Are you aiding in the unlicensed practice of medicine?

This podcast episode is all about the corporate practice of medicine. If you aren’t sure what that is, don’t worry. We are going to tell you. And while the corporate practice of medicine may sound complicated, it’s actually based on a simple idea – that medical practices should place patient welfare above profit. 

Click here to view the resources mentioned in the episode.

Host: Jean Fisher Brinkley, Communications Director, North Carolina Medical Board
Guest: Marcus Jimison, Deputy General Counsel, North Carolina Medical Board
Producer: Sylvia French-Hodges, Communications Specialist, North Carolina Medical Board

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Email your questions to:  podcast@ncmedboard.org.

Transcript

Episode 53 – Are you aiding the unlicensed practice of medicine?

Intro music: 0:00 

Podcast introduction: 0:10

This is Jean Fisher Brinkley, Communications Director for the North Carolina Medical Board and this is MedBoard Matters. This podcast episode is all about the corporate practice of medicine. If you aren’t sure what that is, don’t worry. We are going to tell you. And while the corporate practice of medicine may sound complicated, it’s actually based on a simple idea – that medical practices should place patient welfare above profit.  

My guest today is Mr. Marcus Jimison, the North Carolina Medical Board’s in house expert on all things related to corporate practice of medicine. Let’s get started. 

Interview with Marcus Jimison: 0:55
JFB: Marcus, welcome. Thank you so much for joining me on MedBoard Matters. 

MJ: Thank you. I'm glad to be here. 

JFB: So I wanted to ask if we could just start by having you introduce yourself and maybe talk just a bit about your role with the North Carolina Medical Board. 

MJ: Sure. I’m Marcus Jamison, I’ve been at the Board for 23 years. I'm an attorney. My official title is Deputy General Counsel. The board attorneys handle mostly enforcement cases. We review investigations. We give recommendations about investigations and if those investigations uncover a violation of the Medical Practice Act, we prosecute those cases. Part of being in-house counsel is you do many, many other things. For instance, I staff the Advanced Practice Providers and Allied Health Committee. And I also handle cases. Sort of the point person for what we're going to talk about today, this thing called the corporate practice of medicine. 

JFB: That's right. I was just thinking that as long as I've been here, you have been the go-to guy for all things related to the corporate practice of medicine. Now, some of our listeners may already know what that is, but some may not. So, could you define what we are referring to when we talk about the corporate practice of medicine? What does that mean? 

MJ: Yeah, in the most simplest terms it means who can own a medical practice. The corporate practice of medicine means that if a business is a medical practice, essentially when you go to the doctor, that business should be owned by doctors. It needs to be owned by licensees of the Medical Board. It's a way of keeping the conflict between profit and good medical care separate. So, the law in North Carolina is that if you practice medicine, you have to have a license to practice medicine. You got to go to medical school, take your boards, pass your boards, apply for a license, get a license. But then when you go to work, you can only work in business entities that are owned by doctors. There are a few exceptions to that that kind of get to make the corporate practice of medicine more complicated than the most simple thing that I just said. But for the vast majority of understanding the corporate practice of medicine, it simply means that if you're in the business of practicing of medicine, then the owners of that business have to be doctors. They have to be licensees of this Medical Board. 

JFB: Okay. Just to clarify a point, you said doctors have to own the practice, and then you also said a licensee of the Medical Board has to own it. Can it be a PA? Because the Board, of course, does license PAs as well as physicians? 

MJ: I kind of use doctor and licensee sort of interchangeably. A physician assistant can own his or her own practice, but there are even more sort of complicated considerations you have to take into account. But yes, a physician assistant can own her own practice. There's just other things that the physician assistant has to be mindful of if she does. 

JFB: Sure.

MJ: For instance, she can’t employ a doctor. You can only employ people who have an equal license than you, or people who are ancillary to your license and ancillary means people who help you carry out your profession like nurses, medical assistance, front office staff, billing people. Those are ancillary staff, but you cannot hire someone who has a greater license than you. 

JFB: Okay, so to avoid going deeper down that rabbit hole and getting into the nitty gritty details, we can maybe post some information on our website or on our podcast show page. You touched on this a little bit earlier when you said corporate practice of medicine exists to keep profit, and I think you said patient safety or patient care, separate. Can you talk a little bit more about why that might be important? Why does our state want to do that? 

