CPOM compliance: the operating test
The operating test
CPOM compliance means clinical care runs through a physician-owned Professional Corporation, the MSO is paid fair market value for non-clinical services, and lay owners do not exercise de facto control over medicine. Buyers reconstruct that in the data room; payers sample the claim TIN. Pair CPOM compliance with the CPOM 50-state guide, including new operator pages for Oklahoma, Alabama, and Arkansas. Foundry formation is $15,000 one-time; a friendly PC owner is $3,000 per month.
How do I make sure my MSO and friendly PC are CPOM compliant?
Use this five-point checklist before you scale or sit diligence. Pair it with the CPOM 50-state guide for each patient state.
- Licensed physician owns the PC. Clinical care runs through a physician-owned Professional Corporation. A friendly PC owner (physician owner of your professional corporation) is $3,000/mo when you need that role.
- MSO paid at fair market value. The management services agreement covers non-clinical services only, with a fixed or cost-plus FMV fee, not a percentage of clinical collections as the primary fee.
- No lay de facto control. Lay owners and investors do not hire clinicians, set protocols, or override medical judgment.
- Clean funds flow. Patient or payer pays the PC; the PC pays the MSO on invoice. Buyers sample one claim from payer to PC bank to MSA invoice.
- State map + paper trail. Open each patient state on the CPOM 50-state guide, then keep shareholder, MSA, and bank records ready. MSO-PC formation is $15,000 one-time.
Operating test versus doctrine map
CPOM compliance is the operating test. A CPOM 50-state guide is the doctrine map. They answer different questions. Use CPOM compliance for funds flow, MSA fees, CCI, and how buyers and payers check the file. Use the CPOM 50-state guide for posture, typical structure, notice overlays, and deep .gov pages. Formation is $15,000 one-time; a friendly PC owner is $3,000 per month.
| Question | CPOM compliance | CPOM 50-state guide |
|---|---|---|
| What it answers | Is the file real? Physician-owned PC, FMV MSA, no lay de facto control | Which statute and board apply in each state you treat |
| Where to find it | /cpom-compliance | /cpom/ |
| Who uses it first | Buyer diligence, payer credentialing, CCI / funds-flow review | Operators mapping a footprint before they form |
| What it is not | A Yes/No 50-state blog or a PDF stamp | A plug-in national PC |
In plain terms
- Clinical care runs through a physician-owned Professional Corporation, not a lay-owned corporation practicing medicine.
- The MSO is paid fair market value for non-clinical services under a clean management services agreement.
- Lay owners and investors do not exercise de facto control over clinical hiring, protocols, or medical judgment.
- Buyers sample the data room. Payers sample the claim TIN. Neither is a date stamp on a checklist. See the CPOM 50-state guide.
CPOM compliance is the operating test: physician-owned PC, MSO at fair market value, no lay de facto control. Diligence teams and credentialing teams actually check that file. It is not a recycled checklist.
Book a CallContents
- The operating test
- MSO and friendly PC checklist
- Operating test versus doctrine map
- Ownership, MSA, and control
- Funds flow
- FMV and funds-flow examples
- Operator decision tables
- Fee-risk table
- SB 351 and SB 951
- Limited and Moderate states: Oklahoma, Alabama, Arkansas, Idaho, New Mexico, Hawaii, Delaware, Maine, Nebraska
- Operational checklist (14 steps)
- PC owner vs medical director vs collaborating physician
- Fixed vs cost-plus vs percentage MSA fees
- Clinical-compliance infrastructure (CCI)
- Common mistakes
- Enterprise value and diligence
- How a buyer actually checks the file
- How a payer actually checks the file
- Downloadable checklist PDF
- How Foundry helps
- Sources and citations
- Multi-state telehealth
- FAQ
Ownership, MSA, and control
Corporate Practice of Medicine rules limit who can own and control a medical practice. CPOM compliance means clinical care runs through a physician-owned Professional Corporation, the management company (MSO) is paid at fair market value for non-clinical services, and non-physicians do not own the practice of medicine or exercise de facto control over clinical decisions.
