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ClearLaw is a healthcare compliance platform built by experienced healthcare attorneys. We cover federal and state laws applicable to physician practices, direct primary care (DPC) practices, and health technology companies — written in plain English with primary source citations.
The Anti-Kickback Statute prohibits knowingly and willfully offering, paying, soliciting, or receiving anything of value to induce or reward referrals of items or services covered by federal healthcare programs including Medicare and Medicaid. Applies to physicians, DSOs, ASCs, behavioral health practices, digital health companies, and any entity billing federal healthcare programs. Safe harbors are codified at 42 C.F.R. § 1001.952 and include employment, personal services, space rental, and value-based arrangements. Violations are felonies carrying up to 10 years imprisonment and $100,000 per violation.
The Stark Law prohibits physicians from referring Medicare and Medicaid patients for designated health services (DHS) to entities in which they or their immediate family members have a financial relationship, unless a specific exception applies. Unlike the Anti-Kickback Statute, Stark is a strict liability law — intent is not required. Key exceptions include the Bona Fide Employment Exception (42 C.F.R. § 411.357(c)), In-Office Ancillary Services Exception (42 C.F.R. § 411.355(b)), and Personal Services Arrangement Exception (42 C.F.R. § 411.357(d)). Penalties include denial of payment, refund of amounts collected, and civil monetary penalties up to $15,000 per claim.
HIPAA establishes national standards for protecting individually identifiable health information (PHI). Covered entities — health plans, healthcare clearinghouses, and providers who transmit health information electronically — must comply with the Privacy Rule (45 C.F.R. Part 164), Security Rule (45 C.F.R. §§ 164.302–164.318), and Breach Notification Rule (45 C.F.R. §§ 164.400–164.414). Business Associate Agreements (BAAs) are required before sharing PHI with vendors. Applies to physician practices, DPC practices (if they transmit PHI electronically), digital health companies acting as business associates, dental practices, and behavioral health providers.
The False Claims Act imposes civil liability on any person who knowingly submits false or fraudulent claims to the federal government, including Medicare and Medicaid. Civil penalties range from $13,946 to $27,894 per false claim plus treble damages (2024 amounts per 28 C.F.R. § 85.5). The qui tam whistleblower provision allows private individuals to file suit on the government's behalf and receive 15–30% of recovery. The 60-day overpayment rule (42 U.S.C. § 1320a-7k(d)) requires return of identified Medicare and Medicaid overpayments within 60 days or the retained amount becomes a reverse false claim.
The Corporate Practice of Medicine doctrine prohibits non-physician corporations from employing physicians or controlling medical practice decisions. CPOM is a state law doctrine that varies significantly by jurisdiction. Strong CPOM states include California (Cal. Bus. & Prof. Code §§ 2052, 2400), Texas (Tex. Occ. Code § 165.156), New York (N.Y. Educ. Law §§ 6522, 6527), and Illinois (225 ILCS 60/22.2). The standard compliance structure is the Professional Corporation / Management Services Organization (PC/MSO) model, where a physician-owned PC provides clinical services and a non-physician MSO provides administrative services under a Management Services Agreement.
The Affordable Care Act explicitly excludes qualifying direct primary care arrangements from the definition of health insurance coverage, allowing DPC practices to operate without federal insurance licensure. Requirements: services must be primary care only; the provider must be a licensed primary care physician; the monthly fee must not exceed $150 per individual (indexed for inflation). DPC practices that treat Medicare beneficiaries must either opt out of Medicare under 42 C.F.R. § 405.435 or bill Medicare fee-for-service. HSA compatibility with DPC arrangements remains unsettled — the IRS issued a proposed rule in 2020 (85 Fed. Reg. 68,752) that has not been finalized.
