West Virginia Management Services Agreement Guide: A Board Certificate and a Hands-Off Management Role
West Virginia's Board treats nominee shareholder structures as precluding authorization if a beneficial shareholder is a non-physician, so an MSO agreement must not create a hidden non-physician owner.
Key Highlights
- Every shareholder of a West Virginia medical corporation must be a licensed physician or podiatrist, and nominee shareholder structures are scrutinized.
- The discipline statute covers requesting, receiving or paying consideration for the referral of patients, and we found no rule banning percentage-of-revenue fees.
- The Physicians Freedom of Practice Act limits non-competes to one year and thirty road miles and voids them on termination by the employer.
- A July 2026 IV opinion bans standing orders and says clinics not owned by prescribers may not control a provider's judgment.
How to Price the Management Fee
The discipline statute covers requesting, receiving or paying a payment, rebate, refund, commission or other consideration for the referral of patients. We found no West Virginia statute or rule that bars percentage-of-revenue management fees as such, and the risk comes from the Board's position on lay control and the aiding-unauthorized-practice ground. We use a fixed fee for defined services.
What the Practice Must Keep
The corporation holds the Board certificate, every shareholder is a licensed physician and clinical decisions stay with the practice. The Board's position statement scrutinizes nominee shareholder structures, so no beneficial interest passes to a non-physician.
Terms to Avoid
Avoid any nominee or beneficial interest for the MSO, any control over medical judgment, referral-linked pay and standing-order IV models. We do not rely on the IV opinion's item about non-provider-owned clinics to approve lay ownership, since it sits beside the statutory bar on lay-owned medical corporations.
Term, Records and Departing Clinicians
The Physicians Freedom of Practice Act limits a physician non-compete to one year and thirty road miles and makes it void on termination by the employer, preserving patient list and records protections, repayment clauses, non-disclosure and non-solicitation of patients and employees, and exempting sale-of-business and owner-to-owner contracts. We do not use non-competes for employed clinicians.
Filings, Notices and Watch Items
We found no West Virginia transaction notice law. The certificate renews every two years, and two 2026 bills to let physician assistants own businesses and to amend the statute did not pass the House.
Drafting Checklist
- Fee: fixed for defined services.
- Shareholders: licensed physicians or podiatrists only, no nominees.
- Control: none over medical judgment.
- IV therapy: individual orders, no standing orders.
- 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.