That is different from a medical-director title on paper while lay owners still dictate care. Auditors, payers, and buyers look for real clinical ownership, clean MSAs, and separate corporate formalities. Speakable definition: CPOM compliance is physician ownership of the clinical entity plus an MSO paid fair market value and no lay de facto control, proven the way a diligence team and a credentialing team actually check the file, not by reprinting a checklist date.
Recommended path: start here for CPOM compliance, then the CPOM 50-state guide for doctrine by state, then the MSO-PC structure setup guide to form an MSO-PC.
Funds flow
CPOM compliance is easier to audit when money matches the org chart. Clinical collections belong to the PC. The MSO gets paid for defined administrative work. A Moderate label (South Carolina, Connecticut) or a Limited label (Utah, Missouri) or a Nuanced label (Kentucky) does not move the claim TIN onto the MSO. Buyers still sample one claim from payer to PC bank to MSA invoice.
If the MSO sweeps the lockbox, sets visit quotas, or pays clinicians off its own payroll while calling them “PC employees,” buyers will treat the split as cosmetic. See the MSO-PC structure & setup guide.
FMV and funds-flow examples
Use these as operator examples, not as filed opinions. Prices stay Foundry's published $15,000 formation and $3,000/mo PC owner. Confirm MSA pricing with counsel and a valuation memo when volume changes.
| Example | Cash path | Why it passes a buyer sample | Fail signal |
|---|---|---|---|
| Cash-pay telehealth, one state | Patient card → PC merchant account → PC pays fixed FMV MSA invoice to MSO | Claim/cash TIN sits on the PC; MSO invoice lists non-clinical services | MSO lockbox; clinicians paid by MSO while marketed as PC employees |
| Payer-billed multi-state | Payer → PC bank → PC pays FMV admin fee; each patient state has a licensed owner story | One sampled claim traces payer → PC → MSA invoice | Marketing MSO TIN on the claim; one rented Super PC for the map |
| Cost-plus shared vendors | PC reimburses documented EHR / billing / facilities at cost plus a modest markup | Clinical payroll stays in the PC; markup is scoped and memo-supported | Clinical costs buried inside an opaque MSO "platform fee" |
| % of collections MSA | Avoid as the primary management fee | N/A for base case | Looks like a share of professional fees in many states |
Operator decision tables
Two tables founders actually use in diligence. Pair with the CPOM 50-state guide for doctrine labels.
| Question | If yes | If no |
|---|---|---|
| Do lay owners want equity upside outside clinical control? | Put equity in the MSO; keep the PC physician-owned | Still separate clinical vs admin if you will raise or sell |
| Do patients sit in more than one state? | Form for the footprint; match a 50-state PC owner when needed | Still document FMV MSA and claim TIN on the PC |
| Is the state label Limited or Moderate? | Do not skip CPOM compliance; buyers still sample the file | Strict / Nuanced states need the same operating test plus tighter statute reads |
| Is the MSA a % of professional collections? | Rewrite to fixed or cost-plus FMV with a memo | Revisit FMV when volume or services change |
| Diligence artifact | Who owns it | Foundry path |
|---|---|---|
| Physician shareholder ledger | PC | Friendly PC owner ($3,000/mo) |
| MSA + FMV memo | PC ↔ MSO | MSO-PC formation ($15,000) |
| Claim TIN / group NPI | PC | Keep off the marketing MSO |
| Protocol / formulary authority | PC medical leadership | See CCI section below |
Fee-risk table
Fee-splitting rules differ by state. This is a founder risk map, not a statute chart.