Physicians providing telehealth services must be licensed in the state where the patient is physically located at the time of service. The Interstate Medical Licensure Compact (IMLC) provides an expedited licensure pathway in 40+ member states — California, New York, and Massachusetts do not participate. The Ryan Haight Act (21 U.S.C. § 831) generally requires an in-person evaluation before prescribing controlled substances via telemedicine, with exceptions currently under DEA rulemaking. COVID-19 PHE telehealth flexibilities expired May 11, 2023, with congressional extensions through December 31, 2024.
Alabama prohibits the corporate practice of medicine under Ala. Code §§ 34-24-50 to 34-24-75. NPs require a collaborative practice agreement with a supervising physician (Ala. Code § 34-21-81). Alabama has not enacted a specific DPC enabling statute — practices should seek guidance from the Alabama Department of Insurance before launching DPC arrangements.
Alaska prohibits corporate practice of medicine under Alaska Stat. §§ 08.64.010–08.64.380. Alaska is a full NP practice authority state — NPs may practice and prescribe independently (Alaska Stat. § 08.68.850). Alaska enacted DPC enabling legislation under Alaska Stat. §§ 21.07.010–21.07.090, explicitly providing that DPC agreements are not insurance and are exempt from Alaska Division of Insurance regulation.
Arizona prohibits corporate practice of medicine under Ariz. Rev. Stat. §§ 32-1401 to 32-1493. Arizona is a full NP practice authority state (Ariz. Rev. Stat. § 32-1606). Arizona enacted DPC enabling legislation under Ariz. Rev. Stat. §§ 20-3151 to 20-3157, exempting qualifying DPC arrangements from Arizona Department of Insurance regulation.
Arkansas prohibits corporate practice of medicine under Ark. Code Ann. §§ 17-95-101 to 17-95-411. NPs require collaborative practice agreements (Ark. Code Ann. § 17-87-310). Arkansas enacted DPC enabling legislation under Ark. Code Ann. §§ 23-99-501 to 23-99-508, exempting qualifying DPC arrangements from Arkansas Insurance Department regulation.
California has the nation's strongest Corporate Practice of Medicine doctrine (Cal. Bus. & Prof. Code §§ 2052, 2400). Corporations cannot employ physicians — the PC/MSO structure is required. California's anti-kickback law (Cal. Bus. & Prof. Code § 650) applies to all payers with no AKS-equivalent safe harbors. California NPs received full practice authority in 2023 after completing a 3-year/4,600-hour transition period (Cal. Bus. & Prof. Code § 2835.7). DPC practices are exempt from Knox-Keene Act licensure under Cal. Health & Safety Code § 1349.6 if monthly fees do not exceed $1,000 per individual. Anti-markup rules prohibit charging patients more than outside labs charge (Cal. Bus. & Prof. Code § 654.2). California's Confidentiality of Medical Information Act (CMIA, Cal. Civ. Code §§ 56–56.37) provides a private right of action and is stricter than HIPAA.
Colorado prohibits corporate practice of medicine under Colo. Rev. Stat. §§ 12-240-101 to 12-240-140. Colorado is a full NP practice authority state (Colo. Rev. Stat. § 12-255-112). Colorado enacted DPC enabling legislation under Colo. Rev. Stat. §§ 10-16-107.4 to 10-16-107.5. Colorado has a strong telehealth parity law requiring commercial insurers to cover telehealth services (Colo. Rev. Stat. § 10-16-123).
Connecticut prohibits corporate practice of medicine under Conn. Gen. Stat. §§ 20-8 to 20-12j. NPs received full practice authority in 2023 after 2 years/2,000 hours supervised experience (Conn. Gen. Stat. § 20-87a). Connecticut has not enacted a DPC-specific enabling statute — practices should seek guidance from the Connecticut Insurance Department before launching DPC.
Delaware prohibits corporate practice of medicine under Del. Code Ann. tit. 24, §§ 1700–1795. Delaware is a full NP practice authority state (Del. Code Ann. tit. 24, § 1902(c)). Delaware enacted DPC enabling legislation under Del. Code Ann. tit. 18, §§ 6401–6406, exempting qualifying DPC arrangements from Delaware Insurance Department regulation.
