This episode of Group Practice with Neal Goldstein provides an overview of the Anti-Kickback Statute (AKS), a federal fraud and abuse law enacted in 1972 that applies to all federal healthcare programs. Unlike the Stark Law, AKS is an intent-based statute that prohibits knowingly giving or receiving remuneration to induce referrals for federally reimbursable healthcare items or services. The landmark United States v. Greber case established the “one purpose test”— if even one purpose of payment is to induce referrals, the statute is violated. Due to this broad interpretation, safe harbor regulations were created in 1991, protecting compliant arrangements from prosecution. The episode also discusses advisory opinions and the protection those afford. At the conclusion of the episode, Neal explains the “quid pro quo” concept which is at the core of AKS, and he uses a little league sponsorship analogy which was contained in the jury instructions of the TAP Pharmaceutical case.

In this episode of Group Practice, Neal Goldstein interviews Dr. Richard Harris, founding member and longtime CEO of Uropartners, about building one of the nation’s premier independent urology groups and the leadership principles behind its success. Dr. Harris recounts the challenging two-year process of merging 11 competing practices into a unified organization—overcoming distrust, strong personalities, and the independent nature of physicians. He discusses Uropartners’ strategic growth through high-quality ancillary services, including a centralized pathology lab, a dedicated urology surgery center, and a comprehensive Advanced Prostate Cancer Center. Each initiative was driven by improving patient care, operational efficiency, and clinical expertise. He also describes launching UroGPO to strengthen purchasing power and innovation across large urology groups, and his national leadership role with Large Urology Group Practice Association. The episode closes with Dr. Harris’s reflections on leadership: vision, integrity, humility, respect for all team members, and leading by example—principles that sustained Uropartners’ culture and long-term success in independent practice.

In this episode of Group Practice, host Neal Goldstein explains the federal Stark Law, the prohibition on physician self-referrals, one of the two major healthcare fraud and abuse laws governing physicians. He describes Stark as a complicated but important statute enacted in 1989 and expanded in 1993 to cover ten “designated health services” (DHS), including imaging, physical therapy, durable medical equipment, and hospital services. Neal emphasizes that Stark is technically a Medicare and Medicaid payment law, but it functions like a fraud and abuse statute because violations require repayment and may trigger liability under the False Claims Act. Neal breaks the law down into its core components as he did in the law school course he taught. He also discusses how Stark affects not just physicians, but also hospitals with the expansion of the law in 1993, making Stark a two-headed monster in the health care industry.

In this episode of Group Practice, Neal Goldstein explores the business case for physician group consolidation, distinguishing it from mere aggregation. True consolidation, he explains, involves full integration into a unified group practice—legally and operationally—rather than loosely affiliated practices sharing ancillaries. Neal outlines five primary advantages: (1) central business office efficiencies, allowing groups to hire specialized expertise in billing, revenue cycle, and managed care contracting; (2) increased negotiating leverage with insurers, hospitals, and vendors; (3) enhanced ability to develop and expand ancillary services under Stark-compliant group structures; (4) greater market share through branding, recruitment, and infrastructure investment; and (5) key intangibles, especially camaraderie and the sharing of best practices. He also discusses what gets consolidated—governance, tax ID, billing, financial reporting, and policies—and addresses challenges, including delayed financial rewards compared to private equity deals, administrative strain, cultural shifts, and managing expectations. Neal concludes with his “autonomy-growth” framework, arguing that well-structured group practice offers the optimal balance between autonomy and sustainable long-term growth.

In this episode of the Group Practice Podcast, Host Neal Goldstein interviews his brother, Dr. Wayne Goldstein, founder of Illinois Bone & Joint Institute (IBJI), which grew from 4 surgeons in 1 location in 1991 to 160 across 40 locations today. Dr. Goldstein talks about obstacles he faced early on in his career which motivated him to build an independent, physician-led musculoskeletal group. He also reflects on decisions he made in the infancy of IBJI which were key to IBJI’s success. Among those decisions were hiring the best and brightest out of fellowship, and rewarding quality and hard work versus seniority. The episode concludes with a memorable story of how Dr. Goldstein’s thought leadership in orthopaedic implant design led to his work with a baseball icon.

In this episode, Neal Goldstein explains how the federal Stark Law (physician self-referral law) shapes the legal definition of a group practice. Stark prohibits physicians from referring Medicare or Medicaid patients for designated health services to entities with which they have a financial relationship—unless an exception applies. The most common exception is the in-office ancillary services exception, which depends on meeting the statutory definition of a group practice. Goldstein highlights two key requirements: the unified business requirement (centralized control over assets, liabilities, billing, and financial reporting) and the single legal entity requirement. CMS makes clear that “loose confederations” or “group practices without walls” do not qualify; true groups must be medically and economically integrated, with interdependent financial interests. Beyond compliance, Goldstein argues that strong structure promotes long-term stability, unity, and competitive resilience. Integrated groups are better positioned to withstand market pressures and advocate effectively.