Part I: General Guiding Principles
TAX EXEMPT STATUS
ANTI-KICKBACK STATUTE
PRINCIPLES OF COMMUNITY NEED AND COMMUNITY BENEFIT
Community Need: Acceptable Justifications
Community Benefit: Acceptable Justifications
Unacceptable Justifications
Absence of Community Need/Community Benefit
POLICIES CONCERNING CATEGORIES OF PRACTICE
Policies Applying to All Categories of Physicians
Policies Applying to Existing Medical Practices
Policies Applying to New or Significantly Expanding Medical Practices
OTHER GUIDING PRINCIPLES
Overall Reasonableness of Recruitment Incentives
Type of Physician to Whom Recruitment Incentives Can Be Extended
Requirement for Written Agreement
Duration of Recruitment Incentives
Prohibition Against Renegotiation
Requirement for Reporting to the IRS
Exceptions to Guidelines
Exhibit 1-1 Community Need Analysis
Part II: Current Legal Environment
FRAUD AND ABUSE
Anti-Kickback Statute
Safe Harbors to the Anti-Kickback Statute
Other OIG Pronouncements
Anti-Kickback Case Law
TAX EXEMPTION AND PRIVATE INUREMENT
Private Inurement and Private Benefit
The IRS’s Position on “Insiders”
The Current IRS Concept of Community Benefit
Expanded Hospital Audit Guidelines
Hermann Hospital Closing Agreement
IRS Announcement 95-25
ANTITRUST CONSIDERATIONS
The Sherman Act
The Clayton Act
Examples of “Per Se” Antitrust Violations
Examples of “Rule of Reason” Antitrust Violations
Role of the “Expedited Business Review
Physician-Hospital Organizations: Antitrust and PHO Contracting Activities
BONA FIDE EMPLOYEE STATUS
THE KENNESTONE SETTLEMENT
FELDSTEIN, M.D., v. NASH COMMUNITY HEALTH SERVICES, INC
ALVARADO HOSPITAL MEDICAL CENTER, INC
Gainsharing and its Regulatory History
The OIG’s Analysis
Caveats and Recommendations
THE STARK LAW
Recent Enforcement of the Stark Law
Exhibit 2-1 1991 Fraud And Abuse Safe Harbors
Exhibit 2-2 Management Advisory Report Regarding Hospital-Based Physicians
Exhibit 2-3 May 1992 “Special Fraud Alert” Regarding Physician Incentives
Exhibit 2-4 December 1992 Thornton Letter To IRS
Exhibit 2-5 Analysis Section Of Polk County Vs. Peters Decision
Exhibit 2-6 Physician Recruitment Guidelines
Exhibit 2-7 Announcement 95-25 (Now Known As Rev. Rul. 97-21)
Exhibit 2-8 Expedited Business Review Approval Request—Collaborative
Provider Organization, Inc.
Exhibit 2-9 Twenty Key IRS Classification Factors For Determining Independent
Contractor Status
Part III: Recruitment Policy Development
REASONS FOR CREATING A PHYSICIAN RECRUITMENT POLICIES
DOCUMENT
Development Sequence
Contents Of A Physician Recruitment Policies Document
Preliminary Statements
Supervision and Governance
Supervision and Governance and Role of the Governing Board
The New Era of Corporate Responsibility
Sarbanes-Oxley Overview and Sentencing Guideline Amendments
Raise the Stakes for All Business
Organizations
The Content of the Sentencing Guideline Amendments
OVERVIEW OF STANDARD CONTRACTUAL ELEMENTS
Element I—Recitals
Element II—Obligations of the Hospital
Element III—Obligations of the Physician
Element IV—Prohibitions against Requiring Certain Obligations
Element V—Terms of Financial Benefits
Element VI—Conditions of Termination or Default
Element VII—Miscellaneous Concluding Statements
Element VIII—Exhibits
Recruitment Incentives For Non-Employed Physicians
Practice Start-up Loans and Income Guarantee Loans
Requirements
Legal Documentation
Traditional Repayment
Alternative Repayment (“Loan Forgiveness”)
Signing Bonus, Relocation Expenses, Finder’s Fees, And Other One-Time Payments
General Principles
Requirements
Reimbursement of Relocation Expenses
Requirements
Legal Documentation
Signing or Recruitment Bonus
Legal Documentation
Purchase of “Tail” Medical Liability Coverage
Requirements
Legal Documentation
Professional Liability Insurance
Requirements
Legal Documentation
Education (“CME”) Grants
Requirements
Legal Documentation
Education Loans and Payment of Student Loans
Requirements
Legal Documentation
Use of Hospital Property and Services
Requirements
Legal Documentation
Use of Hospital Support Staff
Requirements
Legal Documentation
Hospital’s Training of Physician’s Support Staff
Requirements
Legal Documentation
Office Leases and Leasehold Improvements
Requirements
Practice Acquisition And Physician Employment
Requirements
Legal Documentation
Medical Practice Valuation—IRS Update
Practice Acquisitions: Integrated Delivery Systems
Integrated Delivery System Models
Requirements
Exhibit 3-1 Access To Records
Exhibit 3-2 Sample Physician Recruitment Agreement
Exhibit 3-3 Example Of Practice Support Promissory Note
Exhibit 3-4 Example Of UCC Financing Statement
Part IV: Templates and Tools
Physician Recruitment Agreement — Forgivable Loan
Agreement For Professional Services—Employee (Primary Care Clinic
- Employee Status)
Medical Director Agreement—Employee
Professional Services Agreement—Employee (Family Practice)
Professional Services Agreement—Independent Contractor
Professional Services Agreement— Employee
Physician Recruitment Agreement—Independent Contractor
Nurse Practitioner Recruitment Agreement—Forgivable Loan
Medical Office Lease Agreement—Hospital And Physician
Physician Recruitment Guidelines
Position Postings
Contingency Search Agreement—Primary Care
Contingency Search Agreement—Specialty And Subspecialty
Physician Recruitment Questionnaire—Pre-Interview Physician Questionnaire
Professional Questions And Attestation
Defining The Position—Getting A Feel For The Opportunity Physician
Recruitment Questionnaire
Candidate Screening—Initial Interview Physician Interview Questionnaire
Candidate Interview Checklist
Candidate Interview Questionnaire
Candidate Peer Interview Evaluation Grid Candidate Evaluation
Candidate Evaluation Checklist - Interviewer’s Evaluation Grid
Letter To Reviewers
Physician Orientation And Development
Physician Retention Plan
Checklist For Initiating Hospital-Employed Physician Practice
Index