| Pattern | Risk | Safer pattern |
|---|---|---|
| MSA fee = % of clinical collections | High: looks like a share of professional fees | Fixed or FMV-supported admin fee with a memo |
| MSO “rents” the PC for a revenue share | High: rent-a-PC / Super PC story | Your PC, your owner, scoped states. See why not a Super PC |
| Physician stipend tied to referrals or volume | High: kickback / fee-split overlay | Fixed FMV ownership stipend |
| MSO pays clinicians and “assigns” them to the PC | High: de facto employment by the lay company | Clinicians contract with the PC |
| Pass-through of clearly non-clinical costs at cost | Lower if documented | Still keep the MSA scope tight |
| FMV management fee + separate PC bank | Base case | Revisit FMV when volume or services change |
SB 351 and SB 951 callouts
California: SB 351 and AB 1415 (effective 1 January 2026). SB 351 targets PE/hedge-fund interference with physician or dentist professional judgment and certain control rights. AB 1415 expands healthcare transaction notice to more MSO and investor deals. If California is in your footprint, strip “MSO may replace the physician for any reason,” keep coding and clinical hiring in the PC, and plan notice periods before a sale. Detail: California CPOM and AB 1415 / SB 351 guide.
Oregon: SB 951 / ORS 58.375-58.376. Among the strictest 2025-2026 CPOM statutes: physician majority, limits on MSO (and MSO-affiliate) ownership or control of the professional entity, and narrower stock-transfer continuity tools. New arrangements face a 2026 timeline; many existing ones a 2029 deadline. Mental-health exemptions exist in the legislative record. Do not assume they cover your model. Detail: Oregon CPOM / SB 951.
The CPOM 50-state guide matrix lists posture and typical structure for all 50 states and D.C., with deep pages for key states.
Limited and Moderate states: Oklahoma, Alabama, Arkansas
A Limited or Moderate label on the CPOM 50-state guide is not a waiver of CPOM compliance. Buyers still sample the data room. Payers still sample the claim TIN. Three high-intent pages were matrix-only until 21 September 2026 and now sit at operator depth with official .gov cites.
Oklahoma (18 O.S. § 809 / 59 O.S. § 492). Limited. § 809 still limits who may hold an interest in a domestic professional entity. 2025 OK AG 16 quotes that licensed-owner rule. § 492 licenses who may practice allopathic medicine. The 2024 SB 620 foreign-entity clause is not a startup waiver. Deep page: Oklahoma CPOM.
Alabama (Ala. Code § 10A-4-3.01 / r. 540-X-9-.06). Limited. A domestic professional corporation may issue shares only to a qualified person. Ala. Admin. Code r. 540-X-9-.06 requires independent medical judgment not subject to unlicensed control. Birmingham diligence still wants a physician-owned PC plus an FMV MSA. Deep page: Alabama CPOM.
Arkansas (A.C.A. § 4-29-307 / § 4-29-309). Moderate. Officers, directors, and shareholders of a medical corporation must be licensed; unlicensed persons may not own, manage, or control it. § 4-29-309 is the Arkansas State Medical Board certificate. SB 262 (2025) is proposed session language, not a digital-health waiver. Deep page: Arkansas CPOM.
Idaho (Idaho Code § 54-1804 / Board 2016). Limited. Worlton v. Davis is the historic case. The Board of Medicine disavowed classic corporate-practice discipline in March 2016. § 54-1804 still licenses practice. Deep page: Idaho CPOM.
New Mexico (NMSA § 53-6-4 / § 53-6-9). Limited. Professional Corporation Act share rules plus the Medical Practice Act. Deep page: New Mexico CPOM.
Hawaii (HRS § 415A-9). Limited. Professional Corporation Act share restrictions plus HRS ch. 453 licensure. Deep page: Hawaii CPOM.
Delaware (8 Del. C. §§ 605 / 610). Limited. Professional Service Corporation Act licensed-shareholder rules. A Delaware HQ does not cover other patient states. Deep page: Delaware CPOM.
Maine (13 M.R.S. §§ 734 / 741). Limited. § 734 requires professional services through licensed individuals. § 741 limits who may hold professional-corporation shares. Title 32 ch. 48 still licenses medicine. Portland diligence still wants a physician-owned PC plus an FMV MSA. Deep page: Maine CPOM.
