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Fee Splitting

Compliance Monitor, March 16, 2007

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Q: We are a primary care physician group practice that refers a lot of surgical procedures to general and specialized surgeons in our community. We are interested in sharing in the revenue stream developed from the care of those patients, but are concerned about fee splitting. How can we divide this revenue?

A: The American Medical Association has issued ethics opinions on fee splitting, and many states have prohibitions in place on this issue. If you're considering becoming a multi-specialty group practice, all the physicians involved in the care of the patients would be able to share in all of the revenue streams. However, be sure that you comply with the requirements of Stark II, including its exceptions, and the anti-kickback statute and its safe harbors at the federal level.

Depending on the state(s) in which your physicians practice, there may be issues to consider under the state insurance or corporate fraud statutes. Moreover, if you are thinking about providing the surgery in your own facility, there will be licensure, accreditation, and survey issues to address. If you are not prepared to become a group practice, then you cannot share in these revenue streams.

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