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agreements in the health-care industry serve the important dual
functions of attempting to avoid inappropriate services (e.g.,
the wrong services for the patient’s needs, or services that are
improperly rendered), and seeking to assure that enough services
are provided to meet the patient’s needs. See 2 National Health
Lawyers Association, Health Law Practice Guide, sec. 25.1, at 25-
3 (1997). The record does not reflect that petitioner performed
any quality assurance work. Likewise, the record is silent as to
how petitioner, in the absence of any operable quality assurance
agreement, purports to assure itself that these vital functions
will be discharged consistently with charitable objectives.
3. Lack of Informal Control
The administrative record provides no basis for concluding
that, in the absence of formal control, petitioner possesses
significant informal control by which it exercises its influence
with regard to the Surgery Center’s activities. Nothing in the
administrative record suggests that petitioner commands
allegiance or loyalty of the SCA affiliates or of the limited
partners to cause them to put charitable objectives ahead of
their own economic objectives. Indeed, until April 1992,
petitioner was in a debtor relationship to SCA. The limited
partners (except for Beaver Medical Clinic, Inc.) all became
common stockholders of SCA when the General Partnership acquired
its interest in the Operating Partnership.
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