Florida's corporate practice of medicine restrictions are largely dismantled — group practice registration is required under Fla. Stat. § 458.348 but there is no broad corporate prohibition. Florida's Patient Self-Referral Act (Fla. Stat. § 456.053) applies to all payers, broader than federal Stark. Florida's Anti-Kickback Statute (Fla. Stat. § 456.054) and Patient Brokering Act (Fla. Stat. § 817.505) prohibit referral fees for all payers. DPC practices are exempt from insurance regulation under Fla. Stat. § 627.419(6). Florida's telehealth statute (Fla. Stat. § 456.47) permits out-of-state provider registration with DBPR. NPs require physician protocol agreements for prescribing — Florida is not a full practice authority state.
Georgia prohibits corporate practice of medicine under O.C.G.A. §§ 43-34-1 to 43-34-48. NPs require physician protocol agreements for prescribing (O.C.G.A. § 43-34-25). Georgia enacted DPC enabling legislation under O.C.G.A. §§ 33-20A-1 to 33-20A-7, exempting qualifying DPC arrangements from Georgia Insurance Commissioner regulation.
Illinois codifies the Corporate Practice of Medicine prohibition at 225 ILCS 60/22.2, with CPOM participation explicitly listed as a ground for physician license discipline. The landmark case Berlin v. Sarah Bush Lincoln Health Center, 688 N.E.2d 106 (Ill. 1997) confirmed Illinois courts void MSAs where physician control is illusory. Fee-splitting is prohibited under 225 ILCS 60/22.2(22). Illinois enacted DPC enabling legislation under 215 ILCS 5/155.50, exempting qualifying DPC arrangements from Illinois Department of Insurance regulation. NPs require physician collaboration (225 ILCS 65/65-40).
Indiana prohibits corporate practice of medicine under Ind. Code §§ 25-22.5-1-1 to 25-22.5-11-5. NPs require physician collaboration for prescribing (Ind. Code § 25-23-1-19.4). Indiana enacted DPC enabling legislation under Ind. Code §§ 27-1-2.5-1 to 27-1-2.5-7.
Iowa prohibits corporate practice of medicine under Iowa Code §§ 148.1–148.12. Iowa is a full NP practice authority state (Iowa Code § 152.1). Iowa enacted DPC enabling legislation under Iowa Code §§ 514F.1–514F.6.
Kansas prohibits corporate practice of medicine under Kan. Stat. Ann. §§ 65-2801 to 65-2899. Kansas is a full NP practice authority state (Kan. Stat. Ann. § 65-1130). Kansas enacted DPC enabling legislation under Kan. Stat. Ann. §§ 40-4901 to 40-4905.
Kentucky prohibits corporate practice of medicine under Ky. Rev. Stat. Ann. §§ 311.530–311.620. NPs require physician collaborative practice agreements (Ky. Rev. Stat. Ann. § 314.042). Kentucky enacted DPC enabling legislation under Ky. Rev. Stat. Ann. §§ 304.17D-010 to 304.17D-050.
Louisiana prohibits corporate practice of medicine under La. Rev. Stat. Ann. §§ 37:1261–37:1290. NPs require collaborative practice agreements (La. Rev. Stat. Ann. § 37:913). Louisiana enacted DPC enabling legislation under La. Rev. Stat. Ann. §§ 22:1045.1–22:1045.5.
Maine prohibits corporate practice of medicine under Me. Rev. Stat. Ann. tit. 32, §§ 3270–3282. Maine is a full NP practice authority state (Me. Rev. Stat. Ann. tit. 32, § 2102-A). Maine enacted DPC enabling legislation under Me. Rev. Stat. Ann. tit. 24-A, §§ 4324–4326.
Maryland has limited CPOM restrictions — corporations may employ physicians with fewer constraints than in California or Texas (Md. Code Ann., Health Occ. § 14-101 et seq.). Maryland is a full NP practice authority state. Fee-splitting remains prohibited under Md. Code Ann., Health Occ. § 14-404(a)(22). Maryland enacted DPC enabling legislation under Md. Code Ann., Ins. §§ 15-150 to 15-154.
