| Parties |
- Physician
- Immediate family member of physician
- Healthcare facility or entity
- Related entities
- Person receiving (directly or indirectly) funds from state
or federal health care program
|
| Term of the Agreement |
- Minimum of one year
- Is there a termination without cause provision?
- Is there an evergreen clause?
- Is there automatic amendment / termination in case of
change in law / enforcement action?
|
| Description of Services |
- All the services provided by the parties must be specified
in the agreement
|
| Aggregate Services |
- Agreement should address all of the services provided
by the parties to each other; or
- Cross reference other agreements for services between
the parties (including immediate family members and closely
related entities)
|
| Commercially Reasonable |
- Amount of services should not exceed what is necessary
to meet the commercially reasonable business needs of the
parties
|
| Compensation |
- Aggregate compensation set in advance
- Compensation formula set in advance
- Total compensation not in excess of fair market value
- Not based on volume or value of referrals for designated
health services
- If the entity is tax exempt, and the physician is a "disqualified
person," has the procedure to establish the intermediate
sanctions fair market value presumption been followed?
|
| Referrals |
- Are there referrals between the parties?
- Evidence of intent to induce referrals?
- Requirement (directly or indirectly) to make referrals?
- Does arrangement contemplate referrals to entity owned
by one of the parties or a related entity?
- Are referrals for designated health services?
- Are referrals for services paid for (in whole or part)
by state or federal healthcare program?
|
| Billing Practices |
- Who will provide billing services?
- Have proper assignment forms been completed?
- If Medicare reassignment is occurring, is an exception
met?
- Is there potential for double B&O tax?
- How is billing service compensated?
|
| Compliance Plans |
- Do one or both parties have a compliance plan?
- Does either party need a compliance plan?
- Are there methods for physician's to ensure proper coding?
|
| Ownership Interests |
- Set at fair market value?
- Distributions proportionate to interest?
- Control proportionate to interest?
|