, the prohibition against corporate practice of medicine imposes strict rules on contractual arrangements between physicians and non-physicians. The corporate name must end with the word "chartered" or "limited" or the abbreviation "Ltd." or with the words "Professional Corporation" or "Prof. Corp." or "P.C." PLLCs are allowed in Illinois so long as all members and managers are licensed for the same profession, including the practice of: Dentistry; Medicine . (42 USC 1320a-7a(b)(1); 42 CFR 1003.102). Board Rules. Negotiating, or assisting other counsel in negotiating, with lenders and insurance providers concerned about state law and/or corporate practice of medicine compliance. . It is important that practices are informed of these regulations from the start of their business operations to ensure they are not engaging in fraud or other illegal activities. Phone: (404) 685-1662 - Medical Practice Formation :: Atlanta Medical Practice Formation Attorney Pennsylvania's corporate practice of medicine doctrine, codified under the Medical Practice Act of 1985 (63 P.S. As we said, the prohibition is not necessarily embodied in a statute, but rather, may be expressed in cases, or, perhaps a policy statement by the state medical board. Seek assurance that there is no such requirement. The TAC developed a list of those decisions which would affect, directly or indirectly, the practice of medicine and assigned the decision making authority of those decisions to the appropriate party, i.e. Title 12. The Parent limits its stock value to a nominal amount. Because of the CPM doctrine, non-physician in California cannot owna medicalclinic or hire physicians. Additionally, if you are found guilty of commit-ting a crime, by illegally being involved in the corporate The crime is designated a felony, punished by a fine of $1,000 per violation or by imprisonment for two to five years, or both. M&A (Acquisitions & Sales of Healthcare Businesses), Fraud & Abuse (Anti-Kickback, Fee-Splitting, Stark), Management Services Organizations (MSO) Issues, Medical Device & Mobile Medical App Issues, ANTI-AGING & FUNCTIONAL MEDICINE PRACTICES, BEHAVIORAL & MENTAL HEALTHCARE PROVIDERS AND LIFE COACHES, COMPLEMENTARY & INTEGRATIVE MEDICINE PROVIDERS, CONCIERGE & DIRECT PRIMARY CARE MEDICAL PRACTICES, DIETARY SUPPLEMENT & NUTRACEUTICAL COMPANIES, HEALTHCARE FACILITIES (HOSPITALS, LABS, DME, IMAGING), Corporate practice of medicine, anti-kickback and fee-splitting: deep down the rabbit hole, Corporate practice of medicine and fee-splitting lead medical spa enforcement. In some states (for example, California), it can be a percentage of gross revenues, whereas in other states (for example, New York), the management fee, at least historically, has had to be a flat fee. The Parent can control the shareholder through an. By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law. Reg. Healthcare Facilities [Please note: Board Rules are currently being re-written to comply with changes to the Medical Practice Act that were passed by the Georgia General Assembly during the most recent legislative session and will be updated on the website as changes to the rules are passed.]. Again, regulatory authorities have a lot of enforcement discretion. This is good news if you are planning a multi-state or national model of health and wellness services, whether through physical healthcare clinic sites or digital health or mobile health (telemedicine, etc.). MSA provides that Manager may terminate at any time without cause with 30 days notice, or immediately upon the occurrence of certain specified contingencies. For that reason, the organizational language should not be contrary or incompatible with the language or intent of the statute(s) creating the Professional Corporation. States that have a strong Corporate Practice of Medicine (CPM) prohibition will likely regard it as a per se violation of Corporate Practice of Medicine for a company other than a professional medical corporation (PMC) to hire physicians. Page Last Reviewed or Updated: 05-Oct-2022, Request for Taxpayer Identification Number (TIN) and Certification, Employers engaged in a trade or business who pay compensation, Electronic Federal Tax Payment System (EFTPS), Treasury Inspector General for Tax Administration, Entities Engaged in the Corporate Practice of Medicine. Sometimes the medical board website spells it out and pulls it all together. For example, a hypothetical Professional Medical Corporation named Occupational Therapists For Everyone a Professional Medical Corporation may only provide occupational therapy services. Exclusive Decisions vested in the MSO has sole responsibility for the decision. Private equity and other nondoctor investment in U.S. health care has grown significantly over the past decade thanks to. Do not hold themselves out to the public generally as being authorized to engage in the practice of the profession for which the . The Idaho Board of Medicine's decision in 2016 to abandon COPM was a much-anticipated development, and is consistent with the trend in other states towards the derogation or outright abrogation of COPM. . Note, however, that this Issue Snapshot will focus on the Corporate Practice of Medicine by organizations formed as corporations. INSIGHTS. InNeill, the Pennsylvania Supreme Court ruled that a corporation is prohibited from engaging in the practice of optometry and may not employ optometrists for the rendering of such services to the public. The applicant must ensure that the PSC operates in a charitable manner and remains an integral part of the exempt parent holding beneficial title. ), is rooted in the