Florida Management Services Agreement Guide: Flat Fees, Referral Risk and Keeping the Clinic Act Exemption

How to Price the Management Fee

Section 458.331 makes it grounds for discipline to pay or receive a commission, bonus, kickback, rebate or any split-fee arrangement for patients referred to health care providers, and the patient brokering statute treats a split-fee in return for a referral as a felony. The Board of Medicine's Bakarania declaratory statement, affirmed on appeal in 1999, said a reasonable flat fee for management services is allowable but a percentage of revenue generated by the services and practice enhancement is not. In Friedenstab, a percentage-of-revenue management agreement was held an indirect referral fee violating those statutes. We relied on secondary summaries of both. One summary describes a later Board statement allowing a capped percentage fee for services unrelated to practice enhancement or referrals, which we could not verify, so we use a fixed fee tied to identified services.

What the Practice Must Keep

The practice stays wholly owned by physicians so that it can fit the Clinic Act's ownership exemptions, and it keeps supervision of the business activities where the exemption requires it. A licensed clinic needs a clinic director and a license for each location, and unlicensed operation is a felony, so the agreement should not move ownership or control in a way that could defeat an exemption. The agreement leaves clinical decisions and records with the practice.

Terms to Avoid

Avoid a percentage of revenue, any fee that pays for practice enhancement or patient generation, any equity or option moving ownership outside the physician group, and any term that makes the management company the provider of services. Commentary warns that exemption status can end if ownership changes in a way that defeats it.

Term, Records and Departing Clinicians

The 2025 CHOICE Act excludes health care practitioners from its covered employees, so clinicians remain under the general non-compete statute, while non-clinical MSO staff may be covered. A physician covenant is void where one entity employs or contracts with all physicians of a specialty in a county. Our template does not ask employed clinicians for non-competes.

Filings, Notices and Watch Items

The Clinic Act defines a clinic as an entity that tenders charges for reimbursement, and a Senate staff analysis says the Agency for Health Care Administration reads that to cover only entities billing third-party payers, so cash-only providers are outside licensure, which we found in staff analysis and not in a rule or court holding. State Farm v. LaRocca is before the Florida Supreme Court on what legally responsible means for an exemption, and we found no decision. A 2026 bill to license med spas handling prescription drugs died in committee.

Drafting Checklist

• Fee: fixed and tied to identified services, never a percentage of revenue.
• No enhancement pay: nothing paid for practice enhancement or patient generation.
• Ownership: wholly physician-owned, with no equity or options to the MSO.
• Supervision: the owner-physician supervises the business activities the exemption requires.
• Billing: confirm whether any third-party payer billing triggers the Clinic Act.
• Non-competes: none for employed clinicians.

How We Draft It

Patients pay the physician-owned practice, the practice pays the management company a fixed monthly fee under the agreement, and the management company pays MedGrid a fixed monthly retainer for consulting. The management company never practices medicine, and the agreement never moves a clinical decision to it. Our template follows the same flat-fee design in every state, with the state-specific limits below layered on top.

Disclaimer

This article is general educational information, not legal advice. Management agreement rules change and differ by state, and this summary draws on our published state guide, parts of which rest on secondary sources, so have health care counsel in the state review any agreement before you sign.