Massachusetts prohibits corporate practice of medicine under Mass. Gen. Laws ch. 112, §§ 1–12G. NPs received full practice authority effective January 1, 2021 after 2 years supervised experience (Mass. Gen. Laws ch. 112, § 80B). Massachusetts has not enacted a DPC-specific enabling statute — regulatory risk is significant under Mass. Gen. Laws ch. 176G (HMO Act). Massachusetts AG actively investigates PE-backed healthcare consolidation.
Michigan prohibits corporate practice of medicine under Mich. Comp. Laws §§ 333.16101–333.18838. Michigan is a full NP practice authority state (Mich. Comp. Laws § 333.17210). Michigan enacted DPC enabling legislation under Mich. Comp. Laws §§ 500.3801–500.3822.
Minnesota prohibits corporate practice of medicine under Minn. Stat. §§ 147.001–147.37. Minnesota is a full NP practice authority state (Minn. Stat. § 148.235). Minnesota enacted a comprehensive noncompete ban effective July 1, 2023 — physician noncompetes are void and unenforceable (Minn. Stat. § 181.988). Minnesota enacted DPC enabling legislation under Minn. Stat. §§ 62Q.81–62Q.83.
Mississippi prohibits corporate practice of medicine under Miss. Code Ann. §§ 73-25-1 to 73-25-94. NPs require collaborative practice agreements (Miss. Code Ann. § 73-15-20). Mississippi enacted DPC enabling legislation under Miss. Code Ann. §§ 83-9-261 to 83-9-267.
Missouri prohibits corporate practice of medicine under Mo. Rev. Stat. §§ 334.010–334.750. NPs received full practice authority in 2021 after 2 years/3,600 hours collaborative experience (Mo. Rev. Stat. § 335.019). Missouri DPC legislation status should be verified with the Missouri Department of Commerce and Insurance.
Montana prohibits corporate practice of medicine under Mont. Code Ann. §§ 37-3-101 to 37-3-345. Montana is a full NP practice authority state (Mont. Code Ann. § 37-8-202). Montana enacted DPC enabling legislation under Mont. Code Ann. §§ 33-22-2001 to 33-22-2006.
Nebraska prohibits corporate practice of medicine under Neb. Rev. Stat. §§ 38-101 to 38-2107. Nebraska is a full NP practice authority state (Neb. Rev. Stat. § 38-2317). Nebraska enacted DPC enabling legislation under Neb. Rev. Stat. §§ 44-8701 to 44-8707.
Nevada prohibits corporate practice of medicine under Nev. Rev. Stat. §§ 630.001–630.400. Nevada is a full NP practice authority state (Nev. Rev. Stat. § 632.017). Nevada enacted DPC enabling legislation under Nev. Rev. Stat. §§ 695K.010–695K.070.
New Hampshire prohibits corporate practice of medicine under N.H. Rev. Stat. Ann. §§ 329:1–329:32. New Hampshire is a full NP practice authority state (N.H. Rev. Stat. Ann. § 326-B:10). New Hampshire enacted DPC enabling legislation under N.H. Rev. Stat. Ann. §§ 420-P:1–420-P:6.
New Jersey has a relatively permissive CPOM doctrine — corporations may employ physicians in certain circumstances (N.J. Stat. Ann. § 45:9-6). Fee-splitting remains strictly prohibited (N.J. Stat. Ann. § 45:9-22.1). New Jersey is a full NP practice authority state (N.J. Stat. Ann. § 45:11-54). New Jersey has not enacted a DPC-specific enabling statute — practices should seek guidance from the New Jersey Department of Banking and Insurance before launching DPC.
New Mexico prohibits corporate practice of medicine under N.M. Stat. Ann. §§ 61-6-1 to 61-6-35. New Mexico is a full NP practice authority state (N.M. Stat. Ann. § 61-3-23.2). New Mexico enacted DPC enabling legislation under N.M. Stat. Ann. §§ 59A-61-1 to 59A-61-7.
