Medical Director Contracts
All contracts with any physician serving as medical director of [PROVIDER] must comply with the provisions of this manual governing vendor and physician agreements and be provided by legal counsel or his or her designee [or other person(s) selected by PROVIDER] prior to execution.
Federal and state anti-kickback and physician self referral laws prohibit the offer or payment of any compensation to any party for the referral of residents. All physician agreements shall be reviewed and approved by legal counsel prior to execution to avoid violation of federal anti-kickback or self-referrals laws. Similar state laws also may apply.
Providers may wish to include the following suggested elements in their corporate compliance policy. To comply with applicable laws regarding resident referrals, [PROVIDER]:
- Shall comply with the policies governing gift set forth in this compliance manual;
- Shall not submit nor cause to be submitted a bill or claim for reimbursement for services provided pursuant to a prohibited referral; and
- Shall not accept or solicit a referral from a physician to an entity in which the physician (or an immediate family member) has a financial relationship (broadly defined to encompass any ownership interest, investment interest, or compensation agreement) for a designated health service as defined in 42 U.S.C. Part 139nn(h)(6), except as permitted by law. Designated health services include:
- Clinical laboratory services;
- Physical therapy services;
- Occupational therapy services;
- Radiology services, including magnetic resonance imaging (MRI); computerized axia tomography (CAT) scan, and ultrasound services;
- Radiation therapy services and supplies;
- Durable medical equipment and supplies;
- Parenteral and enteral nutrients, equipment, and supplies
- Prosthetics, orthotics, and prosthetic devices and supplies;
- Home health services;
- Outpatient prescription drugs; and
- Inpatient and outpatient hospital services.
In addition, physician agreements;
- Shall be in writing;
- Shall be approved by legal counsel or his or her designee prior to execution;
- Shall be negotiated only by [legal counsel, the facility administrator, owner(s) or designees;
- Shall be signed by all parties;
- Shall, when taken as a whole, be reasonable in its entirety;
- Shall specify the terms under which compensation and any other benefits are provided, and compensation and benefits shall be consistent with the fair market value of the services provided;
- Shall specify all obligations of the parties;
- Shall not take into consideration the value or volume of referrals provided to [PROVIDER]; and
- Shall be a term of at least one year.
[PROVIDER] also shall ensure that any physician with whom an agreement is executed, and/or who serves as an attending physician in the facility, has current valid licenses as required by law and has not been excluded from participation in the Medicare and Medicaid programs.
[Note: This sample policy also addresses the topic of “physician self-referral” prohibitions, commonly known as the “Stark Law.” This topic will be covered separately in a later section of these webinar materials.]