Common use of Physician Incentive Plans Clause in Contracts

Physician Incentive Plans. In the event Provider participates in a physician incentive plan (“PIP”) under the Agreement, Provider agrees that such PIP must comply with all applicable requirements governing PIPs, including but not limited to 42 CFR Parts 417, 422, 434, 438 and 1003, as may be amended from time to time. Neither Subcontractor, Health Plan, nor Provider may make a specific payment directly or indirectly under a PIP to a physician or physician group as an inducement to reduce or limit Medically Necessary services furnished to an individual Covered Person. PIPs must not contain provisions that provide incentives, monetary or otherwise, for the withholding of Medically Necessary care. Provider shall maintain adequate and appropriate stop-loss protection in accordance with 42 CFR Part 417 if incentive arrangements with Provider place Provider at substantial financial risk for services it does not provide.