Prompt Pilotby Write.law
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Analyze

Screen an arrangement for Stark and Anti-Kickback risk

Runs Stark and the Anti-Kickback Statute as two separate analyses (a strict-liability exception check element by element, then an intent-based one-purpose analysis) and ends in a structuring or disclosure path, not a comfort letter.

About 35 minadvancedHealthcare, Regulatory

Your prompt5,377 characters

Still to fill in: The arrangement, The compensation formula, State law overlay

RoleYou are a healthcare regulatory lawyer who has structured physician compensation arrangements and unwound two already paid on. You run Stark and the Anti-Kickback Statute in separate sections: one is a strict-liability referral prohibition whose exceptions must be met in every element, the other an intent-based criminal statute with voluntary safe harbors. You will not let a memo say an arrangement fits a safe harbor and mean Stark.What I needScreen the arrangement below for Who you represent under federal law and State law overlay. Posture: Proposed: still fully structurable.InputsThe arrangement: The arrangement Compensation formula: The compensation formula State overlay: State law overlay Posture: Proposed: still fully structurable Client: Who you representHow to work this1. Run Stark to a conclusion before the Anti-Kickback Statute is named. The two never share a paragraph. 2. Work Stark as a sequence: a referral for a designated health service payable by a federal program; a financial relationship between the physician or an immediate family member and the entity; then the exception relied on, every element marked met, unmet, or unknown and cited to its regulation, marked [UNVERIFIED - confirm against the current CFR text] unless it is in my inputs. Intent is irrelevant: every element fits or the arrangement is prohibited. 3. Then run the Anti-Kickback Statute separately: name the remuneration flowing each way and apply the one-purpose test to the facts in The arrangement and The compensation formula. Safe harbors are voluntary: missing one turns the analysis to the facts, it does not make the arrangement unlawful. 4. Treat fair market value, commercial reasonableness, and volume-or-value as evidence questions under each regime. "FMV" with no valuation behind it is not a finding. 5. Add a short section for beneficiary inducement and the self-referral, fee-splitting, and corporate-practice rules in State law overlay. 6. End in a path, not a grade: what to change to satisfy an exception element for element, what to document, and if payments have been made, the disclosure question and what stops now.Ask me firstBefore you produce anything, ask me these questions, then stop and wait: 1. Does this involve a physician or immediate family member on one side and an entity furnishing designated health services on the other, and which DHS category? If none is involved, Stark drops out and we run only the intent analysis and state law. 2. What is the payer mix? If nothing here is reimbursable by Medicare, Medicaid, TRICARE, or another federal program, say so and we go straight to the state questions. 3. Give me the compensation arithmetic, not the label: does any component vary with the volume or value of referrals or other business between the parties, is it set in advance in a signed writing with a stated term, and is there a contemporaneous independent valuation, or are we reverse-engineering it? 4. What other financial relationships exist between this physician and this entity? Arrangements are assessed together, and the second agreement is usually the problem. Do not begin until I answer. If I tell you to proceed anyway, state each assumption at the top and mark it [ASSUMPTION - verify].Output formatTwo separated analyses headed STARK and ANTI-KICKBACK, each with its own conclusion; a Stark exception table marking every element met, unmet, or unknown with the document that resolves each; the one-purpose analysis with facts on both sides; the valuation evidence inventory; the adjacent-regime section; and a numbered path with owners. End with one line naming the two of my answers that most changed which regime carries the exposure and which elements you marked unknown, and what conclusion you would have written without them. If an answer changed nothing, say so. It means I should not have been asked.Never do this- Never call a Stark provision a safe harbor or an Anti-Kickback provision an exception, and never conclude that satisfying one regime satisfies the other. - If the analysis would fit any physician arrangement at any hospital, it is too generic. It turns on this formula and this payer mix. - No hedging filler. Cut "arguably," "it should be noted," and "this structure is common in the industry." Do not tell me to consult healthcare counsel. I am healthcare counsel. - Never invent a regulation, an exception element, a safe harbor condition, an advisory opinion number, or a salary benchmark. Anything not in my inputs is [UNVERIFIED - confirm against the current regulation]. - Where you do not know whether an element is satisfied, mark it unknown and name the document that answers it. Do not smooth a missing writing or valuation over with fluent prose. - Do not pad. If one exception is in play, analyze one. Length is not value.Before you answer- Did I finish Stark before naming the Anti-Kickback Statute? - Did I use "exception" only for Stark and "safe harbor" only for AKS? - Is every element marked met, unmet, or unknown, each unknown tied to a document? - Did I lay out the facts on intent rather than declaring a conclusion? - Would this memo fit a different arrangement? It should not.

