Concierge practices, alternatively known as subscription or retainer practices, are drawing physicians in greater numbers than ever before. This sort of practice forges a direct contract between the patient and their physician, with the patient only paying for an agreed set of healthcare services. The fee paid is fixed, paid either monthly or annually, and covers all of the services offered by the practice. The concierge business model has grown rapidly in recent years and is expected to reach $10 billion in revenue in 2028 with even greater growth forecasted in the years after.

This model appeals to providers by creating an environment where they can spend more time with their patients listening to and understanding their complaints and needs, ultimately allowing them to provide better care. The financial aspect is also appealing, as providers earn more despite seeing fewer patients, setting them up for a healthier work-life balance in the long run. With all of these appealing factors on offer, it is easy to see why so many providers are making the switch, though there remain certain legal concerns that have to be considered.

Here are some possible legal issues that have to be dealt with:

Patient agreements

At the core of the concierge business model is the patient agreement, where patients agree to pay all fee schedule charges at the time of service to gain access to the specific menu of enhanced services that are offered by the practice.

This is where issues can arise as not all patients will fully understand the business model. Patients will continue attempting to pay for services through insurance rather than the patient agreement, and some patients will not be able to afford the agreement at all. Providers must take great care to review all payor agreements so that they may refrain from offering services that may be already be covered by a third-party agreement.

Insurance licensure

An easy mistake to make when switching to the concierge business model is not doing the due diligence to ensure that your patient agreement holds up under state law. Under certain conditions, the patient agreement can appear more like an insurance agreement, and in most states, there are several requirements that must be met before such a contract can be offered to patients. have your attorney thoroughly review the insurance licensure laws of your state before drafting a patient agreement.

Kickbacks

Marketing a concierge medicine business can be tricky. When these practices offer free services, they run the risk of being seen as violating kickback and fee-splitting laws. If Medicare is involved federal kickback laws might have been violated and state kickback laws for non-Medicare cases. Authorities that enforce these laws may view the free services as an illegal inducement for clinical services.

Learn More: 5 Tips For Starting Your Own Practice

Medicare

Medicare providers are allowed to engage in concierge services as long as they comply with Medicare regulations and the terms of assignment agreements. The most notable of these regulations is not charging Medicare beneficiaries extra for services already covered under Medicare.

The concerns of Medicare regarding concierge medicine and assignment agreements are outlined in a 2004 Office of Inspector General advisory opinion alert titled “OIG Alerts Physicians About Added Charges for Covered Services — Extra-Contractual Charges Beyond Medicare’s Deductible, Coinsurance: A Potential Assignment Violation.” It would also be wise for Medicare providers to review federal authorities for civil monetary penalties.