What is the Corporate Practice of Medicine Doctrine? Professional Medical Corporation or MSO and the level of decision making Authority the Professional Medical Corporation or MSO should exercise: exclusive, consultative, shared or joint. Self-referral, anti-kickback, and fee-splitting rules can create legal enforcement issues and must be [], Weak Corporate Practice of Medicine States & A National Strategy. 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. This ban on the corporate practice of medicine (CPM) . 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. 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. To help clarify these muddy waters, the Medical Board of California (MBC) has stepped in and created a document containing Decision Making Criteria to make sure that the Professional Medical Corporation is not contaminated by any conflict of interest which may result in a breach of his medical judgment and practice. Compensation to the physician employees must be reasonable. Providing regulatory advice and counsel to platform entities, including management companies, seeking to expand into new jurisdictions or comply with complex or difficult state regulations. If your state recognizes the corporate practice of medicine doctrine, you may need to structure your arrangement to fulfill any unique requirements applicable to your . 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. For example, some applicants use employment and management agreements instead of shareholder control agreements to bind the physician shareholder to the Parent. The PSC and the Parent should have safeguards in place to ensure that compensation of physician employees is reasonable. Unlike the corporate practice of medicine, Florida expressly prohibits the corporate practice of optometry. 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. Javascript is required to view this site. The non-physician entrepreneur dreams up the healthcare venture, gets it funded, even staffs it with the right medical doctor. has been advising physicians, dentists, and other health care professionals and their businesses as to contractual, regulatory and transactional matters for over 45 years. Professions and Occupations. do permit Professional Service Corporations -- a special type of corporation which must be owned by physicians -- to do so. You may access the Board Rules by clicking here. Pennsylvanias corporate practice of medicine doctrine, codified under the Medical Practice Act of 1985 (63 P.S. Manager approves the expenditures of the PSC. Navigating New York Laws On Corporate Practice Of Medicine. For example, a MSO may, find jobs for licensed professionals; find licensed professionals for potential employers; and manage the services of licensed professionals, including providing services to the professional for a fee, e.g., scheduling or billing. Some medical spas are opened by nurses, believing that because you have a medical license you can do whatever you want. Because of the CPOM doctrine, non-physician investors desiring to offer physician services (alone or with other services) often set up two entitiesa professional corporation that employs physicians through which physician services are furnished (often referred to as a captive PC or friendly PC), and a management services organization (MSO) that, under contract with the professional corporation, furnishes all non-physician services to the business (e.g., space, equipment, non-physician staffing, billing and collection, and other functions). Professional Medical Corporation/ Practicing Physician has no duty to consult with the MSO, even on an informal basis. Digital & Mobile Health Companies Concierge Medical Practices 178 (1938), which has not been overruled or modified in the 82 years since the original holding. PSC and Shareholder abide by terms and conditions of an SCA acceptable to Manager. As a general breakdown, the following states follow the CPOM: Arizona Arkansas California Colorado Connecticut Georgia Illinois Indiana Iowa Kansas Kentucky Louisiana Maryland Massachusetts Michigan Minnesota Montana Nevada New Jersey New York North Carolina North Dakota Ohio Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Washington West Virginia Wisconsin. The organizational test requires that a PSC include "organizational language" in an organization's articles of incorporation limiting its purposes to one or more exempt purposes, not expressly empowering it to engage in activities which are not in furtherance of one or more exempt purposes (other than as an insubstantial part of its activities), ensuring that its assets are dedicated to one or more exempt purposes on dissolution, etc. Seek assurance that there is no such requirement. KFF is an endowed nonprofit organization providing information on health issues to the nation. On a final note, according to CMB, under California Law, the following business or management decisions and activities, resulting in control over the physicians practice of medicine, should be made by a licensed California physician and not by an unlicensed person or entity: Furthermore, the types of decisions and activities described above cannot be delegated to an unlicensed person, including (for example) management service organizations. A corporation entering into a transaction for a physician's services should fully explain that any existing quality assurance, utilization review, capitation/bonus arrangement, or similar plan should not be interpreted to impede or interfere with the independent medical judgment of the physician in treating patients. 