What Is a "Group Practice"?

Understanding the federal Stark Law's definition of a "group practice" is crucial for physicians aiming to comply with regulations and utilize key exceptions like the Physician Services and In-Office Ancillary Services exceptions. A recent article from Day Pitney outlines the specific criteria a medical practice must meet to qualify as a group practice under the Stark Law, including:

Single Legal Entity: The practice must operate as a single legal entity primarily for the purpose of being a physician group practice.

Minimum of Two Physicians: The group must consist of at least two physicians who may be owners or employees.

Range of Care: Each physician member must provide substantially the full range of patient care services that they typically offer, utilizing shared office space, personnel, equipment, and other resources.

Services Furnished by Group Practice Physicians: At least 75% of the physician services provided by the members must be furnished by and billed through the group.

Distribution of Expenses and Income: Overhead expenses and income must be distributed according to methods set in advance.

Unified Business: The practice must have centralized decision-making, as well as consolidated billing, accounting, and financial reporting.

Volume or Value of Referrals: Physician compensation cannot be based on the volume or value of their referrals.

Physician-Patient Encounters: Physicians must conduct at least 75% of the patient encounters of the practice.

By adhering to these criteria, medical practices can ensure compliance with the Stark Law and take advantage of important exceptions that facilitate the provision of comprehensive patient care.

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