MSO Attorney

Experienced Attorneys for All Aspects of Healthcare Management Services Organization (MSO) Compliance

Attorney Lynette S. Byrd
MSO Team Lead
Former DOJ Attorney Contact Lynette

As more healthcare providers and business owners learn about the benefits and viability of forming a Management Services Organization (MSO), these organizations are becoming increasingly popular within the healthcare industry. Forming an MSO (either as LLC or a general business corporation) opens up new opportunities that would not otherwise be available due to restrictions on physician and medical practice involvement in non-medical businesses and non-physician ownership of multiple practices. But, while forming an MSO presents opportunities, it also presents risks. As a result, a proactive and detail-oriented approach to compliance is essential, and this requires the advice of an experienced MSO attorney.

Understanding the Importance of MSO Compliance

Each MSO attorney at Oberheiden P.C. has extensive experience advising clients on all aspects of federal healthcare compliance. This includes issues that are both specific and non-specific to MSOs. When it comes to effectively managing compliance, a key consideration to keep in mind is that while MSO operation involves some unique compliance considerations, MSOs must also address the general compliance obligations that apply throughout the federally regulated healthcare industry and where the medical practice operates.

So, if you own (or manage) an MSO—or if you are thinking about forming an MSO—what does this mean for you?

The short answer is that you need to give compliance the attention it deserves. Far too often, MSOs treat compliance as a check-the-box proposition. They hire an MSO lawyer to draft some policies and procedures, and then they assume that simply having these policies and procedures is enough. But this is not the case. Due to their unique nature, MSOs are frequently under the microscope, and when facing scrutiny from federal authorities, being unable to affirmatively demonstrate an ongoing commitment to compliance can lead to substantial recoupments, fines, and other penalties.

5 Key Compliance Concerns for MSOs

We represent MSOs as well as physicians and other individuals who are thinking about forming MSOs in all areas of federal healthcare compliance. For new MSOs, we also provide formation services and administrative support, which include entity selection, document and management services agreement preparation, and filing. Regarding compliance, some of the key areas of concern for MSOs at all stages of the business lifecycle include:

1. Corporate Practice of Medicine (CPOM)

The corporate practice of medicine (CPOM) doctrine seeks to prevent non-physicians’ financial interests from interfering with physicians’ medical judgment. It also seeks to prevent organizations and individuals from providing clinical services that cross the line from practice management to medical when they are unlicensed to do so. Thoroughly addressing CPOM-related concerns is essential for MSOs; and, at Oberheiden P.C., our MSO lawyers work closely with our clients to ensure that their organizational structures and management services agreements help them steer clear of any potential violations.

2. Fee-Splitting with Physicians

Fee-splitting with physicians is another significant compliance concern for MSOs. Federal and state laws, including the Stark Law and Anti-Kickback Statute, restrict fee splitting, particularly in relation to medical services reimbursements received from Medicare, Medicaid, Tricare, and other federal healthcare programs.

3. Medicare, Medicaid, and Tricare Billing Compliance

Beyond fee-splitting concerns, MSOs must also address all other aspects of federal healthcare program billing compliance. Medicare, Medicaid, Tricare, and other programs all have their own unique and complex sets of rules and regulations. Not only can noncompliant billings lead to reimbursement denials, but they can also lead to fines, prepayment review, exclusion, and other penalties.

4. Private Health Insurance Billing Compliance

Management Services Organizations also need to be extremely careful when billing private health insurance companies and other payors. MSOs’ billings often face enhanced scrutiny; and, when in doubt, insurers will err on the side of denial. To minimize their risk of facing delays, denials, and other unnecessary issues, MSOs need to ensure that they take a transparent and accuracy-first approach to billing compliance.

5. Patient Data Privacy and Security

Patient data privacy and security are also vitally important for MSOs that have access to patient’s health or financial information. Not only is this a compliance concern, but it is also a significant liability concern, as patient data breaches can lead to expansive and costly litigation. Several of our attorneys have extensive cybersecurity experience, and our team includes non-lawyer consultants with cybersecurity expertise as well.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

5 Key Compliance Strategies for MSOs

To address these compliance concerns—among many others—MSOs need to take a comprehensive and custom-tailored approach to risk management. Some key compliance strategies for MSOs include:

1. Taking a Proactive, Top-Down Approach to MSO Compliance

Effective risk management starts with a proactive, top-down approach to compliance. To avoid unnecessary issues, MSOs should work with experienced counsel from the outset to identify their compliance needs and implement custom-tailored compliance solutions. If you own (or manage) an MSO and have compliance-related concerns, speaking with an experienced MSO attorney is the first step in the process.

2. Developing Custom-Tailored Compliance Policies and Procedures

Just like other entities in the healthcare industry, MSOs need to develop custom-tailored compliance policies and procedures. There is no one-size-fits-all approach in a management service agreement, and attempting to rely on templates, checklists, and other generic documents will lead to oversights. At Oberheiden P.C., we work closely with our clients to help them do what they need to do to manage compliance effectively.

3. Providing Training and Emphasizing Everyone’s Role in Compliance

Effective compliance management requires buy-in from personnel at all levels of the organization. With this in mind, compliance training is essential, and all individuals should have a clear understanding of their specific role in helping the organization avoid mistakes, oversights, and unwanted scrutiny.

4. Documenting Compliance on an Ongoing Basis

For MSOs, addressing compliance is not a one-time event. Rather, an ongoing commitment to compliance is essential, and MSOs should also document their compliance efforts on an ongoing basis. In the event of an audit or investigation, having this documentation readily available will be key to resolving the inquiry as quickly and favorably as possible.

5. Continuing to Monitor for Potential Compliance Concerns

Part of an ongoing commitment to compliance involves continuing to monitor for potential compliance concerns. From inadvertent mistakes within the organization to changes in the Medicare, Medicaid, or Tricare billing rules, various issues can present unanticipated risks. Being able to identify these risks is essential, and this, too, requires experienced legal representation.

FAQs: Working with an MSO Attorney to Effectively Manage Compliance

Schedule a Complimentary Consultation with an MSO Lawyer at Oberheiden P.C.

Do you need to speak with an experienced MSO lawyer? If you are thinking about forming an MSO, if your MSO needs help with compliance, or if your MSO is facing scrutiny from auditors or federal authorities, our lawyers are here to help. To schedule a complimentary consultation at Oberheiden P.C. as soon as possible, please call 888-680-1745 or tell us how we can help online today.