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), QUICK SUMMARY OF FEDERAL STARK SELF-REFERRAL & ANTI-KICKBACK LAW AND CALIFORNIA SELF-REFERRAL AND FEE-SPLITTING PROHIBITIONS, HOW SUBSTANCE ABUSE TREATMENT CENTERS NAVIGATE ANTI-KICKBACK RULES. Official Code of Georgia Annotated, Title 43, Chapters 34 and 34A (O.C.G.A. Medical practices of all types are subjected to various regulations from business formation to HIPAA compliance, and everything in between. An official website of the United States Government. (Business & Professions Code 2052 and 2400.). Specifically, under Pennsylvania law, only licensed physicians may be shareholders of or partners or members in, as the case may be, professional corporations, limited liability partnerships or restricted professional companies which have been formed to provide medical services. A PSC has three main hurdles to clear in passing the operational test: To meet the operational test the PSC must show that it is an integral part of a parent exempt organization.4 An organization is an integral part if it provides services for, or carries on a function for the benefit and convenience of, the parent. . A version of this article was published in The Daily Record on September 8, 2015.. The MSO may provide services used by professionals. billing and collecting on behalf of the Professional Medical Corporation. PSC ensures that all outstanding shares are at all times owned by a licensed physician employed by Manager or its affiliate. Like any other applicant, the PSC must meet the organizational and operational tests. The challenge is that the healthcare venture managed by able healthcare entrepreneurs wants to call the shots . Gen. Va. 147. And yet this same entrepreneur cant be in controlthats what the corporate practice of medicine says. Search Georgia Code. That is, it cannot provide management services to other occupational therapists. clinic, or other medical or dental facility prior to, incident to, and appropriate to the . 43-11-17 (2010) . While this innovation certainly has its benefits, businesses offering IV services must still be aware of the potential risks that come along with offering this therapy. 2d 477 (E.D. 3. About The Georgia Composite Medical Board, Frequently Asked Questions About The Board, Frequently Asked Questions about Complaints, Nurse Protocol Agreements Reviewed by the Board, Prescription Drug Monitoring Program (PDMP), Continuing Education and Other Required Training for Physicians. The above are in the domain of the medical doctor and cannot be intruded upon by the MSO. in your telemedicine venture? Most states prohibit the corporate practice of medicine, however, every state provides an exception for professional corporations Performing pre-investment evaluation and due diligence, and, where necessary, amending or restating all documents related to Friendly PC or Captive PC arrangements, including entity formation documents, management agreements, continuity agreements, employment agreements, and lending or leasing agreements. 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. This means that only 49% of those who own a practice can be non-licensed individuals. There are many benefits to operating a business in a corporate form. With the rise of private equity investments, medical practices should be mindful of their business structure and the role those without a medical license are playing in it. the colorado court of appeals ("colorado appellate court") vacated a $14,905,000 colorado medical malpractice verdict that had been reduced to $6,974,692.27 pursuant to colorado's health care availability act ("hcaa"), stating in its opinion dated october 15, 2020: "we conclude that the trial court should have dismissed the corporate negligence The statutes require that all of the ultimate beneficial owners of these entities be licensed persons. 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). Our attorneys understand the high-stakes nature of these prospective ventures and the complex interplay of legal and practical considerations, and regularly work closely with other tax and corporate advisors to ensure that management and related structures address all of their clients legal needs and practical goals. Wednesday, June 6, 2012. Concierge Medical Practices Rul. An official website of the State of Georgia. Guidelines for analyzing professional service corporation cases involving the Corporate Practice of Medicine (CPOM). The issue of noncompliant ownership structure is state driven. Developing internal policies and procedures, communication materials, job descriptions, and related internal compliance materials regarding compliance with state laws, including corporate practice and the proper role of a management organization. In the eyes of the law, the services offered by a managed care company can blur the distinction between professional judgment and utilization review. When contemplating a health care transaction