There’s no shortage of kickback cases, especially in the lab, DME, and telemedicine space. I review the DOJ announcements almost daily, and the common story is that kickbacks are being funneled through MSOs and “marketing companies.” A good example is this case [https://www.justice.gov/usao-wdpa/pr/florida-businessman-pleads-guilty-three-cases-involving-conspiracies-commit-health-care], where a bad actor entered into “sham contracts with marketers.”
HVG receives requests weekly for FMVs for MSO/MSAs. I suspect MSOs will be the next big area the DOJ targets for fraud investigations.
The attorneys and appraisers can draw up the proper/compliant contracts and FMV opinions, but if the clients are not conducting business in accordance with the contracted terms, there’s not much the advisors can do. Clients should be encouraged to maintain thorough and detailed accounting records. Many of the FMV fees are based on a cost-plus markup structure. An appraiser can develop an FMV markup, but the forecasted management/marketing expenses may not always be the same as the forecast. In addition, the commercial reasonableness of certain management or marketing expenses may come into question.
