Ownership and control come first
New York generally requires medical practices to be owned and controlled by licensed physicians, usually through a professional corporation or professional limited liability company. Some types of facilities need separate licensing from the Department of Health. Problems arise when a non-physician investor effectively controls the practice through management agreements, leases, or financing terms, which can lead insurers to deny claims and regulators to investigate. No-fault insurers in New York have been allowed to refuse payment to practices that are actually controlled by unlicensed people, even when the services were provided.
Contracts and billing arrangements
Management services agreements, space and equipment leases, and marketing deals should be structured so that payments reflect fair value for services and are not tied to referrals or patient volume. Federal anti-kickback and self-referral laws apply when government programs are billed, New York has its own versions with their own reach, and private payers add contract rules on top. Enrollment with Medicare, Medicaid, and commercial payers requires accurate disclosures about ownership and management. Keep copies of all agreements and ensure that physicians retain control over clinical decisions, staffing, and finances.
Planning before you sign
We review proposed ownership structures, investor arrangements, and vendor contracts to identify risks before they become problems. We also help with entity formation, licensing questions, and payer enrollment issues, and we coordinate with accountants on financial arrangements. If you have already opened a clinic and are facing audits or claim denials tied to ownership questions, we discuss how to respond and whether restructuring is possible. The goal is a practice that can operate and bill with confidence. We also flag arrangements that resemble structures regulators and insurers have challenged before, so they can be changed while that is still simple.
