What Is Concierge Medicine?
Concierge medicine, also known as boutique medicine, retainer medicine, or direct primary care (DPC), is a membership-based healthcare model in which patients pay an annual fee, monthly retainer, or access fee for enhanced patient care. Unlike traditional fee-for-service systems that rely heavily on third-party payers or insurance reimbursement, concierge medical practices limit the number of patients they serve and focus on providing same-day appointments, extended consultations, physical exams, and direct access to the concierge doctor.
This concierge model can take different business structures, including hybrid models where physicians may still accept insurance or Medicare for covered services, while offering premium concierge services through a retainer fee. Many physicians are turning to concierge and direct primary care models to enhance the quality of care, reduce administrative burdens, and build a more sustainable medical practice.
For primary care physicians, the shift to concierge medicine is driven by a desire to escape insurance-driven constraints and focus more deeply on patient care. With fewer administrative tasks, reduced patient panels, and predictable income through annual membership fees, physicians in concierge practices can provide more personalized attention and spend more time with each patient.
Common Concierge Medicine Legal Issues
Transitioning to or operating within a concierge medicine or direct primary care model offers greater flexibility for physicians and more personalized care for patients. However, this innovative approach introduces unique legal issues and ethical considerations that require attention.
They include:
- Fee-for-Service vs. Insurance Conflicts: Navigating when and how to accept insurance, bill for covered services, or engage in balance billing is critical to avoiding issues with federal payors, state insurance laws, and enforcement authorities.
- Anti-Kickback & Stark Law Compliance: Concierge arrangements that involve fee splitting or referrals must comply with federal laws such as the Anti-Kickback Statute and the Stark Law.
- Telemedicine Laws for Concierge Doctors: Many concierge services include virtual visits or remote clinical services. Your concierge practice must comply with telemedicine laws, including licensure, prescribing rules, and HIPAA compliance.
- Corporate Practice of Medicine (CPOM) Restrictions: States with strict corporate practice of medicine doctrines may limit who can own or invest in a concierge medical practice. Understanding the right business structures is vital to ensure compliance and avoid regulatory action.
- Patient Abandonment & Professional Liability: Transitioning from a traditional to a concierge model raises risks of patient abandonment, especially for non-concierge patients. Proper structuring and communication are essential to prevent liability and uphold the attorney-client relationship with your healthcare law firm.
Who Are Concierge Healthcare Attorneys?
Concierge healthcare attorneys are legal professionals who specialize in the regulatory, compliance and business challenges that come with launching and operating a concierge medical practice. These experienced attorneys understand the legal nuances of retainer-based, direct primary care (DPC) and boutique medicine models, especially when it comes to access fees, insurance regulations, fee splitting, HIPAA compliance, and the corporate practice of medicine.
A concierge medicine lawyer can help you choose the right business structure to comply with state laws and avoid CPOM violations. They will also assist in drafting legally sound membership agreements and retainer fee disclosures.
Furthermore, concierge healthcare attorneys will help you navigate complex federal rules like the Anti-Kickback Statute, Stark Law, and balance billing concerns. Working with a knowledgeable healthcare law firm ensures your concierge services are both profitable and compliant, giving you peace of mind and the freedom to focus on patient care.
What Services Do Concierge Healthcare Attorneys Offer?
Launching or operating a concierge medicine practice requires navigating a complex web of legal issues, insurance regulations, and state and federal healthcare laws. Here are the core legal services that a concierge medicine lawyer typically provides:
- Practice Formation and Structure: Concierge medicine lawyers assist with the legal formation of your concierge medical practice, including choosing the proper business structure, registering the entity, drafting internal governance documents, and ensuring compliance with state laws and the corporate practice of medicine (CPOM) doctrine.
- Contract Negotiation and Review: They draft, review, and negotiate legally sound contracts with patients, management companies, vendors, and other third parties. This includes patient retainer agreements, access fee disclosures, and terms of concierge services.
- Compliance Counseling: Concierge healthcare attorneys advise on federal and state healthcare compliance, including the Anti-Kickback Statute, Stark Law, fee splitting, and HIPAA privacy and security requirements.
