Healthcare Law
Healthcare moves fast.
The regulations
never sleep.
HIPAA, Stark Law, Anti-Kickback, corporate practice restrictions, and state licensing. The regulatory framework for healthcare businesses is layered, interconnected, and unforgiving. We provide compliance counsel, transactional support, and regulatory guidance for healthcare providers and businesses operating in this environment.
Know the Rules
The Regulatory Landscape
Healthcare is one of the most heavily regulated industries in the country. These are the frameworks that govern most healthcare businesses operating in Nevada.
Health Insurance Portability and Accountability Act
HIPAA
HIPAA's Privacy and Security Rules govern the use, disclosure, and protection of protected health information (PHI). Covered entities (providers, payers, and clearinghouses) and their business associates must maintain compliant policies, procedures, and technical safeguards.
Key requirements: written HIPAA policies and procedures, Business Associate Agreements (BAAs) with all vendors who handle PHI, workforce training, risk assessments, breach notification protocols, and Notice of Privacy Practices. OCR enforcement actions and settlement amounts have increased significantly in recent years.
Physician Self-Referral Law (42 U.S.C. § 1395nn)
Stark Law
Stark Law prohibits physicians from referring Medicare or Medicaid patients to entities in which the physician (or an immediate family member) has a financial relationship, unless a specific statutory or regulatory exception applies. It is a strict liability statute; intent is irrelevant.
Common exceptions: in-office ancillary services, employment relationships, personal services arrangements, fair market value compensation, space and equipment rentals. Violations result in denial of claims, repayment, and potential exclusion from federal healthcare programs.
Federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b)
Anti-Kickback Statute
The AKS prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals of federal healthcare program business. Unlike Stark, AKS requires intent, but the definition of "remuneration" is broad and includes cash, gifts, free services, and below-market arrangements.
Safe harbors include: employment, personal services and management contracts, fair market value compensation, referral services, warranties, and space/equipment rentals. OIG advisory opinions and safe harbor analysis are essential before entering any financial arrangement involving referral sources.
Nevada State Healthcare Licensing Requirements
Nevada Licensing
Nevada requires licensure for a broad range of healthcare facilities and providers: medical practices, surgery centers, home health agencies, behavioral health providers, and more. The Nevada Department of Health and Human Services (DHHS) oversees facility licensing; individual providers are regulated by their respective boards.
Key licensing bodies: Nevada State Board of Medical Examiners, State Board of Nursing, Board of Pharmacy, DHHS Division of Public and Behavioral Health. Certificate of Need (CON) requirements apply to certain facility categories. Failure to maintain proper licensure can result in immediate closure orders.
CPOM Doctrine
Corporate Practice of Medicine
Nevada, like many states, limits the ability of non-physician-owned corporations to directly employ physicians or control medical decision-making. The Corporate Practice of Medicine doctrine is designed to prevent commercial interests from interfering with clinical judgment.
Practical implication: most healthcare businesses operated by non-physicians must use a Management Services Organization (MSO) structure, in which a lay entity provides administrative and management services to a physician-owned professional entity (PC or PLLC). Structuring these arrangements correctly is essential for compliance and investor diligence.
Our Clients
Who We Serve
Healthcare legal needs vary significantly by practice type and business model. We work with a range of healthcare businesses, from solo practitioners to multi-site platforms, each with their own regulatory profile.
Medical Practices
Solo practitioners, group practices, and multi-specialty clinics face a unique mix of regulatory, employment, and transactional legal needs. We handle physician employment agreements, partner buy-in and buy-out structures, practice acquisitions, payor contract review, and compliance program development.
DSOs & Dental Groups
Dental Service Organizations operate through an MSO/PC structure that requires careful legal architecture to comply with dental board regulations and state CPOM rules. We structure DSO platforms, draft affiliate and management services agreements, and advise on acquisition and de novo growth strategies.
Telehealth Companies
Telehealth platforms must navigate a complex patchwork of state licensing requirements, prescribing laws, payor policies, and HIPAA obligations. We advise on multi-state compliance frameworks, physician services agreements, platform vendor contracts, and the regulatory boundaries of asynchronous care.
Healthcare Tech Startups
Digital health companies (from EHR vendors to AI diagnostic tools to remote monitoring platforms) are subject to FDA oversight, HIPAA as a business associate, and state regulations depending on their product. We advise on regulatory classification, BAA negotiations, and data licensing agreements.
Medical Spas
Medical spas occupy a regulated gray zone: they offer aesthetic procedures that constitute the practice of medicine, but are often operated by non-physicians. Nevada requires a licensed physician to own or supervise. We structure medical spa entities, draft medical director agreements, and ensure compliance with state medical practice laws.
Ambulatory Surgery Centers
ASCs are federally certified and state-licensed facilities subject to both CMS Conditions for Coverage and Nevada DHHS facility regulations. We advise on ASC formation and governance, physician ownership structures, joint venture compliance under Stark and AKS, and accreditation-related contracting.
Transactional Work
Common Transactions
Healthcare transactions carry regulatory risk that general corporate counsel may miss. Every deal requires healthcare-specific analysis layered on top of standard transactional due diligence.
Healthcare M&A
Healthcare acquisitions require healthcare-specific due diligence: verifying provider licensure and credentials, reviewing payor contracts for change-of-control provisions, assessing Stark and AKS exposure in existing financial relationships, and evaluating compliance program history.