between licensed health care professionals and nonprofessionals . What if every substance abuse patient is supposed to get a session with a behavioral healthcare professional, followed by a visit to the psych nurse for medication is the substance abuse center, which is owned by non-MDs, intruding into clinical practice by, in effect, setting the clinical pathway? Healthcare Facilities Neither Party May Solely Make Ultimate Decision Both the Professional Medical Corporation/ Practicing Physician and the MSO must agree when making a decision. The corporate practice of medicine doctrine (CPOM) is a complex ruling that can easily result in legal problems if not followed accordingly. (Bill) Kalogredis, Esq. The MSO should take care to leave anything that could be regarded as clinical decision-making or a clinical pathway to the healthcare provider. 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. 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. do not allow lay controlled corporations to employ physicians to provide medical services 3, but. Most states do not allow you, a licensed professional, to facilitate what is, in effect, the unlicensed practice of medicine/ podiatry. A Professional service is the personal service rendered by a physician, surgeon or doctor of medicine pursuant to a license under 481 through 524 of Title 59 of the Oklahoma Statutes, and any subsequent laws regulating the practice of medicine. To get to the prohibition against the corporate practice of medicine (or Corporate Practice of Medicine), you have to put these three sources together. Forming and structuring Practice Management entities, including Physician Practice Management companies, as well as Optometrist Management, Dental Management, Therapist Management, and Veterinarian Management. Some legal authorities . 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. Substance abuse treatment centers must steer carefully when sending patients for labs. Tenn. Code Ann. ARTICLE 1 - GENERAL PROVISIONS 43-11-17 - Acts which constitute the practice of dentistry O.C.G.A. MSA provides that Manager may terminate at any time without cause with 30 days notice, or immediately upon the occurrence of certain specified contingencies. However, if the applicant does not meet the flexible community benefit standard, denial is not necessarily indicated. rlusk@lambmcerlane.com. Lets say, for example, compounded skin care creams to treat acne? Attorney advertising. In this way, the Medical Board of California pulls together the various pieces of legislation. Again, these situations are very fact-specific. Because of the CPM doctrine, generally non-physicians in California cannot owna medicalclinic or hire physicians. The corporate practice of medicine doctrine has been shaped over the years by state statutes, regulations, court decisions, attorney general opinions and actions by state medical licensing boards. The roles played by these agreements may vary from applicant to applicant. Can you get the Priestly Blessing from your Healthcare & FDA Lawyer? Nor may they contract with a physician to have the physician provide medical services, either as an employee or an independent contractor. It cannot offer physical therapy services, speech services or any other professional services. Health care investors and health care business companies often look to partner with physicians, dentists, optometrists, therapists, and other licensed professionals. Then usually a third set of statutes that deal with who can organize and own a professional corporation. Telemedicine Ventures, Healthcare M&A: Dos and Donts of Buying or Selling a Medical Practice, Californias New Scope of Practice Law for Nurse Practitioners - Part Two, FDA Issues Warning Letter to Company that Sells CBD Products Online and Through Social Media, 5 Key Stark and Anti-Kickback Legal Rules Youll Want to Know. Work at the direction or under the supervision of those who are so licensed; and. Thus, a medical practice is not supposed to be a business that employs medical professionals but rather owned by mostly practitioners themselves. 2016 BOM Decision. Typically, a corporation or business main goal is to make a profit. The SCA imposes the provisions of IRC 501(c)(3) on the operation of the PSC. How Can a Multi-Disciplinary Health & Wellness Platform Handle Legal Risks? A good healthcare lawyer will work with your healthcare venture to help structure the business model so as to help mitigate regulatory risk. Depending on the circumstances, these rulings may come at a state or federal level. Again, regulatory authorities have a lot of enforcement discretion. Click here to view the December 1, 2020 Legal Intelligencer article. Private equity and other nondoctor investment in U.S. health care has grown significantly over the past decade thanks to. legally may provide medical services except under the supervision, control and responsibility of a licensed physician. AB 1000 significantly changed the Moscone-Knox Professional Corporations Act regarding: The types of professional corporations that may employ a physical therapist, including medical corporations; The types of professional corporations that may allow a physical therapist to have an ownership interest or serve as an officer or director; and These "corporate practice" restrictions are imposed by statute in some states, and in others by regulation or case law. In all states where the IRS has issued determinations, the IRS has received this information. 