- Risk Management: They are involved in identifying and mitigating legal risks that come with operating a concierge practice, such as professional liability, patient abandonment, and regulatory violations. Your attorney can help prevent issues before they arise and protect your concierge medical business from costly mistakes.
- Representation in Disputes: It is their duty to provide legal defense and advocacy in the event of contract disputes, regulatory actions, or claims involving medical errors, insurance billing, or compliance failures.
- Navigating Insurance and Billing: They will help you understand how to manage insurance law concerns in a concierge model, including whether and how to accept insurance, handle Medicare and Medicaid, and avoid pitfalls related to balance billing or covered services.
- Transitioning to Concierge Medicine: These lawyers guide physicians through the legal, operational, and compliance steps involved in moving from a traditional or non-concierge practice to a concierge medicine or DPC model, while avoiding disruptions to patient care or exposure to liability.
How to Start a Concierge Medical Practice Legally
Starting a concierge medical practice involves careful legal planning to ensure compliance with both state laws and complex federal healthcare regulations. One of the first steps is choosing the right business structure for your practice. Depending on your state and professional licensing requirements, this might mean forming a Professional Corporation (PC) or a Professional Limited Liability Company (PLLC). These structures not only provide liability protection but also help ensure compliance with corporate practice of medicine (CPOM) restrictions that prohibit non-physicians from owning or controlling certain aspects of a medical practice.
Next, it’s essential to draft clear and enforceable patient agreements that outline the scope of your concierge services, what the retainer fee or annual membership fee covers, and how services differ from those billed to insurance or federal payors like Medicare. These agreements must be transparent about what constitutes covered services, avoid deceptive language, and comply with insurance regulations and ethical considerations.
Another critical component is structuring your pricing model in a way that avoids running afoul of regulatory risks. This includes carefully navigating laws related to HIPAA compliance, patient privacy, and potential violations of the Anti-Kickback Statute or Stark Law, especially if you’re offering additional services beyond the basic concierge model. You’ll also need to determine whether your practice will operate as a direct primary care (DPC) model that forgoes insurance entirely, or a hybrid model that accepts insurance for covered services while charging a separate access fee.
Why Choose Cohen Healthcare Law Group?
At Cohen Healthcare Law Group, we combine deep knowledge of healthcare regulations, insurance law, and business formation with a practical understanding of how modern concierge practices operate. Our attorneys bring decades of experience at the intersection of medicine, law, and compliance, and we stay ahead of the curve when it comes to evolving models like direct primary care, retainer-based care, and boutique medicine.
What sets us apart is our commitment to crafting a personalized legal strategy for your unique concierge model. We don’t believe in one-size-fits-all legal advice. Whether you’re building a practice around same-day appointments, telemedicine services, or a hybrid of insurance and membership-based care, we tailor our guidance to fit your operational and compliance needs.
We’ve advised hundreds of physicians, nurse practitioners, medical groups, and healthcare entrepreneurs across the country, and our clients routinely praise us for our clarity, responsiveness, and ability to demystify complex legal concepts. Our strong reputation is built on real-world results and long-term relationships with practices that trust us to help them avoid legal pitfalls and succeed with confidence.
Additional reasons to work with us include a proactive risk management approach that helps you prevent regulatory problems before they arise. We also provide ongoing support beyond formation, including contract negotiation, licensing, regulatory compliance, and dispute resolution
FAQs
If you’re considering launching or growing a concierge medical practice, you likely have questions about legal, operational, and compliance matters. Below are some of the most common questions we hear from physicians, healthcare entrepreneurs, and practice owners:
How Do I Find a Good Concierge Medical Practice Consultant?
Look for consultants with proven experience in concierge medicine, direct primary care models, and healthcare compliance who understand both clinical operations and legal risk. A strong consultant should collaborate closely with your attorney to align your business structure and services with regulatory standards.
How Much Do Concierge Medicine Lawyers Cost?
Costs vary based on the scope and complexity of your needs, but most concierge medicine lawyers work on flat-fee packages or hourly rates for services such as entity formation, contract drafting, and compliance review. At Cohen Healthcare Law Group, we offer custom pricing based on your practice model and legal goals.
What Legal Issues Should I Consider Before Launching a Concierge Medical Practice?