Nebraska (Neb. Rev. Stat. §§ 21-2202 / 21-2208). Limited. § 21-2202 defines a professional corporation as one whose shareholders are licensed to render the same professional service. § 21-2208 restricts share issuance and transfer; shares issued in violation are null and void. Chapter 38 still licenses medicine. Omaha diligence still wants a physician-owned PC plus an FMV MSA. Deep page: Nebraska CPOM.
District of Columbia (Nuanced, D.C. Code § 29-505), Rhode Island (Moderate, R.I. Gen. Laws § 7-5.1-3; 2026 bills S2459 and H7721 are proposed, not enacted), and New Hampshire (Limited, RSA 294-A:8) now have operator deep pages. None of those labels skips the operating test. Deep pages: District of Columbia, Rhode Island, New Hampshire.
Sources and citations
Primary authorities cited above. Confirm current text with counsel. Statutes change.
- California B&P § 2400; SB 351; AB 1415.
- Oregon ORS ch. 58; SB 951 (2025).
- Texas Occupations Code ch. 155 / 162.
- New York BCL § 1507; NYSED professional corporations.
- New Jersey N.J.A.C. 13:35-6.16.
- Connecticut CGS § 20-9(a); Chapter 594a. See Connecticut CPOM.
- Missouri RSMo 334.010; Chapter 356. See Missouri CPOM.
- Utah Utah Code § 58-67-301; § 58-67-802. See Utah CPOM.
- South Carolina S.C. Code § 40-47-30; Title 33 Chapter 19. See South Carolina CPOM.
- Kentucky KRS 311.560; Chapter 274. See Kentucky CPOM.
- Colorado C.R.S. Title 12 / § 12-240-138; § 25-3-103.7; Colorado Medical Board. See Colorado CPOM.
- Georgia O.C.G.A. § 14-7-4 (2021 Act 34 / HB 119 summary); Ga. Comp. R. & Regs. 360-3; Composite Medical Board. See Georgia CPOM.
- Kansas K.S.A. 17-2712; K.S.A. 65-28,134. See Kansas CPOM.
- Iowa Iowa Code § 496C.7; § 148.1. See Iowa CPOM.
- Louisiana La. R.S. 12:901; R.S. 40:2198.12. See Louisiana CPOM.
- Oklahoma 18 O.S. § 809; 2025 OK AG 16; 59 O.S. § 492. See Oklahoma CPOM.
- Alabama Ala. Code § 10A-4-3.01; r. 540-X-9-.06. See Alabama CPOM.
- Arkansas A.C.A. § 4-29-307 (quoted in SB 262). See Arkansas CPOM.
Operational split: physician-owned PC, MSO at fair market value, no lay de facto control. See the MSO-PC structure guide.
Operational checklist (14 steps)
Use this as a founder-facing CPOM compliance checklist. It is general information, not legal advice. Print it from the printable checklist.
- 1. PC ownership: a licensed physician (MD/DO in strict states) owns the Professional Corporation that delivers care. See physician PC owner and friendly PC owner ($3,000/mo).
- 2. MSA at FMV: the management services agreement pays the MSO fair market value for admin, tech, and operations, not a share of clinical fees dressed up as rent.
- 3. Funds flow: clinical revenue lands in the PC; the MSO invoices under the MSA. No commingled lockbox.
- 4. Separate bank and EIN: the PC and MSO keep separate accounts, tax IDs, and books.
- 5. Clinical protocols owned by the PC: protocols, credentialing, and clinical policies sit with the physician-owned entity.
- 6. Collaboration agreements where required: NP/PA supervision is documented under state rules, separate from PC ownership. See collaborating physician.
- 7. No de facto control: investors and MSO operators do not veto clinical hiring, coding rules, or medical judgment.
- 8. Succession ready: transfer-restriction and successor-physician terms keep the PC alive if the owner exits, subject to Oregon SB 951 limits.
