In the OIG Advisory Opinion No. 01-17 (2001), the OIG stated that, although the overall compensation for the contract was not set in advance, all the facts and circumstances, in the circumstances, lead to the conclusion that the risk of fraud and abuse did not increase significantly, but this finding is likely due to the existence of a monthly payment limit. In 2003, the OIG stated in Advisory Advisory Opinion 03-8 that a proposed agreement was not eligible for covert protection, as the total remuneration paid under a management agreement would not be set in advance. Unlike most other types of physician-employment, physicians who act as medical directors are compensated only for administrative services related to patient care. This is not to say that a medical director does not play a decisive role in the functioning of a health care provider. The New York State Department of Health recommends or requires that medical directors be set up for certain types of providers, and federal law also requires medical directors for certain types of services and facilities.  42 CFR 1001.952 (d) (2): “The agency agreement covers all services provided by the agent to the contracting entity for the duration of the agreement and defines the services to be provided by the agent.” 42 U.S.C. 1395nn(3) (A) (ii): “The agreement covers all services to be provided by the physician.” This agreement through the Medical Director (this “agreement”) is between Dr. Tattoff, Inc., a Florida company (the “Tattoff”), William Kirby, D.O., Inc., a medical company (the “Corporation”) and William Kirby, D.O., a person (“doctor”), effective January 1, 2010 (effective date”). Because medical directors do not provide medical services, many physicians feel comfortable entering medical management with little or no written documentation. However, physicians should be cautious about the role of the medical director.
In particular, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services often reviews the provisions of medical directors to determine whether the agreement is being used as a means of physician compensation for patient transfers. For this reason, if the contractor participates with federal payers and the physician can refer patients to the contract provider, the physician should enter into a written medical director contract, structured so that it falls within an exception (or safe port) of the federal and anti-kickback statutes. While it is always best to consult an experienced professional before entering the medical director`s convention, compliance with the above criteria can offer protection to both the physician and the institution.  42 CFR 1001.952 (d) (5): “The total compensation paid to the agent during the term of the agreement is set in advance, in accordance with the fair value of arms-time transactions and is not determined in a manner that takes into account the volume or value of any references or transactions made between the parties for which payments may be made in whole or in part under Medicare , execution. Medicaid or other federal health programs. 42 U.S.C. 1395nn (3) (A) (v): “The compensation payable during the term of the agreement is fixed in advance, does not exceed fair value and .