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. For example, chiropractors and nurses can be up to 49% shareholders in a Professional Medical Corporation. 4 Although meeting the integral part test suffices for the operating test, traditionally applicants have also provided or been asked to provide information to establish that they also meet the flexible community benefit standard" derived from Rev. Things are state-specific. We will be focusing on the exclusive decisions of the Professional Medical Corporation/Practicing Physician and the MSO respectively and decisions where neither party may solely make ultimate decision. The CPOM doctrine varies by each state. 2 Note, lay controlled corporations as used in this document refers to organizations controlled by laypersons, as distinguished from corporations run by physicians. To get this down on paper, the California Medical Associations Board of Trustees authorized the formation of a Technical Advisory Committee (TAC) to examine the issues surrounding the corporate practice of medicine bar and the various financial and contractual arrangements currently in place between hospitals, physicians, and other interests and to develop a response to those arrangements. Medical Spas 1990 South Bundy Drive Suite 777 Los Angeles, CA 90025 (310) 444-5244. 68-11-205 and 63-6-204 is a common law legal doctrine known as the "corporate practice of medicine" doctrine. 43-34 and 34A) is the statutory authority (law) that establishes the Georgia Composite Medical Board, the Medical Practice Act, and the Patient Right to Know Act (Physician Profile). a competing practice of medicine with Dr. Parikh . The challenge is that the healthcare venture managed by able healthcare entrepreneurs wants to call the shots. These criteria also show the slippery slope and how enforcement in other states can potentially look to find intrusion by the MSO or healthcare venture into the medical doctors domain. One of the purposes of the CPM doctrine is to separate medical from business decision-making. How you know. The prohibition on the corporate practice of medicine is grounded in public policy concerns based on the principle that when a lay corporation holds a financial interest in a physician's profits, the entity has a direct interest in and ability to control medical decision-making and impact the quality of care provided to patients. 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 . 2008), the District Court for the Eastern District of Louisiana, interpreting Pennsylvania law, found that the ability of a management company to participate in the profits of a dental practice pursuant to the parties business service agreement (which created the illegal partnership but were not severable) was akin to a partnership interest and would be precluded by the Pennsylvania CPOM doctrine. The Parent (not the shareholder) initiates all actions regarding the election and removal of the corporations board of directors. In general, a Professional Medical Corporation may only provide services in its field. Contact us online or call us today for more information on how the CPOM Doctrine impacts your existing or emerging practice. Medicare/Medi-Cal Audits, Appeals and Overpayment Disputes, Moscone-Knox Professional Corporation Act, majority of the shareholders must be licensed. 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. 3. Can a Subscription-Based Healthcare Startup Legally Deploy the RN Profitably? A majority of states restrict the practice of medicine and dentistry by entities that are not owned and controlled by the relevant licensed professionals. Whatever the medical board says on its website is a good indication of the medical boards enforcement position. By Steve Polyakov June 28, 2021, 5:57 PM EDT. Republish Approving of the selection of medical equipment and medical supplies for the medical practice. In some states, you have to read the various rules and figure out what the states position is on corporate practice of medicine. The Parents charity care policy is not sufficient. The Corporate Practice of Medicine (CPM) doctrine continues to befuddle, beleaguer, and bewilder healthcare companies seeking to venture with physicians and non-physician entrepreneurs. There are also a lot of subtle layers of influence, as California indicates on its Corporate Practice of Medicine web page, including: These are criteria that Californiaa strong corporate practice of medicine stateuses to assess whether there has been a corporate practice of medicine violation. 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 OCA, Inc. v. Hodges, 615 F. Supp. Lets just say that these are appropriate arenas for MSO involved. 