New York has one of the nation's strictest CPOM doctrines under N.Y. Educ. Law §§ 6522, 6527 and N.Y. Bus. Corp. Law § 1503 — only Professional Service Corporations owned by licensed physicians may provide medical services. Fee-splitting is prohibited under N.Y. Educ. Law § 6531 and N.Y. Penal Law § 180.03. NPs received full practice authority in 2023 after 3,600 hours supervised experience (N.Y. Educ. Law § 6902). New York has not enacted DPC enabling legislation — significant regulatory risk exists under N.Y. Ins. Law § 1101 and N.Y. Pub. Health Law Article 44. New York's False Claims Act (N.Y. State Fin. Law §§ 187–194) is among the most aggressively enforced in the nation.
North Carolina prohibits corporate practice of medicine under N.C. Gen. Stat. §§ 90-1 to 90-21.38B. NPs received full practice authority effective January 1, 2023 (N.C. Gen. Stat. § 90-18.2). North Carolina enacted DPC enabling legislation under N.C. Gen. Stat. §§ 58-3-295 to 58-3-297.
North Dakota prohibits corporate practice of medicine under N.D. Cent. Code §§ 43-17-01 to 43-17-41. North Dakota is a full NP practice authority state (N.D. Cent. Code § 43-12.1-09). North Dakota broadly prohibits noncompete agreements — physician noncompetes are void (N.D. Cent. Code § 9-08-06). North Dakota enacted DPC enabling legislation under N.D. Cent. Code §§ 26.1-52-01 to 26.1-52-06.
Ohio prohibits corporate practice of medicine through physician license discipline under Ohio Rev. Code Ann. § 4731.22(B)(18). NPs require standard care arrangements with collaborating physicians (Ohio Rev. Code § 4723.431). Fee-splitting is prohibited under Ohio Rev. Code § 4731.65. Ohio enacted DPC enabling legislation under Ohio Rev. Code Ann. §§ 1751.70–1751.73.
Oklahoma prohibits corporate practice of medicine under Okla. Stat. tit. 59, §§ 480–513. Oklahoma is a full NP practice authority state (Okla. Stat. tit. 59, § 567.3a). Oklahoma broadly prohibits physician noncompetes (Okla. Stat. tit. 15, § 219A). Oklahoma enacted DPC enabling legislation under Okla. Stat. tit. 36, §§ 6541–6548.
Oregon prohibits corporate practice of medicine under Or. Rev. Stat. §§ 677.010–677.990. Oregon is a full NP practice authority state (Or. Rev. Stat. § 678.370). Oregon enacted DPC enabling legislation under Or. Rev. Stat. §§ 735.500–735.520.
Pennsylvania prohibits corporate practice of medicine under 63 Pa. Stat. Ann. §§ 422.1–422.51a. NPs require physician collaborative agreements (63 Pa. Stat. Ann. § 422.49a). Fee-splitting is prohibited under 63 Pa. Stat. Ann. § 422.41. Pennsylvania enacted DPC enabling legislation under 40 Pa. Stat. Ann. §§ 4601–4607.
Rhode Island prohibits corporate practice of medicine under R.I. Gen. Laws §§ 5-37-1 to 5-37-18. Rhode Island is a full NP practice authority state (R.I. Gen. Laws § 5-34-49). Rhode Island has not enacted DPC enabling legislation — practices should seek guidance from the Rhode Island Insurance Division before launching DPC.
South Carolina prohibits corporate practice of medicine under S.C. Code Ann. §§ 40-47-5 to 40-47-200. NPs require physician practice agreements (S.C. Code Ann. § 40-33-34). South Carolina enacted DPC enabling legislation under S.C. Code Ann. §§ 38-91-10 to 38-91-80.