Pennsylvania Supreme Court's decision in Neill v. Gimbel Brothers, Inc., 199 A. The corporate practice of medicine (CPM) rule or doctrine forbids medical management organizations (MSOs) from meddling with and effectively, directly or indirectly, control or in some way influencing, the affairs of medical practice. Compliance Issues for Consulting Fees, Honoraria, Medical Directorships, and Other Types of Remuneration. Our location is real and we are now virtually enabled to assist new long distance clients and out-of-town colleagues. Concierge Medical Practices A nuanced approached is best, and that is how our healthcare lawyers roll. ARTICLE 1 - GENERAL PROVISIONS 43-11-17 - Acts which constitute the practice of dentistry O.C.G.A. Epstein Becker Greens state licensure and corporate practice attorneys provide health care investors, companies, and physicians with a thorough and diligent review of applicable state laws, regulations, and board policies. Another risk is fee-splitting, which many states prohibit to reduce the likelihood that unnecessary medical services will be provided to maximize income. In fact, the legislative intent of each of these laws is to authorize only licensed persons to render professional services through these types of entities. And sometimes, the medical board may be more aggressive in its interpretation, signaling a strong enforcement posture to the Attorney General or District Attorney who will actually be the one prosecuting the case. Are not licensed to engage in the category of professional service for which a professional corporation was formed; and. Things are state-specific. georgia corporate practice of medicine. PSC ensures that all outstanding shares are at all times owned by a licensed physician employed by Manager or its affiliate. Bear in mind that these are simply guidelines and should not be construed as exhaustive. Compliance Issues for Consulting Fees, Honoraria, Medical Directorships, and Other Types of Remuneration. McDermott health lawyers contributed to the second edition of AHLAs Corporate Practice of Medicine: A 50 State Survey. These may include favorable income tax treatment and immunity from certain types of liability. The American Health Law Association (AHLA) Corporate Practice of Medicine survey more thoroughly examines the variation of practice restrictions by each state as they relate to behavioral health providers, chiropractors, and other types of health care professionals. Additionally, MSOs are used to navigate state "corporate practice of medicine" (CPOM) laws prohibiting non-physician-owned business entities from practicing medicine or employing licensed health care providers. The MSO structure can work very well in navigating the twin of corporate practice of medicine enforcement: the prohibition against kickbacks and fee-splitting. The challenge is that the healthcare venture managed by able healthcare entrepreneurs wants to call the shots . Please enable javascript. Digital & Mobile Health Companies Such assurance could come, for example, in the form of an opinion from the state attorney general. La. While some nurses may perform certain acts, as a rule, no medical spa should be opened without a doctor associated with it. 2. Georgia law provides a fairly typical definition of the "practice of medicine" (O.C.G.A., Section 43-34-21) as well as a prohibition against unlicensed practice of medicine (Section 43-34-22 (a)). Digital & Mobile Health Companies #healthcarelaw#healthlaw #healthlawattorney, The Newest Trend in Online Medicine: Telehealth, Cover your Assets. The first section of this article explains the constraints on ownership of medical businesses imposed by the corporate practice of medicine doctrine.The second section of the article details the role of the professional medical corporation, which is the only business entity permitted to provide medical services or employ physicians in California. To get to the prohibition against the corporate practice of medicine (or Corporate Practice of Medicine), you have to put these three sources together. Our state licensure and corporate practice attorneys have decades of combined experience in this unique area of the law, working with hundreds of clients to design, establish, counsel, and repair the legal structures necessary to permit non-licensed investors to establish and develop partnerships with licensed health care providers. Subsequent case law is sparse and other authorities provide limited guidance on the applicability of the CPOM doctrine. The MSO is paid a fee for providing these services to the medical practice, which should be fair market value and commercially reasonable for the services provided. As business opportunities abound for both licensed physicians, dentists and other licensed and non-licensed entrepreneurs and investors in the ownership and operation of medical and dental practices, ambulatory care facilities, drug treatment facilities, diagnostic testing facilities and other types of healthcare facilities, doctors and business individuals and entities must ensure that the structure of their businesses comply with their states Corporate Practice of Medicine (CPOM) doctrine. Section 33-18-17, a statute that deals with nonprofit medical service corporations, states that this statute shall not be construed as authorizing the corporate practice of medicine.. Here is a quick summary of federal self-referral (Stark law) and anti-kickback law, and California self-referral and anti-kickback / fee-splitting rules. The SCA imposes the provisions of IRC 501(c)(3) on the operation of the PSC. 3. Memo 1981-23 (1981), Corporations that employ physicians