That lucrative new specialty care network contract might actually be an illegal kickback scheme in disguise.
Specialty care networks are rapidly expanding in commercial healthcare by using bundled payments to control costs. In this solo breakdown, healthcare attorney Neil Goldstein examines how physician groups and healthcare executives can distinguish legitimate value-based networks from disguised pay-for-referral schemes that violate the Federal Anti-Kickback Statute.

What you will learn:
● How legitimate specialty care networks mirror Medicare bundled payment models to lower commercial healthcare costs for employers and TPAs.
● Why paying a physician participation fee to join a network is a major Anti-Kickback Statute warning sign when the network should be funded by payers or shared savings.
● The difference between acceptable network marketing and illegal commission-based patient generation under federal law and state fee-splitting statutes.
● Why carving out Medicare and Medicaid patients provides false comfort unless the network operates solely in a legitimate state-regulated niche like workers’ compensation.
● How termination without cause clauses can be manipulated to adjust fees based on referral volume unless a strict one-year sit-out provision is included in the contract.
● Why a compliant specialty network must assume genuine financial downside risk on bundled payments rather than acting purely as a patient sales broker.
● The operational markers of a legitimate network, including defined clinical care pathways, data analytics, and active care management.

Timestamps:
00:00:00: Anti-Kickback Statute risks in specialty care networks
00:02:17: How legitimate specialty networks use bundled payments
00:04:00: True care management vs disguised referral schemes
00:06:45: Warning sign 1: Physician participation fees
00:09:05: Warning sign 2: Marketing as the primary network service
00:10:31: Warning sign 3: The false comfort of federal carve-outs
00:13:00: Warning sign 4: Termination clauses without a one-year sit-out
00:15:09: Warning sign 5: Networks taking zero financial downside risk
00:17:11: Warning sign 6: Lack of meaningful clinical pathways and data services

Neal Goldstein is an experienced healthcare attorney, advisor, and host of Group Practice, dedicated to helping physician leaders navigate complex legal, financial, and governance structures. He counsels medical groups on sustainable growth, partner alignment, and sound operational decision-making. His strategic guidance ensures independent practices stay profitable and resilient in rapidly consolidating markets.

Website: https://www.pfs-law.com/
Website: https://www.goldsteingrouppractice.com/
Website: https://nealtgoldstein.com/
LinkedIn: https://www.linkedin.com/in/neal-t-goldstein-841aa652/

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This content is for informational and educational purposes only and does not constitute formal legal or financial advice.

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