- 9. State scope is real: form for states you operate via MSO-PC formation ($15,000). Do not rent a plug-in Super PC. Multi-state needs a 50-state licensed physician match.
- 10. California diligence: read B&P 2400 / SB 351 / AB 1415 if you treat California patients or run a CA MSO deal.
- 11. Oregon diligence: read SB 951 / ORS 58.375-58.376 before recycling a generic friendly-PC template.
- 12. Other high-scrutiny pages: Texas, New York, Oklahoma, Alabama, Arkansas, Kansas, Iowa, Louisiana, Indiana, Tennessee, Maryland, Minnesota, Connecticut, Missouri, Utah, South Carolina, Kentucky, Massachusetts (CHIA), Pennsylvania (Neill), Nevada, North Carolina, plus the CPOM 50-state guide.
- 13. Role clarity: medical director ≠ PC owner ≠ collaborating physician. Confusing them is a common diligence failure. See how matching works.
- 14. Dated review: keep a counsel memo dated after the latest effective statute. Last reviewed 2 October 2026.
Friendly PC owner vs medical director vs collaborating physician
CPOM compliance fails when founders collapse three different jobs into one title. Use this table on diligence calls.
| Role | What they do | Satisfies CPOM ownership? | Foundry |
|---|---|---|---|
| Friendly / physician PC owner | Licensed MD/DO who legally owns the Professional Corporation | Yes. This is the ownership role | $3,000/mo matching |
| Medical director | Oversees clinical quality and protocols | No. Title alone is not ownership | Distinct from PC owner |
| Collaborating physician | NP/PA supervision under state rules | No. Scope-of-practice, not PC ownership | Separate matching |
Fixed vs cost-plus vs percentage MSA fees
How you pay the MSO is a CPOM compliance fact, not a finance preference. This is a founder risk map, not a statute chart.
| Fee pattern | How it works | Risk | When it is used |
|---|---|---|---|
| Fixed FMV admin fee | Set monthly or annual fee for defined non-clinical services | Base case when supported by a memo | Most Foundry formations. Revisit when volume or services change. |
| Cost-plus | Pass-through of documented non-clinical costs plus a modest markup | Lower if scoped tightly | Shared vendors, facilities, or software billed at cost. Keep clinical costs out of the invoice. |
| % of clinical collections | MSO paid a share of professional fees or encounters | High: looks like fee-splitting in many states | Avoid as the primary management fee. See Massachusetts CHIA disclosure and Pennsylvania / Nevada ethics themes. |
Clinical-compliance infrastructure (CCI)
CPOM compliance is not only entity papers. Clinical-compliance infrastructure (CCI) is the operating system that keeps the PC in control after formation. Buyers look for this layer: who can change a protocol, who holds the EHR admin keys, and whether the MSO can quietly become the practice.
- Protocol ownership. Clinical protocols, formulary, and visit templates live in the PC. The MSO may host software; it may not publish “required” clinical scripts without PC approval.
- Credentialing and privileging. Who is allowed to treat sits with the physician PC owner and medical staff process, not the growth team’s hiring dashboard.
- Quality and incident review. Peer review, incident files, and prescribing audits are PC records. MSO ops can staff the process; they cannot close a quality file to protect CAC.
- Access control. EHR admin, e-prescribe tokens, and medical-records release authority sit with the PC. Lay founders should not be super-admins “just for convenience.”
- Change log. Material changes to clinical scope, states, or MSA fees get a dated memo. That is how CPOM compliance stays auditable a year after formation.
CCI is why Foundry matches a real physician PC owner ($3,000/mo) instead of a figurehead. Pair CPOM compliance with the CPOM 50-state guide so state doctrine and operating systems stay aligned.
