Medical Group Management Association
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The voice of medical practices in Washington

Engage with a team that advocates on your behalf and translates complex regulations into focused updates on the latest health issues from Washington.

Risk-sharing arrangements

42 CFR § 411.357(n) provides an exception for compensation pursuant to a risk-sharing arrangement (including, but not limited to, withholds, bonuses and risk pools) between a managed care organization or an independent physicians’ association and a physician (either directly or indirectly through a subcontractor)
  • This amount must be for services provided to enrollees of a health plan. 
  • The arrangement must also not violate the federal antikickback statute, or any law or regulation governing billing or claims submission.
"Health plan'' and enrollees'' have the meanings ascribed to those terms in other sections of the Medicare rules, specifically 42 CFR 1001.952(l).
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