Private Direct/Concierge Medicine: Complying With Medicare Regulations, State Laws, and Business Regulations

Description

Private direct healthcare practices and affiliated business models continue to be popular healthcare options. As primary care remains an area of concern for the U.S. healthcare system, and with the increase of reported primary care physician burnout, private direct practice models (often partnered with affiliated businesses) continue to garner interest.

Hospitals, businesses, and large retail healthcare businesses have implemented, or are in the process of creating, innovative primary care solutions that frequently combine plan-reimbursed services with private fee amenities beyond plan coverage. Some models incorporate employer funding and package these services as employment benefits. All these models face common compliance challenges relating to federal and state laws applicable to the delivery, and billing of, healthcare services.

Private direct practices, where the healthcare professionals wish or need to remain Medicare participatory, must carefully organize their fees and offerings as outside of Medicare coverage (and outside Medicaid coverage if Medicaid eligible are involved).

Federal and state laws prohibiting referral compensation/kickbacks also must be considered with business/healthcare practice models. Federal tax and employment laws impact how healthcare services can be packaged and delivered to employees. State insurance and consumer protection laws may impact whether private fee offerings constitute the "doing of insurance" under state insurance laws or that may overpromise services relative to capacity.

While the variety and complexity of federal and state laws may seem formidable, there are time-tested compliance solutions for all these legal challenges.

Listen as our authoritative panel provides a review of pertinent legal issues involved in organizing and operating various models of private direct healthcare practices (often referred to as concierge, direct care, integrative/functional medicine, and connected care practices) and affiliated business models, including a discussion of compliance challenges and solutions.