Holland & Hart Healthcare Law Blog

Physician Recruitment Agreement Not Indemnification.

Hospitals recruiting physicians into a community frequently seek to place them into friendly practices. They agree to pay an existing practice group for any shortfall in income paid to the recruited physician and an incremental share of overhead for a period of time, usually for a year. The arrangement provides a site for the recruited physician to practice with a group of physicians who may serve as mentors to the physician. It is a way for hospitals to help support friendly physician practices by effectively recruiting members into their practice to accomodate growth in the practice or to replace retiring physicians. All support payments made in the first year are then reduced to a note obligation which is then forgiven on a pro rata basis over a number of years (usually ranging from 3 to 6 years) as long as the physician continues to practice in the community during the forgiveness period.  Sometimes for personal or financial reasons the physicians leaves the community before the forgiveness is complete and the hospital sues the physician to recover the balance on the note.  Sometimes the nesting group gets dragged into the litigation.

Indian Health Plans May or May Not Be Exempt From ERISA.

In Dobbs v. Anthem Blue Cross and Blue Shield, No 05-1319 (1-30-07), The Tenth Circuit Court of Appeals remanded the case to the District Court below to determine whether the plaintiffs’ Indian tribal health insurance plan was a “governmental plan” that is excluded from ERISA. The Dobbs brought a suit against Anthem in a Colorado district state court asserting five state law claims against Anthem.  Anthem responded by removing the state court case to a federal district court in Denver, asserting that ERISA preempted the state court claims.  The Dobbs argued that their plan, sponsored by the Southern Ute Indian tribe, was exempt from ERISA because it was a “governmental plan.”  Governmental plans for federal and state employees are exempt from ERISA.  There was no explicit inclusion of Indian tribal plans within the definition of governmental plans in the ERISA statute.

Foreign Docs Find Urban Route To Greencard.

It is rare to visit a rural hospital in America without encountering a physician of foreign birth, frequently with a strong foreign accent. As more and more American physicians reject the isolation of rural practice in favor of the perceived lifestyle advantages on urban/suburban practices, rural communities infill with foreign doctors on J-1 visas.  J-1 visas are allocated among the states.  The visa holds out the carrotof a green card for foreign doctors wanting to stay in the United States following their advanced medical training rather than returning to their country of origin for two years before application as would otherwise be required. After serving three years in a medically underserved community, a foreign physician is the eligible to directly apply for a green card.

According to a recent article by Miriam Jordan in The Wall Street Journal,("With A Quirck In Visa Law, Small Towns Loose Doctors.") (February 16, 2007), the flow of foreign doctors into rural communities has slowed dramatically because of the H1-B visa that was liberalized in 2000 to fill skilled professional and technical positions going vacant in the U.S. The h1-B does not require a three year period of rural "detention" for physicians like the J-1.