MJ: Yeah. And before I'll sort of explain the public purpose of the corporate practice of medicine. It's good to understand that medicine is not the only profession that has this doctrine. Many other professions that touch on the public safety have this issue where you can't have corporations that are privately owned practicing their profession. My profession, law, is a good example. Non-lawyers cannot own law firms. So, the way the government and legislatures, policy makers view this is that if people who do not own a license practice a profession, then they will put profits above the ethics of that profession and they will put profits over good care. And we have seen that in North Carolina. So, the thinking is, is that if, say, Acme Inc. opened up a doctor's office and hired doctors, they might start telling doctors how to practice medicine. They'll tell doctors, you know, you need to see 20 patients or you need to see 40 patients per day. They won't hire nurses, but they will hire only people fresh out of school who aren't experienced. And when they get experience, they'll let them go. They'll push them to order more tests, because the more tests you order, the more profits you make. There will push doctors to provide unnecessary services again, because the more services you provide, the more profit you make. So, what you see is that when non-licensees, private individuals own medical practices, there's this tension between putting profit above what's good for the patient. So that's why the corporate practice of medicine doctrine came to be. It's also just simply an outgrowth of licensure. If I own the practice or you own the practice, then we don't have a medical license. But if we own a business, we're going to control how that business operates. 

JFB: Right. 

MJ: So, we're going to start telling doctors, even if we don't want to, even though we know they know their job better than we do, we still want to make money, and we're going to start telling them how to do their job. And we don't have a license. So, when we start doing that, when we start directing and telling doctors how to practice medicine, then we ourselves are engaged in the unlicensed practice of medicine. You know, we didn't go to medical school. We didn't take the test. But yet we were basically practicing medicine without a license. So, the corporate practice of medicine, basically, it's a recognition of two things. You have to have a license to practice medicine. And if you are engaged in a business that provides that service, then you also have to have a license. And that way we can control that. Whatever happens inside that business is one being controlled by a person who knows what they're doing, and two they're adhering to the ethics of a profession, which just means they're putting the interests of the patient first and not profit making first.

JFB: Well, thank you. I think that was very helpful analysis. And thank you for mentioning that it’s not just medicine, but it also applies to professions like law. So despite this, despite the fact that we have a law that says non-physicians cannot own medical practices, despite that, every year the Medical Board sees quite a few cases that involve violations of this law where we discover situations where a non-physician does in fact own and operate a medical practice. I actually looked up the numbers and it's been consistently between about 30 and 40 cases a year, where the primary subject of the case is a corporate practice of medicine violation. So, I was wondering if we could talk about what those cases look like. You know what is kind of the typical scenario or some typical scenarios and how our licensed physician or PA is involved?

MJ: Yeah, the typical case usually involves a complaint about someone being unhappy about the care they received, and it usually happens within a certain type of practice. And the reason it happens in a certain type of practice is because lay people who are not doctors, who want to get into medicine and make money, their typical markets that basically lend itself to the corporate practice of medicine. Med spas are a good example of that. Weight loss clinics. Male health clinics. These are clinics typically where insurance is not accepted. Some of these things are elective services like med spas and the non-licensee owner. The lay owner, the private owner, wants to start up a business. Well, they know they don't have a medical license. And, you know, a lot of these places prescribe drugs or use medical devices. So they hire a doctor or a physician assistant or nurse practitioner to basically provide the medical service. But they keep the money. So, when they open up their business and they advertise that they're in the market to hire a doctor or a physician assistant or a nurse practitioner, the licensee, the nurse practitioner, the doctor, the PA, they're looking through the want ads, they're looking through LinkedIn. They see a job opening. They say, hey, this is something that I would maybe like to do. I'm looking for a job or looking for a part time job to supplement my income. And they just show up like, you know, anyone else. They fill out an application, then they get an interview. They…they get offered a job, and they start practicing medicine. What they don't realize is that what you are basically aiding and abetting, you're assisting something that's illegal because most licenses, most doctors, most PAs, most nurse practitioners, they're not aware of the role that a business or entity has to be owned by a person who has a medical license. So, they take these jobs really without knowing. So, we get a complaint and we start investigating that complaint. And our investigator, the Board’s investigators are seasoned veteran investigators, many of them are ex-law enforcement, and they know about the corporate practice of medicine, and they start getting a little bit suspicious about, you know, what's going on here. So, they start asking questions like, who's your boss? Who runs this place? Who owns it? And when they get an answer that seems to suggest that it's not another doctor or another licensee, then they know they got a possible corporate practice of medicine violation. So that's kind of how these cases start. We get a complaint and sometimes it's a patient. Sometimes it's a disgruntled employee, sometimes it's a competitor. But however we get the complaint we look into it. Our investigators are like I said, they're…they're really smart. They're really well trained. And they have a good sense for this. I think some of their protocols is to ask, you know, who owns and operates this practice. So, they kind of sniff it out pretty quickly. Sometimes the complaint is just that, if a complaint comes from a competitor and they say, hey, you know, I'm a doctor, I own my own spa, and this med spa was being run by some layperson and I've heard something about this corporate practice of medicine, and I think they're violating it. So, you know, we'll open up the case on that. We know we'll look into it. So that's kind of how it typically starts. It's typically within those areas of medicine I mentioned before. You know a lot of it is self-pay lifestyle medicines. 

