Concierge medicine offers a personalized, membership-based approach to healthcare, allowing patients to receive enhanced medical services in exchange for direct payments or retainer fees. While this model provides greater flexibility for physicians and improved patient access, it also presents significant legal and regulatory challenges. Physicians operating concierge practices must navigate federal and state healthcare laws, fraud and abuse statutes, insurance regulations, and ethical concerns to ensure compliance and avoid legal liabilities.
This course provides an in-depth legal analysis of regulatory compliance for concierge medicine practices, focusing on contractual obligations, anti-kickback concerns, billing transparency, insurance implications, and patient rights. Students will gain expertise in structuring legally compliant concierge practices, mitigating liability risks, and responding to regulatory enforcement actions.
Course Objectives
By the end of this course, students will:
-
Understand the Legal and Regulatory Framework Governing Concierge Medicine – Analyze state and federal laws, including Medicare, Anti-Kickback Statute (AKS), and Stark Law implications.
-
Examine the Role of Patient Agreements and Contractual Requirements – Learn how to draft legally compliant membership contracts and avoid misleading advertising.
-
Evaluate Compliance Risks Related to Insurance and Medicare Regulations – Study how concierge practices interact with private insurers, Medicare opt-out rules, and direct primary care models.
-
Analyze Case Law and Regulatory Enforcement Actions Against Concierge Practices – Review key lawsuits, enforcement trends, and OIG guidance on retainer-based healthcare models.
-
Assess Fraud and Abuse Risks, Including the Anti-Kickback Statute and Stark Law – Investigate legal boundaries for financial relationships in concierge medicine.
-
Explore Best Practices for Structuring a Compliant Concierge Medicine Model – Develop risk mitigation strategies for billing, patient selection, and service offerings.
-
Identify Legal and Ethical Issues Related to Patient Access and Non-Discrimination – Learn how to ensure fair pricing and compliance with federal anti-discrimination laws.
-
Prepare for Future Trends and Legislative Changes Affecting Concierge Medicine – Examine policy proposals, insurance industry shifts, and regulatory developments.