Buyers now ask for a CCI map, not just articles of incorporation. Use this split on diligence calls:
| Control | PC owns (CPOM compliance) | MSO may do |
|---|---|---|
| Clinical protocols / formulary | Publish and amend | Host the software; never “required scripts” |
| EHR super-admin / e-prescribe | Tokens, break-glass, records release | Ticket queue and uptime |
| Credentialing / privileging | Who may treat | Growth hiring dashboard is not a privilege list |
| Quality / incident files | Peer review, close the file | Staff the process; cannot bury a CAC problem |
| Marketing clinical claims | What the brand may say about care | Creative, media buy, brand kit |
| State add / scope change | Dated memo + counsel | Ops calendar only after PC sign-off |
Common mistakes
These are the funds-flow and control errors that show up in diligence. Catch them on this CPOM compliance table before a raise. For the funds-flow story in more detail, read CPOM compliance checklist: funds-flow mistakes.
| Mistake | Why it fails CPOM compliance | Fix |
|---|---|---|
| MSO lockbox / commingled collections | Looks like the lay company owns the practice of medicine | PC bank, PC claims, MSA invoice. See funds flow above. |
| Percentage-of-collections MSA | Looks like fee-splitting in many states | Fixed or FMV-supported admin fee with a memo |
| MSO payroll for clinicians “assigned” to the PC | De facto employment by the lay company | Clinicians contract with the PC |
| Medical-director title, no PC owner | Quality role is not ownership | Match a friendly PC owner ($3,000/mo) |
| Lay veto on hiring, coding, or protocols | De facto clinical control | Park those rights in the PC; see CCI |
| Plug-in 50-state Super PC | Shared national shell is not your PC | Scope states; match a 50-state PC owner |
| Unsigned / expired MSA | No paper for FMV or scope | Execute before first claim; revisit when volume changes |
| Ignoring SB 351 / SB 951 if CA or OR is in footprint | 2026 statutes bite recycled templates | Read California and Oregon |
Enterprise value and diligence
CPOM compliance is an enterprise-value fact, not a legal footnote. In a sale, recap, or Series A, counsel will ask who owns the PC, how the MSA is priced, whether funds flow matches the org chart, and whether lay owners can fire the physician for clinical reasons. Cosmetic papers (a figurehead owner, a percentage fee, a commingled lockbox) reprice as a structure rebuild or a walk. Clean CPOM compliance (physician PC, FMV MSA, CCI, scoped states) is what survives a quality-of-earnings review.
Foundry forms the MSO-PC ($15,000) and matches the physician PC owner ($3,000/mo) so that diligence file exists before the first term sheet. Download the CPOM compliance checklist PDF and keep it with the MSA. Doctrine by state: CPOM 50-state guide.
Counsel’s first-hour questions. Here is what they ask and what a pass looks like:
| Diligence question | Fail signal | Pass signal |
|---|---|---|
| Who is the PC shareholder? | MSO, PE vehicle, or “we’ll assign later” | Named licensed MD/DO; $3,000/mo match if needed |
| Can the MSO fire the owner for clinical reasons? | Any-reason termination in the MSA | Clinical termination sits with the PC / board |
| Where does the lockbox sit? | MSO sweeps collections | PC bank; MSA invoice |
| How is the MSA priced? | % of professional collections | Fixed or FMV-supported admin fee + memo |
| Who holds EHR admin keys? | Lay founder as super-admin | CCI: PC owns tokens and records release |
| Which states are actually formed? | Rented Super PC / “all 50” | Scoped formation ($15,000) + 50-state owner if needed |
How a buyer diligence team checks the file
PE counsel, a strategic acquirer, and Series A healthcare counsel do not grade CPOM compliance by whether you can produce articles of incorporation. They reconstruct control. Use this as the data-room map. For the funds-flow mistakes in more detail, see the checklist post.
Documents they request
- PC shareholder register vs Secretary of State print. The named MD/DO on the ledger must match the professional-entity filing. “We’ll assign later” is a fail. Matching is $3,000/mo when you need an owner.
- MSA plus the FMV memo, not only the signature page. They want the fee schedule, scope of non-clinical services, and how the number was set. A percentage of professional collections is the high-risk pattern. See the MSA fee table.
- Three to six months of PC and MSO bank statements. Who receives clinical deposits? Who pays clinicians? A commingled lockbox is the classic cosmetic split.