JFB: So, I'm familiar really only because of my work through the Board. And I certainly didn't know this before I came to work with the North Carolina Medical Board. But can you explain, you just described kind of how these situations work generally, but could you talk about the concept of straw ownership and what that means? 

MJ: Yeah, that's a big deal. Straw ownership comes from you know, the whole notion of a straw man, the straw man, as you know, it's a euphemism about that something isn't what it appears to be. It's just something put up front to make it look like a man, but it's not really a man, it's full of straw. So many of these people who open up these medical practices, sometimes they consult with attorneys, sometimes they consult with accountants or other business people. And what they find out is that, hey, you're not a doctor. You cannot own this. And, like, but I really want to, like, I really want to operate my own weight loss clinic or my own med spa or my own testosterone clinic. And they go to a lawyer and hopefully it's a, you know, an experienced health care lawyer. And they explain to them, you can't do this. So, then they said, well, how can I do it? And this is the struggle I have with people within my profession because they'll do this thing well, what will happen is that you will hire a doctor and we'll go ahead and create your business. You know, we'll call it North Carolina Med Spa, and it'll be yours. It'll be Jean’s Med Spa. And your lawyer will tell you if, say, I'm your lawyer, I will tell you, Jean, you can't own it. So what we're going to do is you're going to hire a doctor. You're going to hire Doctor Smith, and we're going to make, not only is Doctor Smith going to be the person who works in your med spa, but we're going to create a corporation on paper, and we're going to say that he is the owner of this med spa. But in reality, he's just an owner on a piece of paper. All the money goes into bank accounts controlled by you. You pay him a salary and whatever money is left over at the end of the day, that's money to you. You take all the profits. It's basically, for all intents and purposes, your med spa. But we made it look like Doctor Smith was the owner because we filed some paperwork with the Medical Board, we filed some paperwork with the Secretary of State's office that has Doctor Smith's name as the owner of a corporation, or what we call a PLLC, which stands for Professional Limited Liability Company, which is like a corporation. And that piece of paper is going to make it look like Jean's Med Spa is actually owned by Doctor Smith. So, he’s the straw man. You know, he's the owner. But when you look behind it, he's just filled with straw. He's not really a true owner. 

JFB: He's just employee. 

MJ: He’s really an employee. And, sometimes they're employees, sometimes they're not. Sometimes it’s that, you know, the practice is, most of the care is being provided by a PA or nurse practitioner. Then the doctor is there, supervising physician, but he has some connection to the practice, but he's not really a true owner. And when we start investigating what we suspect to be a straw ownership or, you know, basically a fraudulent owner, you start seeing all kinds of pieces of evidence that just completely support that conclusion. And if you like, I can talk about that at some point.

JFB: Yeah, I would be interested in hearing some of the stories. I know you've got to be a little bit careful not to use specific names and things, but I am interested in hearing about some of the situations that you're familiar with. 

MJ: Sure. When we have found corporate practice violations as a result of a straw owner, there's a couple things that we immediately ask that almost become smoking gun of straw ownership. One, we ask the straw owner, the doctor whose name is on the piece of paper, how much did you pay to buy this clinic, or how much money did you pay to start up this clinic? And the answer is almost always zero. We know that anything in this building with that says Jean’s Med Spa out front and all these lasers and medical devices and all the furniture and equipment and the light bill, the doctor, the owner who's on paper paid for zero of that. I mean, yeah, no money. If the straw owner is just a supervising physician and not an employee, normally that straw owner will be paid a monthly fee and is usually sometimes like $1000 or $2000 a month. Not something incredibly a lot, but it's essentially free money because not only is he being paid to be the straw owner, he's also being paid to be the supervisor of the person, the nurses, the PA’s. 

