Forming Physician Supergroups: Structural and Regulatory Challenges

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

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

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Conducted on Wednesday, January 13, 2021

Recorded event now available

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Course Materials

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

Description

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

However, supergroup formation is not without its challenges. There are structural issues and regulatory hurdles to consider when creating supergroups. The parties should consider the type of entity to form, 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 supergroups, including Stark and Anti-Markup Rule compliance and the impact of ancillary services.

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Outline

  1. Structural considerations in forming a supergroup
    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 supergroups

Benefits

The panel will review these and other high priority issues:

  • What are the critical legal and business concerns for physicians considering forming a physician supergroup?
  • What considerations should healthcare counsel weigh when selecting the appropriate legal entity for the business?
  • What are the main regulatory hurdles under Stark with forming and operating a physician supergroup?

Faculty

Goodman, Rachel
Rachel B. Goodman
Senior Counsel
Foley & Lardner

Ms. Goodman focuses on representing a wide array of clients nationally with transactional and related regulatory issues...  |  Read More

Zaitlin, Hannah
Hannah E. Zaitlin
Senior Counsel
Foley & Lardner

Ms. Zaitlan focuses on advising providers and investors in the healthcare sector on mergers, acquisitions and...  |  Read More

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