Forming Physician Super Groups: Structural and Regulatory Challenges

Entity Structure, Governance, Reimbursement, Federal and State Stark Laws, Anti-Markup Rule

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

Conducted on Wednesday, August 15, 2018

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will provide a review of key legal issues involved in forming physician super groups, including applicable laws and regulations and business considerations. The panel will offer guidance on structuring practice management arrangements and selecting compensation models.


Healthcare organizations are facing increased pressure to improve quality while cutting costs. Physicians are banding together to form super groups to achieve scale to generate cost efficiencies. Physician consolidation can improve the group’s negotiating position with payors and make provisions of ancillary services possible.

However, super group formation is not without its challenges. There are structural issues and regulatory hurdles to consider when creating super groups. The parties should consider the type of entity being formed, impact on reimbursement, and Stark Law requirements.

Another consideration is the application of the Anti-Markup Rule, which prohibits a billing physician or supplier from marking up either the technical component or professional component of a diagnostic test ordered by the billing physician or supplier unless the performing physician shares a practice with the billing physician or supplier.

If the performing physician does not share a practice with the billing physician or supplier, then the rule applies; the healthcare provider/supplier cannot bill Medicare an amount that exceeds payment to the physician.

Listen as our authoritative panel examines the structural and regulatory challenges involved when forming physician super groups, including Stark and Anti-Mark-up Rule compliance and the impact of ancillary services.



  1. Structural considerations in forming a super group
    1. Due diligence
    2. Governance
    3. Entity structure
    4. Distribution of profits
  2. Regulatory challenges
    1. Federal and state Stark laws
    2. Federal Anti-Markup Rule
  3. Best practices for forming physician super groups


The panel will review these and other high priority issues:

  • What are the key legal and business concerns for physicians considering forming a physician super group?
  • What considerations should healthcare counsel weigh when selecting the appropriate legal entity for the business?
  • When and how does the Anti-Markup Rule come into play in the formation of physician super groups?


Donald H. Romano
Donald H. Romano

Of Counsel
Foley & Lardner

Mr. Romano has extensive experience counseling hospitals, skilled nursing facilities and academic medical centers and...  |  Read More

Wool, Hayden
Hayden S. Wool

Garfunkel Wild

Mr. Wool advise clients on a variety of business, regulatory and transactional issues. His practice includes the...  |  Read More

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