JFB: That are actually providing the services. 

MJ: That are actually providing the services. Exactly. But that supervision is typically non-existent. Many times when we found a straw owner, not only are they usually a supervising physician, they supervise remotely, meaning they don't work at the practice, and many times they haven't even been there. We have had several occasions where the straw owner has actually never been to the practice that he purportedly owns. One time we had a straw owner meet our investigator for an interview. You know, he's like, I want to talk to you about this practice you purportedly own. And a straw owner had asked for directions to how to get to his office. 

JFB: Little bit suspicious there.

MJ: Yeah. So the fact that, you know, if they pay nothing to the practice, the only money they get is a monthly stipend for whatever it is they're purportedly asked to do. And usually it's to supervise a physician assistant or nurse practitioner, what you find out is that that supervision is usually pretty lax or non-existent. It's not very stringent with supervision at all. It's certainly not day to day supervision. And then there usually there's these agreements in place between the straw owner and the actual owner, what's called a management service organization or MSO. And the MSO has an agreement called a managed services agreement or MSA. And that agreement also provides a lot of evidence that the manager is the true owner and not the doctor. Provisions that we look for is that who owns the medical records from any time they'll say that the practice were to close, then the medical records revert to the manager and not the doctor. All the bank accounts are in the manager's name. And one that I think is really, really important is that even though the doctor purportedly owns this practice, he cannot sell it unless he gets the manager's permission. So, imagine that you own something, you own a house, or you own a business. Let's say you own a barbershop, and you have someone who helps, you know, manage your books. You have a bookkeeper and you want to sell your barbershop to someone else. And the bookkeeper says, no, you have to get my permission before you can sell your own barbershop. Many of these agreements have such provisions. We call them restrictions on the transfer of shares. So, and basically saying like, hey, you can't sell this because one, you really don't own it, we own it. So, if you're going to sell it to somebody, it's going to have to be somebody who's acceptable to us. In fact, one very quick example of that. I thought, it's funny, I don't know, other people will see the humor as I did. But we had a person call in to the Medical Board. It was an office staff worker. The straw owner, for whatever reason, decides he doesn't want to be connected to this medical practice. It was really controlled by these other people who are not doctors. And so, he tells the people there, I'm done, I'm quitting. I'm no longer going to be your straw owner. I'm no longer going to be the supervising these PA’s. You're going to have to find someone else. So the office manager called the Medical Board and asked the following question. How long do we have to hire a new owner…to hire somebody?

JFB: I see the humor there. I don't know, we'll see how it translates to the general audience here. But yeah, I think you're drawing a pretty vivid picture of how when you scratch the surface, you can see that things are not quite right, especially too if you own a practice and you look at your books and you see, let's say it's $1,000 a month, is what you're getting paid. Your profit from the business you own is only $12,000 a year. That doesn't seem like a very smart investment. 

MJ: No. Well, it's truly not profit. We've seen cases and where we get the financial records when we investigate these cases, we get tax returns, we get business records. We get the agreements, we get communications, we get letters. And it could be hundreds and hundreds of pages. But you quickly can get a feel for it. And you quickly go to the bottom line, so to speak. And many times in the financial records we get, we'll see that a practice will bring in. I'll give you one example, over $1 million and the owner makes 12,000 a year, which as we know, is $1,000 a month. So, the owner's being essentially paid $1,000 a month just to put his name on a piece of paper. And the practice itself pays out hundreds of thousands of dollars in management fees. We had a practice that essentially it was a just three person practice, and we take all the salaries and the expenses. It reflected a professional salary, say close to a couple hundred thousand dollars. The management fees were at least three times that much. So, it costs $600,000, say for example, just to manage three people at this practice. 

JFB: Yeah. 

MJ: So all together we're making about $200,000 altogether. You know, between salaries and benefits and all that. 

JFB: Right. So what that actually represents is a lay owner taking profit out of the business. Is that right?

MJ: Yeah. Yeah. The lay owner is keeping most of the revenue for himself. 