Before launching, you’ll need to consider legal issues such as corporate structuring, fee arrangements, state-specific laws on membership models, HIPAA compliance, and marketing practices. It’s also critical to ensure your services fall within your licensed scope of practice and don’t trigger insurance or regulatory violations.
Once again, the arrangement must be structured carefully by an attorney well-versed in corporate practice of medicine, fee-splitting and kickback laws, insurance law, and other legal rules, so that the transaction passes legal muster and is legally compliant.
FAQ
Great! Let us know and we’ll do a conflicts check and then send you an engagement letter. Typically we want to know if we are going to represent you as an individual, or your entity (corporation or LLC); we’ll also want to know your website and some basic contact information.
Review our legal services to see some of the areas we like to work in; check our testimonials, client roster, and experience; read some of our blog posts; check out our Linked In community; or just call or email us to explore. Put simply, we represent health and wellness products, technologies, practices and ventures that accelerate health and healing.
We are very comfortable working with clients via phone and email. You can sign, scan and email the engagement letter, and submit the advance by check or online.
The answer depends on the complexity of the project. Each client’s situation is different. We want every client to receive the best possible advice, and so we want to be in a position to devote as much time as is required to do that. Look to our testimonials, client roster, and experience. We work with our clients effectively and efficiently and build long-term relationships based on mutual trust. We bill hourly and do not offer project or flat fees. Lawyering is an art, not a science – we’re intuitive as well as skilled lawyers.
Yes, like most law firms, we require an advance against fees and costs. Our typical advance ranges from $3,500 – $10,000. We offer our expertise and savvy and work hand-in-hand with you toward your goals. Occasionally, we will offer you a one-hour consult as a way to jump-start our work together, and give you an overview of critical issues, with guidance on the critical business cross-roads you’re facing. We do not take equity or deferred compensation.
Our Firm doesn’t quite “quotes” or answer “how much does it cost.” Through long experience, we’ve found that the answer is pretty much meaningless. Some lawyers and law firms give quotes, but if you read the accompanying disclaimer, you’ll see that the disclaimer basically says that you can’t depend on the quote for anything. In our long experience, “how much it costs” depends on a lot of variables, including:
- What the client is asking for
- What the client really needs
- What the client doesn’t know they don’t know
- What we discover as we dive into the legal research and analysis
- How complicated the problem really turns out to be
- How much client will want to do on their own
- Whether we can find some elegantly simple solutions to sub-parts of the puzzle
- What decisions we make together, and separately, as we explore the puzzle and put solutions and strategies together
In many cases, we might think a project is very complex but then as dig in, we can make executive decisions and recommendations that save the client dozens of hours of lawyer time and tens of thousands of dollars. This happens a lot with our clients. In other cases, the client might think the problem is simple but as we start to review it, the puzzle is much larger; sometimes the client throws in extra facts and complications at the last minute, and that will increase the expense and work; sometimes we’ll give the client “homework” so they can DIY a piece, taking it outside the need for lawyer time.
One thing we do is get our clients frequently on the phone. We find that the Legal Strategy Session often cuts through the fog. Where we need to do a chunk of written legal work, we’ll do so and let you know that’s what we think is needed. Where we can be more efficient with a call, we’ll tell you that as well.
Many clients come us after having wasted tens of thousands of dollars with other lawyers. Read our testimonials. We’re here to provide a lot more value than the retainer—our business model and Firm policy is to provide at least 3-5 times the value back to you. That’s our model and we’re sticking to it. We’re not trying to sell you on a “cheap retainer” or promise of discounts. We’re here to solve a big hairy problem and get you where you need to go, as efficiently and productively as we can.
Typically, assessing feasibility involves legal and strategic advice, which we provide in the 45-minute consult, in a way that is appropriate to the time we have together there.
The only way to know is to jump into the process. If you want to know more about us and how we work, browse our testimonials, look at our client rolodex, or review our experience on our website.
Work with us and find out how efficient and engaged we are with your business. We like to work with clients for life. It is a deep and trusting relationship.
Michael’s bio is online here. He has written books on healthcare law and policy, taught healthcarelaw as a faculty member at Harvard Medical School, garnered NIH and other medical research grants, and published over 100 articles in legal and medical journals. Michael speaks all over the world on healthcare topics.
