Maryland Management Services Agreement Guide: Referral Fees, Self-Referral and Keeping the Practice Out of the MSO
Maryland discipline bars paying any sum to any person for bringing or referring a patient, and the professional corporation may not take part in non-professional activities, so it should not own the MSO.
Key Highlights
- The health occupations article bars paying or agreeing to pay any sum to any person for bringing or referring a patient, and we found no express percentage-of-fees ban.
- A professional corporation may not carry on non-professional activities or take an active role in running an unrelated venture, so the practice should not own the management company.
- The self-referral statute bars referrals to entities in which the practitioner has an ownership interest or compensation arrangement, with an in-office ancillary services exception.
- Maryland voids non-competes for direct-care providers earning $350,000 or less.
How to Price the Management Fee
The discipline statute covers paying or agreeing to pay any sum to any person for bringing or referring a patient, soliciting through an agent and violating any state or federal law. There is no express percentage-of-fees ban in the text we read, and a percentage fee that rewards the MSO for generating patients is the exposure under the referral ground, which is our inference. We use a fixed fee for defined services.
What the Practice Must Keep
The practice keeps clinical decisions and the COMAR delegation duties: written protocols at each site, a personal initial assessment by the physician, a written treatment plan, informed consent and on-site supervision when a non-physician performs procedures, except under a Board-approved physician assistant delegation agreement.
Terms to Avoid
Avoid making the practice the owner of the MSO or other side businesses, since the professional corporation act bars non-professional activities, avoid referrals to MSO-affiliated pharmacies, labs or imaging in which the physician holds an interest, and avoid pay that rewards bringing in patients.
Term, Records and Departing Clinicians
Maryland voids non-competes for licensed health care providers who give direct patient care and earn $350,000 or less, and above that threshold limits them to one year and ten miles. We do not use them for employed clinicians.
Filings, Notices and Watch Items
Senate Bill 494 and House Bill 944 of 2026 would have required 90 days' notice to the Maryland Health Care Commission of material change transactions including MSOs and private equity, and the status index shows hearings only and no passage.
Drafting Checklist
- Fee: fixed, nothing rewarding patient generation.
- Practice role: does not own the MSO.
- Self-referral: no referrals to affiliated entities where the physician has an interest.
- Delegation: protocols, initial assessment, treatment plan and consent.
- 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.
MedGrid MSO provides management services to independently owned practices; it does not practise medicine and does not direct clinical decisions. Requirements vary by state and by service, and change over time — nothing on this page is legal or medical advice. Talk to us or your own counsel before making a structural decision for your clinic.