JFB: Okay. So we've talked about how many if not most licenses are not aware of the corporate practice of medicine law that makes these sorts of business arrangements unlawful. But, I can't help but ask. I mean, shouldn't a licensee know that things are not kosher if they agree to an arrangement like this? I always think about it this way just if you're being paid $1,000 a month, what are you being paid for? And if it is as you described and you're not really providing bona fide supervision to the APS who are actually doing the work, you don't really own the practice. What are you being paid for? And I'm just curious, like in your experience, do the licensees have any idea that what they're doing is suspicious?

MJ: That's an excellent question. My personal take on that is they have to know, you know, it's that whole adage is too good to be true. You're getting paid $1000 or $2000 a month to basically do nothing. You're signing papers that you have no idea what you're signing, and it's connected to a medical practice. And if you're going to be a doctor and you're going to connect your license for this practice, there's responsibility that goes with that, you know? And, it's up to you. I mean, you're an educated professional. I know these folks say, well, I'm not business savvy, but you're savvy enough to know that if you're going to connect your license to a medical practice, you need to know what's going on there. You need to take some responsibility. You need to look, investigate it a little more than simply look the other way while you cash the checks. And so, there are times you want to feel sympathy for the doctor for not knowing about the corporate practice of medicine. We really don't fault doctors for not knowing about the corporate practice of medicine. We fault them when they do something patently unreasonable. And when you know you agree to be a supervisor of a PA or a nurse practitioner, you agree to associate your license with a medical practice, and you do nothing that can be demonstrably shown about having any oversight of that practice, and all you do is cash checks. Then you kind of lose that sympathy because my response to, you know, when they say, well, I'm not business savvy, right. Well, you're business savvy enough to know how to cash a check. 

JFB: I mean, I think Marcus this is really the crux of it right here, what we're talking about. Because really, you know, and this is maybe a little cynical, but what you're being paid for, if you're the licensee in one of these scenarios, you're not being paid to actually supervise anyone. You're being paid because you have a medical license. 

MJL Yeah.

JFB: Right. I mean, you're…you're leasing or you're renting the use of your medical license to this person who doesn't have one but needs one in order to satisfy this legal requirement, or they think they're satisfying the legal requirement. It's not quite the case. 

MJ: Oh, that's exactly it. That's, those are exactly the words that we use when we talk about this, when we're in the Board Room. Those are exactly the words we use that the straw owner is renting out his or her license so someone else can do something that they otherwise couldn't do. And that's when it becomes easier for the Board to take action. One thing we argue before the Board, when I'm in the Board Room discussing these cases, if we come across a true corporate practice medicine violation that involves straw ownership, many times we'll work with the people just to correct it. We'll give them a chance to solve it and correct the problem. So, when you talk about those 30 or 40 cases that we open up per year, where one of the allegations is corporate practice medicine, I think it's useful for people to know that those 30 to 42 cases a year are going to be broken down in a lot of different buckets. One bucket is that, you know, the violations aren’t true. I mean, it just might not be a corporate medicine violation because all we have is an allegation. We investigated it and then if there's not a violation, we just simply what we call accept the case as information and we close the file. If there is a violation, but it looks like people just don't know or we can solve it, and there’s nothing else bad going on, we will try to solve those cases privately. We will work with the parties to essentially bring them into compliance without imposing discipline on the licensee. Then we have one a bucket I like to call corporate practice of medicine plus one, and that's the kind of thing I've kind of adopted over the last 23 years working on these cases. It's that when you have a corporate practice of medicine violation and something else bad is going on like you see billing fraud, you see substandard care, you see dangerous practices. And we have seen those very things. When you have that corporate practice of medicine plus one, that plus one meaning some other bad thing, that's typically when we want to take public action. So the public action numbers are not going to be close to 30 to 40 public actions. 

JFB: Absolutely, that’s correct. 

MJ: And it's going to be a handful if, you know, if not a few per year. And usually we reserve that for not just the corporate practice of medicine violation, but something that's bad that's resulting from that corporate practice of medicine violation.

JFB: Right. So let's say the Board confirms yes, there's a corporate practice of medicine violation. What is the Board going to do to resolve that situation? 

