Why exceptions exist
Congress recognized that some financial relationships between physicians and entities they refer to are legitimate if structured carefully. CMS regulations define dozens of exceptions with specific requirements.
Common exceptions
In-office ancillary services, bona fide employment, fair market value compensation, and personal services arrangements appear frequently in hospital and group practice compliance programs.
Documentation matters
Meeting an exception on paper is not enough — hospitals must maintain contracts, fair market value analyses, and logs showing services actually performed. Failures here fuel FCA cases.
When exceptions fail
Insiders who see arrangements that do not match their exception paperwork — or that exist only to funnel referrals — may have information worth discussing with qui tam counsel.