Recruiting packages can raise tax, antitrust issues. (Low-Interest Loans, Joint Recruitment).

WASHINGTON -- Physician recruiting efforts can raise several legal concerns that must be considered simultaneously a panel of experts said at a meeting sponsored by the American Health Lawyers Association.

The panelists discussed a hypothetical recruitment situation: A local hospital wants to recruit a certain female ob.gyn. who currently practices in another state. A local medical group that wants to employ this physician asks the hospital to provide a package that includes a 2-year income guarantee in the form of a line of credit to the medical group at 1% below the prime rate. The loan would be forgiven if the physician stayed in the area for at least 4 years.

Most of this arrangement would probably pass muster under the Stark self-referral laws, said Thomas S. Crane, a lawyer in Boston. "You would have to go out of your way to mess up under the Stark exemption for physician recruitment," he said.

But he questioned the fraud issues raised by having the hospital's loan payments go directly to the physician group. "Depending on how the deal is structured, it could involve hidden referrals" to the hospital, Mr. Crane said at the meeting, also sponsored by the Health Care Compliance Association. "I would like to see the [medical] group pay For some part of the recruitment, and then the payments going ...