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.

In this premier episode of Group Practice with Neal Goldstein, Neal shares his background and how he got his start representing physician groups. He also discusses how he developed his expertise in the federal Stark law, which led to him teaching a law school course specifically on Stark. Neal lays out what to expect in future episodes, and explains why he chose the name Group Practice for the podcast. In addition, Neal discusses the thesis of the podcast, which is that private practice is very much alive, and can thrive if physician groups take a more strategic approach to structure and business. Neal’s goal for the podcast is to provide leaders of group practices with valuable information that will serve as a foundation for successful strategies.