South Dakota prohibits corporate practice of medicine under S.D. Codified Laws §§ 36-4-1 to 36-4-63. South Dakota is a full NP practice authority state (S.D. Codified Laws § 36-9A-12). South Dakota enacted DPC enabling legislation under S.D. Codified Laws §§ 58-41A-1 to 58-41A-6.
Tennessee prohibits corporate practice of medicine under Tenn. Code Ann. §§ 63-6-101 to 63-6-243. NPs received full practice authority effective July 1, 2023 after 3 years/3,000 hours collaborative experience (Tenn. Code Ann. § 63-7-123). Fee-splitting is prohibited under Tenn. Code Ann. § 63-6-225. Tennessee enacted DPC enabling legislation under Tenn. Code Ann. §§ 63-1-501–63-1-504, explicitly providing that DPC agreements are not insurance and are not subject to Tennessee Department of Commerce and Insurance regulation.
Texas prohibits corporate practice of medicine under Tex. Occ. Code § 165.156, enforced by the Texas Medical Board. Texas's anti-kickback statute (Tex. Occ. Code §§ 102.001–102.012) prohibits referral payments for all payers — third-degree felony for violations. NPs require physician prescriptive authority agreements — Texas is not a full practice authority state (Tex. Occ. Code § 157.054). Texas enacted DPC enabling legislation under Tex. Ins. Code §§ 1274.001–1274.006, exempting qualifying DPC practices from Texas Department of Insurance regulation. Texas telehealth is governed by Tex. Occ. Code § 111.001 et seq. and Texas Medical Board rules at 22 Tex. Admin. Code §§ 174.1–174.12.
Utah prohibits corporate practice of medicine under Utah Code Ann. §§ 58-67-101 to 58-67-804. Utah is a full NP practice authority state (Utah Code Ann. § 58-31b-702). Utah enacted DPC enabling legislation under Utah Code Ann. § 31A-4-106.5.
Vermont prohibits corporate practice of medicine under Vt. Stat. Ann. tit. 26, §§ 1311–1399. Vermont is a full NP practice authority state (Vt. Stat. Ann. tit. 26, § 1572). Vermont has not enacted DPC enabling legislation — practices should seek guidance from the Vermont Department of Financial Regulation before launching DPC.
Virginia prohibits corporate practice of medicine under Va. Code Ann. §§ 54.1-2900 to 54.1-2986. NPs received full practice authority effective January 1, 2021 (Va. Code Ann. § 54.1-2957.01). Fee-splitting is prohibited under Va. Code Ann. § 54.1-2964. Virginia enacted DPC enabling legislation under Va. Code Ann. §§ 38.2-6501 to 38.2-6507.
Washington prohibits corporate practice of medicine under Wash. Rev. Code § 18.71.030. Washington is a full NP practice authority state (Wash. Rev. Code § 18.79.240). Washington is unique in requiring DPC practices to affirmatively register as a "Direct Practice" with the Office of the Insurance Commissioner (OIC) under Wash. Rev. Code §§ 48.150.005–48.150.100 — failure to register may constitute unlicensed operation as a health care service contractor. Washington's anti-rebate law (Wash. Rev. Code § 19.68.010) prohibits referral payments for all healthcare referrals. Washington has a strong telehealth parity law (Wash. Rev. Code § 48.43.735). Physician noncompetes are limited to 18 months maximum duration (Wash. Rev. Code § 49.62.020).
West Virginia prohibits corporate practice of medicine under W. Va. Code §§ 30-3-1 to 30-3-16. West Virginia is a full NP practice authority state (W. Va. Code § 30-7-15a). West Virginia enacted DPC enabling legislation under W. Va. Code §§ 33-50-1 to 33-50-6.
Wisconsin prohibits corporate practice of medicine under Wis. Stat. §§ 448.01–448.985. NPs require physician collaborative agreements (Wis. Stat. § 441.16). Wisconsin enacted DPC enabling legislation under Wis. Stat. § 628.36(2)(b).