to provide medical services are engaged in the corporate practice of medicine.1 Several states restrict the practice of medicine by lay controlled corporations.2 These CPOM states. There must be no inurement to stockholders in the form of dividends or profits on transfers of their stock, distributions in the event of dissolution, or excessive compensation. Professions and Occupations. The Tennessee Ultimately, there are a variety of business structures which allow practitioners to provide professional services while being employed, partnering with, and/or engaging the services of other licensed professionals, and even creating business arrangements with non-licensees. Searchable directory of Georgia Board of Dentistry Rules and Regulations. Official Code of Georgia Annotated, Title 43, Chapters 34 and 34A (O.C.G.A. Georgia law provides a fairly typical definition of the practice of medicine (O.C.G.A., Section 43-34-21) as well as a prohibition against unlicensed practice of medicine (Section 43-34-22(a)). Carefully review the state law when performing a field examination of an entity that is engaged in CPOM. Expanded to cover a broader range of healthcare professionals, this edition contains the latest information on practice restrictions by state as they relate to behavioral health providers, dentists, chiropractors, optometrists, and more. Corporate practice of medicine laws prohibit an entity from providing medical services or employing physicians if non-physicians own it. do permit Professional Service Corporations -- a special type of corporation which must be owned by physicians -- to do so. Is your therapy an FDA-regulated medical device? The legal principle that undergirds both Tenn. Code Ann. In terms of risk mitigation, here some key legal strategies the healthcare venture can bake into its operational plan: Your healthcare lawyer can provide nuanced advice as what is good for business, often is fodder for enforcement; and conversely, what is most compliant, is often neither efficient nor profitable. Atty. 776-77 (Tenn. 2000) (corporate practice of medicine doctrine applies in Tennessee); 94-009 Op. The intent of the doctrine was to ensure that only licensed medical professionals delivered medical care and that lay persons and entities not influence treatment decisions. Corporate Practice of Medicine: A 50 State Survey. Similarly, in Allstate Insurance Company vs. Northfield Medical Center, P.C., 228 N.J. 596, 159 A.3d 412 (2017), the New Jersey Supreme Court affirmed a trial courts conclusion that a New York lawyer and a California chiropractor violated the states Insurance Fraud Prevention Act (IFPA) because they promoted and assisted in the creation of a practice structure that was designed to circumvent regulatory requirements with respect to control, ownership and direction of a medical practice.. Because providers are often paid separately for their services in the current fee-for-service environment, there is little need for the exceptions related to management, organization, or fee-splitting. in your telemedicine venture? Although most prohibit it, some have no regulatory statute at all. Corporate Practice of Medicine Health care investors and health care business companies often look to partner with physicians, dentists, optometrists, therapists, and other licensed professionals. Also, because it is allowed only to provide professional services, it can only manage the services that it provides. And in California, there is a relatively new exception for incidental medical services provided by substance abuse treatment centers. 2 These "CPOM" states. As we noted, whenever you find Corporate Practice of Medicine concerns, youre likely to also find state law prohibitions against fee-splitting, kickbacks, conflict of interest, patient exploitation, and so on. We understand the state-by-state nuances of the state laws governing licensed professional services, and we work closely with our clients through each step of their venture to ensure state licensure compliance. Providing advice to management companies and related platforms regarding state limitations on covenants not to compete and other professional employment considerations. The corporate practice of medicine, or CPOM, is a doctrine that's enshrined in many states' laws, either by statute, which is the laws on the books, or by judge-made law case law. The court concluded that the medical practice was essentially under the control of the management company and the physician was a nominal owner; thus, because the medical practice was not legitimately structured, it was not allowed to submit medical insurance claims. For example, in Virginia there is at least one Attorney General opinion that is permissive with respect to Corporate Practice of Medicine: The Virginia Attorney General concluded that Virginia statutes and court decisions allow a hospital to employ a physician as long as the employment agreement authorizes the physician to exercise control over the diagnosis and treatment of the patient, the physicians professional judgment is not improperly influenced by commercial or lay concerns, and the physician-patient relationship is not altered. There are a few exceptions to the CPOM doctrine in Pennsylvania, including practicing medicine through a professional corporation, limited liability partnership, or restricted professional company. One of the purposes of the CPM doctrine is to separate medical from business decision-making. Responding and managing internal complaints or disputes with regard to asserted noncompliance with state laws, such as a complaint made by a terminated physician or other