Nebraska Management Services Agreement Guide: Referral-Based Fee Risk and Administrative Services
Nebraska's fee-splitting rule reaches fees divided for bringing or referring a consumer, so a percentage tied to an MSO's patient generation faces more risk than a fee for administrative services.
Key Highlights
- Section 38-179(2) bars dividing fees for professional services with any person for bringing or referring a consumer, with exceptions for partners, employees, landlords and former partners.
- An MSO is not within those exceptions, and the rule is referral-based so it does not on its face reach a flat or percentage administrative fee.
- Percentage of collections tied to patients an MSO generates faces more risk, which is our inference and not authority.
- A 1905 Supreme Court rule that contracting for physician services is not practicing medicine does not change how we draft.
How to Price the Management Fee
The statute treats as unprofessional conduct dividing fees received for professional services with any person for bringing or referring a consumer, with exceptions for a partner or employee, a landlord under a written rent-on-gross-receipts agreement and a former partner or employee under a retirement or separation plan. An MSO that markets and generates patients and is paid a percentage of collections on them faces more risk, which is our inference. We found no Nebraska authority on percentage fees, and we use a flat fee for administrative services.
What the Practice Must Keep
The practice keeps clinical decisions. The task-assignment exemption lets unlicensed persons perform routine, recurring tasks that need no independent clinical judgment and have predictable minimal-risk results with a standard unchanging procedure, so the agreement limits unlicensed staff to those tasks.
Terms to Avoid
Avoid a fee for patients the MSO brings in, delegation beyond the task-assignment exemption and any reliance on the 1905 decisions to give the MSO a clinical role.
Term, Records and Departing Clinicians
Non-competes follow common law, and a 2026 law limits only healthcare staffing agencies. We do not use non-competes for employed clinicians.
Filings, Notices and Watch Items
We found no Nebraska transaction notice law. Professional corporation shares cannot be issued or transferred without a regulating-board certificate.
Drafting Checklist
- Fee: flat for administrative services, not patients brought in.
- Referrals: no payment for bringing or referring consumers.
- Tasks: unlicensed staff limited to the exemption.
- Clinical decisions: with the physician.
- 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.