- Clinician contracts and payroll registers. W-2 / 1099 should sit on the PC EIN. MSO payroll for “assigned” clinicians is de facto employment by the lay company.
- EHR admin roster and e-prescribe token holders. CCI: the PC owns break-glass and records release. A lay founder as super-admin “for convenience” is a control fact.
- State filings that match the marketing map. NYSED certificate, California PC, Texas PA, not a rented Super PC. Doctrine: CPOM 50-state guide.
What they sample (not what they skim)
| Sample | Pass for CPOM compliance | Fail signal |
|---|---|---|
| One claim, end to end | Payer → PC lockbox → PC bank → MSA invoice → MSO | MSO sweeps collections or bills under the MSO TIN |
| One protocol change | Dated PC approval; MSO hosted the software | Growth team published a “required script” |
| MSA termination | Clinical termination sits with the PC / board | MSO may fire the physician for any clinical reason |
| Owner interview | Can name the last protocol they approved | Figurehead who cannot describe the practice |
| States vs website | Formation scoped to states you treat ($15,000) | “We operate in all 50” via a plug-in shell |
If those samples fail, buyers reprice the deal as a structure rebuild. Foundry forms the MSO-PC ($15,000) and matches the physician PC owner ($3,000/mo) so the file exists before the first term sheet.
How a payer or credentialing team checks the file
A payer integrity or network-credentialing team runs a different test from PE counsel. They rarely read the MSA. They look at enrollment. That is still CPOM compliance: the claim file has to match the org chart.
| What they look at | What they want | CPOM compliance fail |
|---|---|---|
| Billing TIN / group NPI | Physician-owned PC EIN and NPI on the 1500 / 837 | MSO TIN on clinical claims |
| Rendering vs billing NPI | Rendering clinician under the PC group | MSO listed as the billing provider for professional fees |
| CAQH / enrollment ownership | Managing employees and owners match the PC ledger | Lay founder listed as owner of the practice of medicine |
| Fee-splitting / kickback attestations | No share of professional fees to the MSO as the management fee | Percentage-of-collections MSA sitting behind the attestation |
| Practice location / telehealth registration | Where required (for example Florida out-of-state telehealth registration) | Marketing map that does not match enrollment |
Payer CPOM compliance is why funds flow and CCI are not “legal footnotes.” A clean PC on paper with the MSO’s TIN on claims still fails. Pair this table with the funds-flow section and the CPOM 50-state guide so doctrine and enrollment stay on the same page.
Downloadable checklist PDF
Need a file for diligence, not a print dialog? Download the true PDF: CPOM compliance checklist PDF. A printable web version is at /cpom-compliance-checklist. No email gate.
How Foundry helps
Foundry forms the MSO-PC for the states you actually need (MSO-PC formation, $15,000 one-time) and matches a friendly PC owner ($3,000/mo). When multi-state coverage is required, that can be a 50-state licensed physician as the PC owner, not a rented plug-in PC network.
We are Catalyze Care LLC d/b/a Foundry PC. Not a law firm. Document customization and attorney sign-off are handled by independent healthcare counsel you engage directly.
CPOM compliance for multi-state telehealth
CPOM compliance for multi-state telehealth follows the patient. Each patient state needs a physician-owned Professional Corporation path, an FMV MSA, and clean claim TINs on the PC. Map doctrine on the CPOM 50-state guide, then keep the data room ready. Formation is $15,000 one-time; a friendly PC owner is $3,000 per month. Compare scoped formation options on Permit Health alternatives and Foundry vs Permit Health.
Frequently asked questions
What is CPOM compliance?
CPOM compliance means clinical care runs through a physician-owned PC, the MSO is paid at fair market value, and lay owners do not practice medicine or exercise de facto clinical control. See the CPOM 50-state guide for state detail, including Oklahoma, Alabama, and Arkansas.
How do I make sure my MSO and friendly PC are CPOM compliant?
