With tam hungry reporters looking for potential goals, having a rigorous compliance program in place and providing clear instructions and information on corporate agreement assessments and requirements will go a long way in preventing legal attacks. Buying back shares held by medical investors during certain “trigger events” is the best way to maintain compliance with the ASC Safe Harbors of the federal anti-kickback law. Similarly, pricing a profit multiple is a generally accepted method for determining fair value. However, at least one OIG opinion (AO 09-09) found that the assessment of a CSA on a revenue multiple could be considered as taking into account the volume or value of transfers made by doctors in violation of the anti-kickback status. 2. Hospital ambulance operations and “co-management agreements”. Since the government has banned “arrangement” transactions, there has been considerable growth in situations where an operations center sells to a hospital and develops a so-called “co-management” relationship. This offers the doctor or group of doctors compensation for the management of the hospital service, but allows the hospital to actually own and provide the services and provide the services at hospital ambulance rates. The big challenge of these relationships will be to ensure that they have fair market value and that they pay doctors for reasonably necessary services, and not just a way to get money from doctors in exchange for transactions. The other big challenge of these relationships will be what they look like 3-5 years after closing a deal. For the most part, nothing is as congruent for interests as a true joint venture. Over time, there is a good chance that the volume of fall will be reduced and the glue of the relationship will not be as strong as during the first formation. 3.

Off-grid refund. The ability to meaningfully benefit patients outside the network continues to decline. . . .