Advertisement - Members don't see this ad
It appears to be a Stark Law / Anti-kickback Statue issue.
Job Market
Started by DogSnoot
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
BeaverBlade
Full Member
in private practice i dont think it is a stark law/anti-kickback but if you're in an ortho group it is. I'M NOT A LAWYER as a disclaimer
I am obviously a legal expert based on my use of Google Gemini, but according to our AI overlords it appears the safest way to reimburse doctors in a practice for DME is through profit sharing based on percentage of ownership in the practice.
Advertisement - Members don't see this ad
BeaverBlade
Full Member
yes so podiatrists are usually non partners (especially in multispecialty groups/ortho groups) so their DME = nothing to their own collections.
Willing to bet that describes way more PP associate jobs than hospital jobs. Except the Idaho part.
Had verbage in a previous offer that also excluded DME to count towards collections for first 2 years.
Not that it will make anybody feel better, but I’ve never, across all of medicine, heard of a non-owner get a cut of ancillaries. *insert Discover Podiatry poster* Some folks can use it as a negotiating tool (e.g. oncology getting $100+/wRVU because their infusion centers print money), but that’s about it if you don’t have money in the game already.
It’s one of the biggest ways PE can squeeze the blood out of the coin and you. It’s why a GD drug distributor bought the largest number of retina practices in the country to make sure said docs use the most profitable products they sell. How there’s not some price fixing investigation or Stark law stuff there, I have no clue.
I’m no angel - it’s still in our associate contract as well. Zero chance my partners would change it, but at least they let me significantly improve the current base and bonus compared to the junk that was my deal.
It’s one of the biggest ways PE can squeeze the blood out of the coin and you. It’s why a GD drug distributor bought the largest number of retina practices in the country to make sure said docs use the most profitable products they sell. How there’s not some price fixing investigation or Stark law stuff there, I have no clue.
I’m no angel - it’s still in our associate contract as well. Zero chance my partners would change it, but at least they let me significantly improve the current base and bonus compared to the junk that was my deal.
Dispensing DME isn't really an ancillary. Part of the reimbursement includes "fitting it for the patient and educating them on proper use" which is a professional service. I've literally been audited about this and had claims denied because I failed to document how I fitted an AFO even though said fitting/education only consisted of affixing the velcro.
From an accounting perspective, it's a lot of extra EHR reports to calculate the associate's collections. You'd have to look up aggregate collections and then run individual collections reports from L3040s, L3000s, L4361s, L4397s, and so on ...which I guess is still easier than paying the associate
But from a business perspective, I don't understand why you wouldn't want your associates to make money off DME. I guess it's scarcity mindset vs abundance mindset. Scarcity mindset is every dollar I pay out is one less dollar I make. Abundance mindset is the more I pay, the more income they are incentivized to produce.
From an accounting perspective, it's a lot of extra EHR reports to calculate the associate's collections. You'd have to look up aggregate collections and then run individual collections reports from L3040s, L3000s, L4361s, L4397s, and so on ...which I guess is still easier than paying the associate
But from a business perspective, I don't understand why you wouldn't want your associates to make money off DME. I guess it's scarcity mindset vs abundance mindset. Scarcity mindset is every dollar I pay out is one less dollar I make. Abundance mindset is the more I pay, the more income they are incentivized to produce.
Last edited:
Easy overbill and treat
Much like you’ve already read in this thread, they hide behind the stark law lie that is repeated to podiatry associates all over the country. I’m sure they figure that the employee will dispense DME regardless of the incentive and therefore keeping all of the DME profits for themselves is worth it.
They provided more clarification. Collections will include everything like DME, grafts, imaging etc. They have it in writing as well. How much of a difference will this make?
The sign-on bonus was increased to 20k, not clear why they didn’t just increase the base salary
BeaverBlade
Full Member
$550,000 is really high amount to collect to bonus. I don’t think you’re going to get that especially not year 1. It should be 35-40% if you get that too (if it was a fair offer)
1. Its obviously an improvement to receive more of the services you perform. I can't quantify how much it will be worth for you. Look up what Medicare pays for common imagery codes in your area. Be aware though that commercial insurances contracts are variable and that part of the business model of large PE groups is essentially arbitrage. They understand the value of your services better than you do.
2. Sign-on bonuses can be taken back if you leave. They can be spread over large time period. There is also potentially some sort of accounting value to them that the companies may use to help with cash flow- base pay may or may not continue, but bonuses are understood to be fleeting. Increasing your base pay also generates issues with other associates - it allows them to be consistent in their description of base. If another associate doesn't negotiate on bonus then that's their problem.
3. Here's my real problem for you. To have any chance of hitting any sort of bonus you need credit for everything that you do, but you will never get adequate credit. I remain skeptical that you'll have any chance of hitting your bonus in a first year. The painful truth is - associates probably benefit most from having maximized guaranteed income ie. the highest base they can get. Your base is fine for private practice. The battle with increasing starting pay is via sign on bonuses is that they can be spread over several years where you owe payback of the money if you decide to leave. Private equity is also notorious for long 401K vesting periods. They likely know all the tricks related to trapping an associate into a tail arrangement. In the end you will always be best served by leaving and they will make it painful for you.
Six year vesting period 🚮
Advertisement - Members don't see this ad
I appreciate the info. Trying to navigate this has been interesting to say the least.
Seems like the bonus is paid with first paycheck. No clawback terms for the bonus. 401k is vested immediately once I start contributions, but I have to work there for a year before I can start contributions.
Edit: I misspoke on this one. I can start contributing a month after I start, but they will only start matching a year after I work there. It will vest immediately after they start matching.
Last edited:
For clarity - personal contributions to a 401k are always immediately vested. That's your money. Its obviously a bummer to have to wait a year to contribute. Most employers do not allow their matching contribution (ie. the 4% that places often offer as a safe harbor contribution) to vest until some sort of time period has passed.
You'll take the best deal you can get, but what we hope to accomplish for you here is warning you about ways that employers move your money back into their pocket or make your awesome salary offer less awesome.
So I don't think this applies to you but some employers try to make employees fraudulently into contractors rather than employees.
Tail is another podiatry battle. Your tail is often a multiple of your annual premium ie. 2x. Could even be 3x though I think that might be for higher risk surgical fields. A few years at a practice and you could be owing $20K. Who saved money on this deal - the employer because they could have bought you an occurence policy to start with.
Certain benefits that you need are often expenses that you'll now have to pay for with post tax dollars if the employer doesn't offer them. ie. health insurance.