MJ: Yeah. If there is if it's just a straight up corporate practice medicine violation, what we'll do is we'll write letters to the affected parties and tell them why we think there is a corporate practice violation here. We'll tell them to stop it or fix it or bring it into compliance. And we have seen things from well, we can't. So we just shut it down. You know, they literally closed a practice and that happens not infrequently. Another way is to empower the doctor who's a straw owner, to be more involved. They rewrite agreements, the doctor becomes more of a true owner, and then we follow up to check to see if that's actually the case. I'm working on one right now where, you know, we met with the attorneys for the affected parties, and they're rewriting agreements, and we hope that will solve the problem. So if it's just a simple corporate practice of medicine issue, we will try to fix it. And if it can’t be fixed then practice has to stop. 

JFB: I know I've seen or I've heard agreements discussed where if it can't be fixed, then the licensee is ordered to just disassociate themselves. Untangle yourself from this business arrangement and then the non-physician entity just has to stop operating that practice. 

MJ: That's exactly right. And that's actually the words that we use we…we…we use the term disassociate. You got x number of days to disassociate. Wound down the practice. So patients aren't abandoned and stop resisting the unlicensed practice medicine. And if they don't disassociate within a certain period of time we bring disciplinary charges. We have done that. We have done exactly that. And that's the tool that we can use as a disciplinary tool, which is they have to have a licensee to provide the services. And if the licensee doesn't disassociate him or herself with an unlawful practice, then the Medical Board can take action against her license. And we've done that. That's an infrequently used tool. Typically, people will try to avoid that. Yeah. So, there have been cases where, you know, we have done that. 

JFB: Right. I infer from your comments that if it's a situation where it's corporate practice of medicine violation and the plus one situation where there's substandard care or there's some sort of fraud going on, then the Board is also going to address whatever that other bad thing is.

MJ: Yeah. And those cases where corporate practices of medicine plus one, we're going to likely bring a public action, those practices are going to shut down. And the physician, she or he is going to have some type of public discipline on their license. So sometimes, depending on mitigating the aggravating factors, we might issue a non-disciplinary public letter of concern. So, there's a range for what the sanction is for the plus one depending on the aggravating and mitigating factors. But if it's a corporate practice of medicine plus one then there's going to be some public discipline. There was a case that we learned about from I believe from some bankruptcy, and this practice was being investigated for false claims by the federal government. And there was all kinds of false claims. And, I think that also had to do there was some aspect of controlled substances involved. And it turns out the practice was owned by a North Carolina physician who was a straw owner. And no one held that straw owner responsible for the false claims because the false claims were being submitted, basically without that straw owner's knowledge. But when the feds came in and did all what they were doing and the practice closed and went into bankruptcy, and we found out about it that straw on a public record, and it was, I would call it, you know, significant discipline. So, so, yeah, depending on how severe the plus one is, it can range from anywhere from a public letter of concern to loss of license.

JFB: And just to be clear, it can be pretty serious. I'm just imagining people listening, saying, what's the big deal? These are aesthetics practices or lifestyle medicine. It's nothing really dangerous, is it? But there have been plenty of cases where there was very real and pretty serious patient harm. 

MJ: Yeah, we don't see it as much now. I don't have an explanation for why. And hopefully the empirical, observational, anecdotal, since, you know, for the last few years is that you're not seeing corporate practice for medicine involving controlled substance and pain. There were pain clinics that popped up that had this corporate practice of medicine aspect to it. And of course, if there's substandard care involving controlled substances, you know, that's a serious public health threat. And so those cases get immediate higher level scrutiny, higher level attention to them. We haven't seen that as much here in the last several years as we did in the 2000s. And so what we're seeing more and more these days is, you know, like I said, the self-pay lifestyle, wellness practices. 

JFB: I mean, what I honestly, what I had more in mind when I'm thinking of, you know, there being sort of adverse consequences of the kinds of straw ownership arrangements you've been talking about. I'm thinking of things like people having, you know, reaction to a medication or getting burned by a laser for doing laser hair removal or things like that. So, you know, situations where you have non-physicians at the helm in these medical practices and really an absentee straw owner sometimes patients are harmed, they don't necessarily die. And it maybe it's not super serious but there is harm and there is risk.

MJ: Now we've seen that, there was a case early on that involved a fatality. And I believe the entity may not have been owned by a doctor, but you have seen when unlicensed people do procedures, especially procedures like cosmetic procedures and they're not trained, we have seen deaths in that and sometimes that involves, you know, like some topical anesthetic. Sometimes it involves some injectable, some cosmetic injectable, where the patient has some sort of systems failure as a result of it. And they don't know what to do. But those are just two cases from my recollection of 23 years that that have happened. And at my last Federation meeting in Nashville, I believe there was a presentation of these bad outcomes at one of these I.V. hydration clinics. So, yeah, hopefully those are rare, but they should never happen in the first place and should never happen by unlicensed and untrained people.