Adds driver's-seat tunes: options instead of answers, questions before work, every citation flagged. Your values come with it.

2

Pressure-test it

Makes the AI switch hats and attack its own answer.

Read the memo twice more, from the two chairs that decide what it costs. First as the OIG attorney reviewing a self-disclosure submission, who has the payment ledger and the physician's referral volume for the same period side by side: name the two facts that make this look like an inducement and the sentence in my memo that reads as advocacy. Then as the buyer's regulatory counsel in diligence, who will price this as a contingent liability: tell me what number they put on it and what representation they will demand at closing.
3

Go deeper

Pushes the work further once the basics are right.

You have a payment scheduled and an arrangement that does not fit an exception. Build the remediation package: the amendment that brings the arrangement inside an exception element for element, with the time-log and documentation obligations written into the agreement rather than the file memo; the one-page instruction to the finance team on what stops and what continues before the next payment; and the outline of a disclosure submission (facts, period, payment total, corrective action) that we can hold in reserve without filing.

Before you run it

What to gather first

  • The draft or executed agreement, including every exhibit and any related agreement with the same physician
  • The exact compensation formula, including bonuses, stipends, and anything productivity-linked
  • Payer mix: whether any item or service is reimbursable by a federal program
  • Any fair market value opinion or benchmark data, with its date and who prepared it
  • Every other financial relationship between this physician and this entity

Watch for

  • Stark exceptions and Anti-Kickback safe harbors are amended regularly and their elements are unforgiving. Read the current regulatory text for every element before relying on any conclusion here. Do not accept an element list the model produced from memory.
  • Stark is strict liability. A well-intentioned arrangement that misses one element of one exception is prohibited, and the payment consequences run from the first tainted referral.
  • Missing an Anti-Kickback safe harbor does not make an arrangement unlawful, and fitting one does nothing for Stark. Any memo that blends the two conclusions will mislead the client precisely where it matters.
  • Every financial relationship between the physician and the entity is assessed together. Screening one agreement in isolation is the most common way these reviews go wrong.
  • If payments have already been made, this is a disclosure and repayment question with its own timelines, and the analysis should be run under privilege with the client's knowledge before anyone writes a conclusion down.

What comes back

Two separated analyses under headings STARK and ANTI-KICKBACK, each with its own conclusion; a Stark exception table listing every element as met, unmet, or unknown, with the document that would resolve each unknown; an Anti-Kickback one-purpose analysis setting out the facts cutting each way; an inventory of the fair market value and commercial reasonableness evidence; a short adjacent-regime section covering beneficiary inducement and state self-referral, fee-splitting, corporate-practice, and licensure rules; and a numbered structuring or disclosure path with owners and dates.

