CPOM Compliance for Washington Healthcare Startups
Washington is more flexible than California or Texas on classic CPOM, but RCW 18.100 still expects licensed professionals to own the clinical entity, and RCW 19.68 still polices rebating.
Get a Free CPOM AssessmentThe law in Washington
Key authorities (official text)
Washington Medical Commission · RCW 18.100 · RCW 19.68Washington Medical Commission · RCW 18.100 Professional Service Corporation Act · RCW 18.71 Physicians · RCW 19.68 Rebating by practitioners.
Washington CPOM is moderate. The state does not copy California Business & Professions Code § 2400. RCW 18.100 still requires a professional service corporation that renders medical services to be owned by licensed professionals. RCW 19.68 restricts rebating, the Washington fee-split overlay. Seattle digital-health and multi-state telehealth companies still stand up a physician-owned PC plus a fair-market-value MSA so ownership, funds flow, and rebating questions have one answer.
Washington is often labeled “limited” or “flexible” in vendor tables. That is not permission for a lay LLC to hold the practice of medicine. RCW 18.100.050–.060 tie professional-service corporations to licensed owners and to rendering professional services through licensed people. The Medical Commission still expects clinical judgment to stay with licensees. A medical-director title on a Delaware operating company does not satisfy that.
Nurse-practitioner independence in Washington does not erase PC ownership for the practice of medicine, and it does not erase rebating rules. Collaboration is a different job from owning the Professional Corporation. See collaborating physician vs physician PC owner. Longer narrative: Washington CPOM blog guide.
Typical PC / MSO structure in Washington
Form a Washington professional service corporation or PLLC owned by a Washington-licensed MD or DO. The MSO, often the Delaware operating company, provides non-clinical services under a written MSA at fair market value. Clinical revenue lands in the PC. Foundry forms that structure ($15,000) and matches a friendly PC owner ($3,000/mo). Not a rented Super PC.
If you also treat California, Oregon, or New York patients, Washington’s relative flexibility does not control those states. Oregon SB 951 in particular will not accept a recycled Washington template. Start with the CPOM 50-state guide and form for the footprint you actually have.
Fee-splitting note
RCW 19.68 is Washington’s rebating statute. Practitioners may not pay or receive rebates for referring patients. A percentage-of-collections management fee is the pattern that looks most like a rebate on professional fees. Prefer a fixed or FMV-supported admin fee. Pair this page with the fee-risk table on CPOM compliance.
| Washington pattern | Risk | Safer pattern |
|---|---|---|
| Lay LLC owns the clinical practice | High: RCW 18.100 ownership | Licensed-professional PC / PLLC |
| MSO paid % of professional collections | High: RCW 19.68 rebating overlay | Fixed FMV admin fee with a memo |
| Physician PC + FMV MSA + separate books | Base case | Revisit FMV when volume changes |
What Washington founders need to know
- Washington is moderate, not permissive-in-practice. Licensed professionals own the clinical entity under RCW 18.100.
- RCW 19.68 rebating is the fee-split overlay even when classic CPOM commentary is light.
- Seattle health-tech diligence still asks who owns the PC, who bills, and how the MSA is priced.
- Oregon SB 951 and California SB 351 do not get softer because your HQ is in Washington. Form for each state you treat.
- Foundry does not drop clients into a plug-in 50-state PC. Multi-state needs a 50-state licensed physician.
Operational checklist: CPOM compliance. Setup path: MSO-PC structure. Full map: CPOM 50-state guide.
Washington CPOM FAQ
Does Washington have strict CPOM?
Washington is moderate. RCW 18.100 requires professional service corporations to be owned by licensed professionals. RCW 19.68 restricts rebating. There is no California-style statutory ban, but Seattle digital-health diligence still wants a physician-owned PC plus FMV MSA.
Do I still need an MSO-PC in Washington?
Yes for most venture-backed and multi-state models. The professional entity holds clinical care; the MSO is paid fair market value for non-clinical services.
How does Washington treat fee-splitting?
RCW 19.68 (rebating by practitioners) is the fee-split overlay. A percentage-of-collections MSA is the high-risk pattern. Prefer a fixed FMV admin fee.
How does Foundry help with Washington CPOM?
MSO-PC formation is $15,000 one-time. A Washington-licensed physician PC owner is $3,000/mo. Foundry is not a law firm.