Wyoming prohibits corporate practice of medicine under Wyo. Stat. Ann. §§ 33-26-101 to 33-26-503. Wyoming is a full NP practice authority state (Wyo. Stat. Ann. § 33-21-120). Wyoming enacted DPC enabling legislation under Wyo. Stat. Ann. §§ 26-63-101 to 26-63-106.
Physician private practices must comply with the Stark Law (42 U.S.C. § 1395nn) for any designated health services referrals, the Anti-Kickback Statute (42 U.S.C. § 1320a-7b) for all Medicare and Medicaid arrangements, HIPAA Privacy and Security Rules (45 C.F.R. Parts 160/164) as covered entities, and the False Claims Act (31 U.S.C. §§ 3729–3733) for all Medicare and Medicaid billing. Physician employment contracts must satisfy Stark Law fair market value requirements (42 C.F.R. § 411.357(c)) and comply with state Corporate Practice of Medicine laws. Physician noncompetes are subject to state law restrictions that vary significantly — several states including Minnesota, North Dakota, Oklahoma, and California broadly prohibit or void physician noncompetes.
Direct primary care practices must navigate federal and state insurance exemption requirements, Medicare opt-out rules (42 C.F.R. § 405.435), HSA compatibility limitations, and state-specific registration requirements. Washington state uniquely requires DPC practices to register as a "Direct Practice" with the OIC (Wash. Rev. Code §§ 48.150.005–48.150.100). States without DPC enabling legislation — including Massachusetts, New York, Connecticut, Rhode Island, Vermont, and New Jersey — present significant regulatory risk for prepaid primary care arrangements. DPC patient agreements must disclose that the arrangement is not insurance, specify covered services, and include termination provisions compliant with applicable state law.
Digital health companies and health technology platforms must analyze Corporate Practice of Medicine compliance in every state of operation — non-physician ownership of clinical services requires the PC/MSO structure in CPOM states. HIPAA applies to health tech companies acting as business associates of covered entities (45 C.F.R. § 160.103). The FTC Health Breach Notification Rule (16 C.F.R. Part 318) applies to health apps not covered by HIPAA. Anti-Kickback Statute analysis is required for any compensation arrangement with physicians that could influence federal program referrals. The Ryan Haight Act (21 U.S.C. § 831) governs telehealth prescribing of controlled substances for tech platforms facilitating telemedicine.
Dental Service Organizations must comply with state Corporate Practice of Dentistry laws — which parallel CPOM for dentistry in most states — using the PC/MSO structure where required. DSO management fees structured as a percentage of Medicaid dental revenue risk Anti-Kickback Statute violations. DSO-affiliated practices billing Medicaid face heightened OIG scrutiny for billing compliance, particularly for pediatric dental services (OIG Report OEI-02-17-00560). Fee-splitting prohibitions apply to DSO management arrangements in all states.
Physician ownership of ASCs is protected by the Anti-Kickback Statute ASC safe harbor (42 C.F.R. § 1001.952(r)) if ownership meets specific requirements including proportional returns and active surgical use by physician-investors. Most ASC surgical services are not designated health services under Stark — ASC surgical referrals generally do not implicate the Stark Law. ASC billing must comply with CMS ASC payment system rules and the 72-hour bundling rule for pre-operative services.
Behavioral health and substance use disorder treatment practices face heightened Anti-Kickback Statute scrutiny for patient brokering arrangements (OIG Special Fraud Alert, Feb. 2023). Substance use disorder records are governed by 42 C.F.R. Part 2, which is substantially more restrictive than HIPAA and requires specific patient consent for most disclosures. Psychotherapy notes have enhanced HIPAA protection (45 C.F.R. § 164.508(a)(2)). Medicare and Medicaid telehealth flexibilities for behavioral health have been extended by Congress through December 31, 2024.
Legal citations reflect laws as of the date this content was prepared. State statutes are subject to amendment. Verify current versions at official state legislature websites. This content does not constitute legal advice and does not create an attorney-client relationship.