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. By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law. How Can a Multi-Disciplinary Health & Wellness Platform Handle Legal Risks? For example, the Parent could negotiate the compensation, or an independent compensation committee could set compensation based on objective criteria. Ask the Parent of the applicant to provide the following written representations: The Parent's SCA with the physician shareholder is enforceable at law and in equity., The Parent will not suffer or permit the physician shareholder (together with all successors, heirs and assigns of the physician shareholder and all subsequent designees holding the corporation's stock) to financially benefit in any manner, directly or indirectly, from the physician shareholder's legal ownership of the stock of the corporation as the designee and fiduciary of the Parent., The Parent will expeditiously and vigorously enforce all its rights in the shareholder control agreement and will pursue all legal and equitable remedies to protect its interest in the assets and stock of the corporation., Carefully review all organizational documents. Although most prohibit it, some have no regulatory statute at all. 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. A nuanced approached is best, and that is how our healthcare lawyers roll. Please enable javascript. So, what it means is that only doctors can practice medicine. https://cohenhealthcarelaw.com/michaelhcohen/wp-content/uploads/2022/08/cohen-healthcare-horizontal-2020_v2.webp, Cohen Healthcare Law Group | Healthcare Lawyers | FDA & FTC Law, https://cohenhealthcarelaw.com/michaelhcohen/wp-content/uploads/2014/12/bigstock-doctor-meeting-teamwork-diagno-108851294.png. In order to avoid regulatory pitfalls, however, contractual MSO arrangements need to be structured carefully to ensure that . Business and Professions Code section 2400, within the Medical Practice Act, provides in pertinent part: Corporations and other artificial entities shall have no professional rights, privileges, or powers.. Welcome to FindLaw's Cases & Codes, a free source of state and federal court . Strong v. Weak Corporate Practice of Medicine States. State licensure laws, including fee-splitting and the Corporate Practice doctrine, can complicate that collaboration. There can, and the heart of a CPOM case is a demonstration that the PSCs physician shareholder or shareholders are subject to stringent restrictions on their activity to the point where a separate 501(c)(3) exempt organization exercises effective control in all respects over the PSC. Health Care Law, Workforce Management Lawyer, Litigation Attorney. E.g. What is the corporate practice of medicine? 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.). While some nurses may perform certain acts, as a rule, no medical spa should be opened without a doctor associated with it. Another risk is fee-splitting, which many states prohibit to reduce the likelihood that unnecessary medical services will be provided to maximize income. Atty. Under this doctrine, neither non-physicians nor lay corporations (corporations that are not medical professional corporations) nor limited liability companies (LLC) may contract to provide medical services. Limitations to the Weak Corporate of Medicine Allowance. In Californiaas one example, the prohibition against corporate practice of medicine imposes strict rules on contractual arrangements between physicians and non-physicians. 78-41. We wouldnt necessarily say that the physician has a legal duty to consult with the MSOthe physician can run his or her practice on the business with or without the MSO. While medical practice allows nurses to perform certain procedures, that doesn't mean a doctor can be relieved of their responsibilities. Corporate Practice of Medicine Exceptions. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. The physician owner had no control over any decisions made by the medical practice, nor did the physician owner appear in charge of any of the practice profits or design. Often, this language appears inconsistent when read in conjunction with the laws created to govern a Professional Corporation formed under a state's business corporation laws. 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. More below. For example, the SCA or employment agreement can be used to control the shareholders choice of board members, by providing that the shareholder can vote only as approved in advance by the Parent. Georgia and grant the right to temporary independent medical practice to them. The corporate practice of medicine doctrine therefore deduces that corporations, which employ physicians, are engaging in the practice of medicine without themselves having a medical license, 3 The assumption is made in such cases through the law of agency in which the acts of employees are attributable to the employer. And so long as the MSO does not overly interfere with the clinical duties of the medical doctors leaves a lot of room for interpretation. And in California, there is a relatively new exception for incidental medical services provided by substance abuse treatment centers. The "incapacity" of a shareholder means that a determination by a court of competent . The purposes of the PSC must meet the flexible community benefit standard, denial is not necessarily.. Past decade thanks to contemplating a health care transaction between licensed health care Law,:. Email systems use georgia.gov or ga.gov at the end of the CPM doctrine is to separate medical from decision-making... 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