Follow the five-point checklist above: licensed physician owns the PC; MSO paid at FMV for non-clinical work; no lay de facto control; clean funds flow; state map plus paper trail. Formation is $15,000 one-time; a friendly PC owner is $3,000 per month. Then open each patient state on the CPOM 50-state guide.
How is CPOM compliance different from a CPOM 50-state guide?
CPOM compliance is the operating test. A CPOM 50-state guide is the doctrine map. Use the comparison table above. Formation is $15,000 one-time; a friendly PC owner is $3,000 per month.
Does a Moderate or Limited CPOM state skip CPOM compliance?
No. Arkansas is Moderate. Oklahoma and Alabama are Limited. Kansas and Iowa remain Moderate; Louisiana remains Nuanced. Colorado, Georgia, and South Carolina are Moderate. Utah is Limited. Kentucky is Nuanced. None of those labels is a waiver of CPOM compliance. Buyers still sample the data room; payers still sample the claim TIN. Formation is $15,000 one-time; a friendly PC owner is $3,000 per month.
How much does Foundry charge for CPOM-related work?
MSO-PC formation is $15,000 one-time. Friendly PC owner matching is $3,000 per month. Book a call to scope states and timeline.
Does Foundry use a Super-PC or plug-in 50-state network?
No. Foundry does not drop clients into a shared plug-in Super PC. When multi-state coverage is required, Foundry matches a 50-state licensed physician as the PC owner for the states you actually operate.
What is a clean FMV funds-flow example?
Patient or payer pays the physician-owned PC. The PC pays a fixed or cost-plus FMV MSA invoice to the MSO for defined non-clinical services. Buyers sample one claim from payer to PC bank to MSA invoice. Formation is $15,000 one-time; a friendly PC owner is $3,000 per month.
Do Idaho, New Mexico, Hawaii, or Delaware skip CPOM compliance?
No. All four are Limited on the CPOM 50-state guide, with deep pages at Idaho, New Mexico, Hawaii, and Delaware. A Limited label is not a waiver of the operating test.
Do Maine or Nebraska skip CPOM compliance?
No. Both are Limited on the CPOM 50-state guide, with deep pages at Maine and Nebraska. Maine cites 13 M.R.S. § 741. Nebraska cites Neb. Rev. Stat. § 21-2208. A Limited label is not a waiver of the operating test.
What do buyers sample for CPOM compliance?
Buyers sample the physician shareholder ledger, the MSA plus FMV memo, one claim from payer to PC bank to MSA invoice, and who controls protocols. That is the operating test. Pair it with the doctrine map on the CPOM 50-state guide. Formation is $15,000 one-time; a friendly PC owner is $3,000 per month.
What is CPOM compliance for multi-state telehealth?
CPOM compliance for multi-state telehealth means clinical care in each patient state runs through a physician-owned Professional Corporation, the MSO is paid fair market value for non-clinical work, and lay owners do not exercise de facto clinical control. Open each patient state on the CPOM 50-state guide, including deep pages for Maine, Nebraska, Idaho, and Oklahoma. Formation is $15,000 one-time; a friendly PC owner is $3,000 per month. After comparing vendors, start from Permit Health alternatives or MSO-PC formation, then run this operating test.
How do payers check CPOM compliance on claims?
Payers sample the claim TIN. Clinical claims should bill under the physician-owned PC, not the MSO. Buyers then sample one claim from payer to PC bank to MSA invoice. That is the operating test for CPOM compliance, separate from the doctrine map on the CPOM 50-state guide. Formation is $15,000 one-time; a friendly PC owner is $3,000 per month.
Should the MSA be a percentage of collections?
Avoid percentage-of-collections as the primary management fee. Prefer a fixed FMV admin fee or a tightly scoped cost-plus invoice with a memo. See the fee-risk and FMV examples tables above.
Where do I book a call and see pricing?
Book a call on the homepage. Published pricing is on /#pricing: $15,000 formation and $3,000/mo PC owner matching.
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