licensed practitioner. Contact our healthcare law and FDA attorneys for legal advice relevant to your healthcare venture. Unlike the corporate practice of medicine, Florida expressly prohibits the corporate practice of optometry. OPEN SESSION Dr. Butler made a motion, seconded by Dr. Weil, to license Dr. Beirne with terms and conditions. While there often is a Corporate Practice of Medicine exception for hospitals that hire physicians, the AGs rationale in the 1995 opinion, cited above, provides a good statement of the logic behind the weak version of the prohibition against Corporate Practice of Medicine. Rev. If you are a tax-exempt entity, you will also want to ensure the compensation reflects fair market value to avoid 501(c)(3) tax issues. In order to avoid regulatory pitfalls, however, contractual MSO arrangements need to be structured carefully to ensure that . However, they can own a management entity which can serve as an administrative and non-medical, management services organization (MSO) for the clinic or medical practice, which is frequently organized as a professional medical corporation (Professional Medical Corporation). The management company controlled the day-to-day operations of the medical practice, had responsibility for all financial matters, and had the right to seize control of the practice at any time through an undated resignation letter signed by the physician. However, they can own a management entity which can serve as an administrative and non-medical, management services organization (MSO) for the clinic or medical practice, which is frequently organized as a professional medical corporation (Professional Medical Corporation). The team of experienced and proactive healthcare attorneys will work with your practice to make sure it can receive the funding needed without jeopardizing the organization. One of the benefits of getting advice from an astute healthcare lawyer is finding the right Goldilocks strategyneither too hot on the enforcement side, nor too cool on the profit side. Medical Management (MSOs) Like any other applicant, the PSC must meet the organizational and operational tests. Some medical spas are opened by nurses, believing that because you have a medical license you can do whatever you want. Medical Practice Act: Business and Professions Code Section 2052, requiring a medical license to practice medicine, and Section 2400, declaring that corporations have no professional rights, privileges, or powers. A majority of states restrict the practice of medicine and dentistry by entities that are not owned and controlled by the relevant licensed professionals. Gen. Va. 147. Medical Groups, Medical Centers For example, some applicants use employment and management agreements instead of shareholder control agreements to bind the physician shareholder to the Parent. Typically, a corporation or business main goal is to make a profit. The above are in the domain of the medical doctor and cannot be intruded upon by the MSO. Austin. The official Administrative Rules are published separately from the law and further clarify the regulations form the OCGA and are specific to the professions licensed by . In the eyes of the law, the services offered by a managed care company can blur the distinction between professional judgment and utilization review. Miami, Partner | Further to the guiding/non-exhaustive lists provided above, in these cases, there must be a clear distinction between who is providing professional services and who is providing the management services. Depending on the circumstances, these rulings may come at a state or federal level. Healthcare providers must be careful to comply with the CPOM doctrine because violating these laws could result in a providers loss of license and repayment of all revenue for billed services to patients, insurance companies and the government, as well as other fines and penalties, including potential criminal issues. Medical practices of all types are subjected to various regulations from business formation to HIPAA compliance, and everything in between. Part Two. Forming and structuring Practice Management entities, including Physician Practice Management companies, as well as Optometrist Management, Dental Management, Therapist Management, and Veterinarian Management. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. You may access the Board Rules by clicking here. Can there be a parent-subsidiary relationship if the parent does not hold title to the stock of the PSC? 422.1 et seq. In the strong form of Corporate Practice of Medicine, there is a typically a violation, whether the physicians are hired as employees or independent contractors, to provide medical services. The court examined whether the PLLC "engages in any business other than the practice of medicine," and found that it did not.11 Physical therapists are licensed, and the practice of physical therapy falls within the "practice of medicine." The arrangement did not violate the doctrine. The state-level laws governing the conduct of licensed professionals and their investors or partners may appear in general laws, criminal laws, common or judge-made law, corporate formation requirements, Attorney General opinions, professional licensing laws or rules, or even in informal announcements or contested case determinations of applicable licensing boards. WE PROVIDE LEGAL STRATEGY & REGULATORY ADVICE TO BUSINESSES THAT ACCELERATE HEALTH AND WELLNESS, Addiction Treatment Centers Corporate Practice of Medicine (CPOM) application is far from simple, and adoption and enforcement vary by state. 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