INTRODUCTION

Because of the ever increasing focus on how health care dollars are spent, all aspects of health care spending are hot topics, especially physician compensation based on the premise that physicians hold the keys to all of the dollars in the health care bank.

The most straight forward way to state the problem, and which understates the actual complexity of the issue, is that physicians cannot receive compensation directly or indirectly based on their referrals for medical services where those services could possibly be reimbursed by federal or state health care dollars. It sounds like a simple enough proposition but trying to implement that principle has resulted in extremely complex payment arrangements and full-time work for many an attorney.

These materials will discuss the two major federal statutory frameworks that restrict physician compensation based on referrals, the relationship of those frameworks with the Federal False Claims Act and three additional state statutory prohibitions on the payment of compensation for referrals.

To a large extent, these various statutory frameworks overlap but they each have their own idiosyncrasies and traps. In addition to those five basic statutory frameworks, these materials also discuss two other legal and regulatory matters that are important to physician compensation, namely the corporate practice of medicine doctrine and Medicare reassignment rules. These materials attempt to provide a basic discussion of the framework of the various statutory and regulatory rules, with appropriate and helpful references and citations.

next page ›››