JFB: Right? I mean, that's what the law is there to, to supposedly deter and prevent. 

MJ: Yeah. No, no. That's it. That's yeah. That's exactly what, you know, you have licensure to begin with. So you can make sure that people who are practicing medicine are educated and trained to do so. 

JFB: And honestly, you know, one of the reasons that we wanted to do the podcast episode on this topic is that we want to help spread the word, we want to help educate our licensees about the risks of getting yourself involved. And one of these sounds pretty good, you know, you know, free money type of situations. Because if you find yourself being offered an opportunity to get free money, you should definitely be asking some questions. What's going on here? Is this legit? And that really leads me to sort of really the last few questions I had for you, which is what advice can you give to licensees who are listening to help them avoid getting mixed up in a bad business relationship like this? And what are some of the red flags that they should be looking for? 

MJ: Yeah, the first red flag is what we discussed before. If something looks too good to be true, it probably is. And if you're getting paid for essentially no work whatsoever and they're having to sign documents because they need a doctor with a license to sign this document, that is the biggest red flag out there, and the best advice you can give such a person is to consult with an attorney. You know, you can call the Board. We can explain what the corporate practice of medicine is. We can't give you personal advice, but we can tell you that there's lots of experienced lawyers out there who do this work. And we would encourage them to consult with a private attorney before agreeing to some sort of arrangement where it looks too good to be true, where you are getting paid essentially to do nothing. You know, just ask questions, who owns it. And licensees, when they go to medical school and, you know, then they do a residency and they pass their boards, they went to medical school to be a doctor, you know, most people go to medical school to be a traditional doctor. You know, when they're all said and done, they just want to work and see patients and take care of people. And they have an idea of what those practices look like. These are medical practices owned by doctors or associated with big health care systems and hospitals. And those are the kind of employers that are completely legit. When you kind of go onto social media, alternative media like Craigslist, and you're seeing job postings for something that doesn't seem to be in line with your concept about what traditional medicine usually looks like, that's where you need to start asking questions. And, you know, one of the things that we've seen, this is, a little bit off topic, but, you know, these matchmaking firms for PAs and nurse practitioners, physician assistants, you know, you sign up for one of these organizations and says and they they're very up front, for $2000 a month, you agree to be a supervisor or, some nurse practitioner who you've never met, who doesn't live anywhere close to you. Sometimes it's out of state. You just happen to have a license in that state, and you agree to supervise someone who you've never met. That's another huge flag.

JFB: Well, Marcus, this has been so interesting, and I hope it will be really helpful for our licensees and for the general public. I just wanted to close by thanking you for your time and your expertise, and just to offer you the chance, if there's anything that I have not asked you about, about this topic of corporate practice of medicine, now's your chance. You know, any final words? 

MJ: Now, we do have a position statement on it, so, you know, go to the Board's website. There's a lot of information on the Board's website about the corporate practice of medicine. You know, you can research our disciplinary cases, you'll see those. And if you have any questions, just call us. We get these phone calls all the time. And we'll always be happy to talk to you about it. 

JFB: Great. Thank you again. 

MJ: Thank you.

Episode closing: 40:29

That brings us to the end of this episode of MedBoard Matters. I think Marcus did an outstanding job of making North Carolina’s corporate practice of medicine law easy to understand, and I hope you agree. If you would like to learn more, visit our show page at www.ncmedboard.org/podcast. 

We have posted a link to the medical board’s position statement on the corporate practice of medicine, as well as a link to the statute itself. The statute lists the specific combinations of professionals who may lawfully partner with physicians to form a professional corporation that provides medical services. 

Now, while the medical board cannot provide legal advice, the Board strongly encourages any licensee who is considering a business opportunity to do their due diligence.

If a deal seems to offer you compensation for little or no work, that should be a big red flag. If you’re offered the chance to own a practice without investing any money, ask yourself if that makes sense. Before signing anything, it’s worth hiring a knowledgeable attorney to check out the deal and make sure it’s legit. Remember, if it looks too good to be true, it probably is. 

If you have comments, questions, concerns, or suggestions, send an email to us at podcast@ncmedboard.org. Thank you for listening and I hope you will join me again.