Concierge Medicine: Complying With Medicare Regulations, State Laws and Anti-Kickback/Anti-Referral Laws

Recording of a 90-minute CLE webinar with Q&A

Conducted on Wednesday, October 17, 2018

Recorded event now available

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Program Materials

This CLE webinar will provide you with a review of critical legal issues involved in organizing and operating various models of concierge and direct care practices, including applicable laws and regulations. The panel will also offer guidance on evaluating and structuring such arrangements.


The popularity of concierge medicine, direct primary care, and similar approaches to personalized medical care are on the rise. Increasing numbers of healthcare providers are opting to shift away from insurance-dependent practice reimbursement models to help alleviate the stress and financial pressures common to traditional practice models. Physician interest in alternative practice models that avoid plan-related practice challenges continues to increase. And concierge and direct care pricing diversity means that these models are not just for the wealthy, but can be made affordable for a wide range of patients. Employers, hospitals, large providers, and even investors are evaluating ways to deliver healthcare outside of health insurance requirements.

Whether they are referred to as “concierge”, “membership” or “direct care” practices, these practice models can be structured in a number of different ways, and can incorporate varying integration and participation with government and commercial health plans. Each model provides unique benefits and challenges. Models where the physicians wish or need to remain Medicare participatory must carefully organize their fees and offerings as outside Medicare coverage. Models where physicians wish to formally opt out of Medicare can adopt a different approach, yet these practices are not entirely free of regulatory issues.

To the extent these models involve lay investor or business entity connections, a variety of legal issues may be implicated and must be addressed. These may include corporate practice of medicine prohibitions (CPOM), as well as federal and state payor rules, contractual issues, and anti-kickback/anti-referral laws.

Listen as our authoritative panel of healthcare attorneys explains the crucial legal and business considerations with concierge medicine, including applicable laws and regulations. The panel will offer strategies for evaluating and structuring concierge practices to meet compliance requirements.



  1. Concierge medicine—current trends
  2. Key structural and legal considerations
    1. Evaluating the models
    2. Periodic fee for enhanced or preferred access
    3. Periodic fee for access and medical services
    4. Per visit access fee
    5. Fee for non-covered services
  3. Legal considerations
    1. Medicare participation
    2. Insurance Issues
    3. State laws
    4. Anti-kickback/anti-referral/improper remuneration
    5. Contractual issues
    6. Data privacy


The panel will review these and other noteworthy questions:

  • What is driving physician interest in alternative practice models that are either less dependent on or disconnected entirely from healthcare insurance? Why are corporate interests now investing in these models, as well as in telehealth platforms and other healthcare and wellness models that seek to limit health insurance plan constraints?
  • What are the different business models for concierge and direct care practices —and the benefits and risks of each?
  • What are the primary legal and business considerations counsel to providers should consider when structuring the various models? How should providers be guided while weighing which model may work best for them, and how much to integrate their practice model with insurance plans?


Einhorn, Alan
Alan H. Einhorn

Of Counsel
Foley & Lardner

Mr. Einhorn represents provider networks, hospitals, clinics, practice groups and individuals in entity formation,...  |  Read More

Eischen, James
James J. Eischen, Jr.

McGlinchey Stafford

Mr. Eischen has 30 years’ experience representing commercial interests locally, nationally, and...  |  Read More

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