Source: http://www.camlawblog.com/articles/spa-legal-issues/antikickback-and-feesplitting-issues-for-integrative-medicine-clinics-and-medical-spas/print.html
Timestamp: 2018-08-20 16:08:17
Document Index: 644490117

Matched Legal Cases: ['§6500', '§6503', 'art29', '§ 29', 'art;\n4', 'art 11']

Anti-kickback and fee-splitting issues for integrative medicine clinics and medical spas : CAMLAW: Complementary and Alternative Medicine Law Blog:
Anti-kickback and fee-splitting issues can pose challenges to integrative medicine clinics and medical spas.
This is particularly true when integrative medicine clinics and medical spas, wellness centers, and other health care organizations run into corporate practice of medicine issues. The corporate practice of medicine doctrine and anti-kickback concerns (also known as self-referral or conflict of interest laws) often come together, yet confuse lawyers as well as business owners and operators.
The corporate practice of medicine doctrine prohibits corporate entities from practicing medicine or from interfering in the physician's practice of medicine. State corporate practice of medicine rules often require physicians to be housed within their own professional medical corporation, which can then contract with the integrative medicine center or medical spa.
Anti-kickback, self-referral, and fee-splitting statutes prohibit physicians from getting or giving a percentage-based referral. In other words, they cannot receive or render any fee, payment, discount, or other kind of remuneration that would essentially make it appear as though this is being given in exchange for accepting or furnishing a patient referral.
This is simple concept but difficult in practice, because the organization (medical spa, integrative care center, wellness clinic, holistic health enterprise) needs to structure its financial arrangements so that at the end of the day, it makes a profit and can also reward the physician for his or her labors, and it is difficult to do so without appearing to offer an unlawful 'kickback' if the arrangement is in way tied to patient volume.
One possible solution is to structure the arrangement as a lease, so that the physician pays fair market value for rental of space, and additionally, pays the corporate entity (center or clinic), which then acts as a medical services organization (MSO), for administrative services. The patient makes the check out to the doctor and the doctor renders a flat, monthly fee for the lease and the administrative services. The facility has to calculate the economics so that this is mutually profitable, even though it does not give the appearance of having payments flow based on patient volume.
Some states extend the anti-kickback rule / prohibition on fee-splitting to other professions, such as chiropractic, nursing, and psychology. Note New York's law which does so, while exempting massage therapists:
§6500 Introduction.
This title provides for the regulation of the admission to and the practice of certain professions. This first article applies to all the professions included in this title, except that prehearing procedures and hearing procedures in connection with the regulation of professional conduct of the profession of medicine and physician's assistants and specialist's assistants shall be conducted pursuant to the provisions of Title II-A of article two of the public health law. Each of the remaining articles applies to a particular profession. §6503 Practice of a profession.
Admission to the practice of a profession (1) entitles the licensee to practice the profession as defined in the article for the particular profession, (2) entitles the individual licensee to use the professional title as provided in the article for the particular profession, and (3) subjects the licensee to the procedures and penalties for professional misconduct as prescribed in this article (sections sixty-five hundred nine, sixty-five hundred ten, and sixty-five hundred eleven).
Just for good measure, the Rules of the Board of Regents throw in a mirror prohibition (http://www.op.nysed.gov/part29.htm#29.1):
1.	directly or indirectly offering, giving, soliciting, or receiving or agreeing to receive, any fee or other consideration to or from a third party for the referral of a patient or client or in connection with the performance of professional services;
2.	permitting any person to share in the fees for professional services, other than: a partner, employee, associate in a professional firm or corporation, professional subcontractor or consultant authorized to practice the same profession, or a legally authorized trainee practicing under the supervision of a licensed practitioner. This prohibition shall include any arrangement or agreement whereby the amount received in payment for furnishing space, facilities, equipment or personnel services used by a professional licensee constitutes a percentage of, or is otherwise dependent upon, the income or receipts of the licensee from such practice, except as otherwise provided by law with respect to a facility licensed pursuant to Article 28 of the Public Health Law or Article 13 of the Mental Hygiene Law;
: § 29.13 Special provisions for the profession of massage therapy.
a.	Unprofessional conduct in the practice of massage therapy shall include all conduct prohibited by Sections 29.1 and 29.2 of this Part, except as provided in this section, and shall also include the following:
1.	advertising not in the public interest shall include but not be limited to:
i.	using pictures depicting an unclad or undraped human form;
ii.	using any proper name under which the licensee is not registered unless it is the name of the establishment, firm, partnership, corporation, or professional limited liability partnership or corporation;
2.	nothing in this Part shall be construed to prevent a licensed massage therapist, when advertising his or her practice, from using the letters "LMT" or from identifying areas of practice, such as, but not limited to: shiatsu, acupressure, amma, bodywork, reflexology, Swedish medical massage therapy, polarity, tuina, and connective tissue massage, provided that such identified areas of practice are within the scope of practice of massage therapy as defined in Section 7805 of the Education Law.
3.	nothing in this Part shall be construed to prevent the ownership of a firm or corporation practicing massage therapy in this State by an unlicensed person or persons, or to prevent any contractual or employment arrangement between such person or persons and the professional licensee conducting such practice and computing the salary of professional employees, or the amount due the owner of such firm, partnership, or corporation on the basis of a percentage of the receipts from the performance of professional services. This provision shall apply in lieu of Section 29.1(b)(4) of this Part;
4.	the provisions of Section 29.1(b)(5) of this Part prohibiting immoral conduct shall apply in the practice of massage therapy. Massage of genital areas and massage of a client who is not properly draped for massage, or by a massage therapist who is not properly dressed, shall be considered immoral conduct;
So essentially, New York law appears to allow fee-splitting for a massage therapist, while prohibiting fee-splitting for the Title VIII professions which include: chiropractor, nurse, psychologist, and others. However, these non-physician providers do not have corporate practice of medicine issues, so it may be possible to structure the agreement between them and the health care facility more directly than the way the arrangement is structured with the physician or professional medical corporation.
One has to go state by state to determine whether the anti-kickback provisions apply more broadly than to physicians, and also note that in some states, the 'kickback' issue is distinct from an additional but related concern, that of the physician or health care practitioner having a financial interest in an entity to which he or she refers.
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