Key diligence areas: licensure and credentialing, government program billing history, OIG exclusion checks, pending audits or overpayment demands, medical records retention obligations, and quality measure performance.
Practice Acquisitions
Buying or selling a medical or dental practice involves valuation, structure (asset vs. stock), goodwill allocation, restrictive covenants, payor credentialing transitions, staff retention, and often a post-closing employment or consulting arrangement with the selling physician.
Typical documents: Letter of Intent, Asset Purchase Agreement or Stock Purchase Agreement, Bill of Sale, Assignment of Contracts, Non-Compete and Non-Solicitation Agreements, Transition Services Agreement, and Employment or Independent Contractor Agreement for the seller.
Management Services Agreements
An MSA is the foundational contract in an MSO/PC structure. It defines the scope of services the management entity provides to the clinical entity, the compensation structure, the term and termination rights, and the allocation of control over non-clinical decisions. Getting the MSA right is essential for both compliance and enforceability.
MSA key provisions: services scope (billing, HR, facilities, marketing, IT), compensation methodology (flat fee, percentage of collections, or fee-for-service), control provisions that preserve physician autonomy over clinical decisions, assignment restrictions, and compliance obligations.
Joint Ventures
Physician-hospital and physician-investor joint ventures are heavily scrutinized under Stark Law and the Anti-Kickback Statute. The structure, economics, and operational terms must fit within an applicable exception or safe harbor. We structure and document healthcare JVs with full regulatory analysis.
Common JV vehicles: limited liability companies with co-ownership, ambulatory surgery center JVs (often structured under the AKS ASC safe harbor), ancillary services JVs, and diagnostic imaging partnerships.
Real Estate for Healthcare
Healthcare real estate transactions (medical office building leases, surgery center facility agreements, space and equipment rentals between physicians and facilities) implicate both Stark Law and AKS. All financial terms must reflect fair market value and meet safe harbor or exception requirements.
Stark and AKS compliance requires: written agreement, fair market value compensation not tied to referral volume, commercially reasonable terms, and (for space rentals) aggregate space and services set in advance.
Common Questions
FAQ
What is the Corporate Practice of Medicine doctrine?
The Corporate Practice of Medicine (CPOM) doctrine holds that only licensed physicians (or other licensed professionals in their respective fields) may own a medical practice or employ physicians to provide medical services. The rationale is that lay corporations should not control medical decision-making. In practice, this means that healthcare businesses owned by non-physicians must use an MSO/PC structure: a professional entity (PC or PLLC) owned by a physician holds the licenses and employs the clinical staff, while a separate management services organization (owned by non-physicians or investors) provides all non-clinical business services under a Management Services Agreement.
What is a Management Services Agreement?
A Management Services Agreement (MSA) is the contract between a Management Services Organization (MSO) and a physician-owned professional entity (PC or PLLC) that defines what administrative, operational, and business services the MSO provides and how it is compensated. The MSA is the primary mechanism by which a non-physician investor or operator extracts economic value from a healthcare business while leaving clinical control with the licensed physician. A well-drafted MSA will clearly delineate non-clinical services (billing, HR, marketing, facilities) from clinical decision-making, which must remain exclusively with the physician. MSA compensation must reflect fair market value to avoid AKS issues.
Do I need a healthcare attorney for my medical spa?
Yes. Medical spas in Nevada occupy a regulated space where aesthetics intersects with the practice of medicine. Procedures like Botox injections, laser treatments, and IV therapy constitute the practice of medicine and require physician oversight. Nevada law requires that a licensed physician either own the practice or be present and supervising certain procedures. Non-physician owners must use an MSO/PC structure with a properly structured Medical Director Agreement. Without proper structure, a medical spa risks operating unlicensed, triggering board complaints, and exposing the medical director to license sanctions. This is an area where DIY legal work creates significant downstream risk.
What are the basics of HIPAA compliance?
HIPAA compliance requires covered entities (healthcare providers, health plans, and clearinghouses) to implement administrative, physical, and technical safeguards to protect PHI. At minimum, a compliant program includes: a written HIPAA Privacy Policy and Security Policy, a designated Privacy Officer, workforce training, a current risk assessment, Business Associate Agreements with all vendors who access PHI, and a documented breach notification procedure. HIPAA is not a one-time exercise; it requires ongoing maintenance, annual reviews, and updates when you adopt new technology or change workflows. OCR settlements now regularly exceed $1 million even for small covered entities.
What is Stark Law and does it apply to my practice?
Stark Law (42 U.S.C. § 1395nn) applies to any physician who refers Medicare or Medicaid patients to an entity providing "designated health services" (including laboratory, physical therapy, radiology, DME, home health, and others) in which the physician has a financial relationship. It is a strict liability statute: if a financial relationship exists and no exception applies, the claims are not payable and must be refunded. Common financial relationships that trigger Stark include: ownership of an ancillary services entity, compensation arrangements with hospitals or other providers, and space or equipment rental arrangements. If your practice bills Medicare or Medicaid and has any financial relationships with referral sources or entities to which you refer, Stark analysis is essential.
Work With Us
Healthcare law is complex. Let us handle it.
Initial consultations are straightforward — no pressure, no jargon. Just an honest conversation about your business and what you need.
Attorney Advertising. The information on this page is for general informational purposes only and does not constitute legal advice. No attorney-client relationship is formed until a written engagement agreement is signed. See full Disclaimer.