See an example of what you’ll get
*(After you answer the four questions, say, hospital furnishing inpatient and outpatient DHS, 62% Medicare, flat $95,000 with no time records, no independent valuation, and a second call-coverage agreement with the same physician.)* BOTTOM LINE. Stark is the exposure, not the Anti-Kickback Statute. The arrangement has been paid on for eleven months with no documentation that the services were performed, and the two agreements have never been assessed together. Stop the twelfth payment until the time-record question is answered. STARK *Step 1: Referral for a designated health service.* Yes. Dr. Rao refers to Lakeside for inpatient and outpatient hospital services; 62% Medicare. *Step 2: Financial relationship.* Yes. Direct compensation arrangement, plus a second compensation arrangement for call coverage. Both are assessed together. *Step 3: Exception.* The personal services route is the only realistic candidate. [UNVERIFIED - confirm every element against the current regulatory text before relying on this list.] | Element | Status | What resolves it | |---|---|---| | Signed writing | Met | Executed Jan 4, 2026 | | Covers all services; aggregate services do not exceed what is reasonable and necessary | Unknown | Time logs for Jan-Nov; there are none | | Term of at least one year | Met | One-year term stated | | Compensation set in advance | Met | Flat $95,000, fixed at signing | | Compensation is fair market value | Unknown | An independent valuation. $990/hour for administrative time is the figure a reviewer will start from | | Not determined in a manner that takes into account volume or value of referrals | Likely met | Flat annual fee, no productivity component | | Commercially reasonable | Unknown | Evidence the directorship duties exist and are being performed | | Aggregation with the call-coverage agreement | Not yet analyzed | The call agreement and its payment ledger | STARK CONCLUSION. Three elements unknown, and any one of them unmet means no exception applies and the referrals were prohibited from the first payment. This is not curable by good intentions. ANTI-KICKBACK STATUTE *Remuneration.* Hospital to physician: $95,000 annually plus $1,200 per call night. Physician to hospital: administrative services, if performed. *One-purpose analysis: facts cutting each way.* Toward legitimate purpose: the directorship predates the current referral pattern; the rate is flat and does not move with referral volume; the hospital has a documented need for a cardiology director. Toward inducement: no time records for eleven months; $990/hour against no benchmark; a second agreement with the same physician; and Dr. Rao is among the hospital's highest-volume referring cardiologists. Intent is a fact question and this memo does not resolve it; it identifies what a reviewer would put in front of a jury. *Safe harbor.* The personal services and management contracts safe harbor is voluntary and this arrangement does not clearly satisfy it on the documentation record. Missing it is not a violation and does nothing for the Stark analysis above. ADJACENT REGIMES. Illinois self-referral and fee-splitting statutes reach some arrangements federal law does not, and the corporate-practice doctrine bears on how the directorship duties are supervised. [UNVERIFIED - read the current Illinois provisions.] PATH. 1. Stop the December payment pending step 2. Owner: CFO, this week. 2. Reconstruct what Dr. Rao actually did each month from committee minutes, calendars, and email. Owner: medical staff office, 10 days. This single document decides the exposure. 3. Obtain an independent valuation of both agreements together, dated now, and a second opinion as of January 2026 if one can be supported. Owner: outside valuation firm. 4. Amend the agreement to require contemporaneous time records as a condition of payment. 5. If steps 2 and 3 do not support the elements, the question becomes disclosure and repayment, a decision for the client with the board, not a legal conclusion I make here. ASSUMPTIONS. That the call-coverage agreement is with the same hospital entity [verify - if it sits in a different TIN the analysis changes]. That no other financial relationship exists, including space, equipment, or a family member's employment [verify]. That the hospital is not part of a group practice arrangement that would change the analysis [verify]. What your answers changed. That there are no time records and no independent valuation is what put three elements of the table at unknown and produced the instruction to stop the December payment. With contemporaneous logs and a dated valuation already in the file, every element is met, this memo is two pages of documentation hygiene, and nothing stops. The second call-coverage agreement is what turned a single-arrangement screen into an aggregation problem; without it I would have analyzed the $95,000 alone, and the one-purpose section loses the fact a reviewer puts first. Your 62% changed nothing in the analysis. Stark turns on whether the services are payable by a federal program, not on what share of them is, and at 6% Medicare every row in that table reads the same. That number sizes the repayment, not the conclusion.
Why this prompt is built the way it is
## Framework 1. **Finish Stark before naming the Anti-Kickback Statute.** They never share a paragraph. 2. **Stark is a sequence.** Referral for a designated health service, financial relationship, then an exception that fits in every element or does not fit at all. Intent is irrelevant. 3. **AKS is intent.** Remuneration in each direction, then the one-purpose test. Missing a safe harbor is not a violation; it moves the analysis to the facts. 4. **Vocabulary is substantive.** Exceptions are Stark. Safe harbors are AKS. Swapping the words is a wrong answer, not a style problem. 5. **Elements are met, unmet, or unknown**, and every unknown names the document that would resolve it. 6. **Fair market value, commercial reasonableness, and volume-or-value are evidence questions**, tested separately for each regime. 7. **End in a path.** Structure it, document it, or disclose it, and if money has moved, say which agency's path and what stops before the next payment.