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contracting with a panel of approximately 1,435 primary care
physicians and specialist physicians to provide such services.
Approximately 75 percent of these physicians were members of
independent, multispecialty, physician medical groups,6 while the
6 42 C.F.R. sec. 417.100 (1991) defines the term “medical
group” as:
a partnership, association, corporation, or other
group:
(1) Which is composed of health professionals
licensed to practice medicine or osteopathy and of such
other licensed health professionals (including
dentists, optometrists, and podiatrists) as are
necessary for the provision of health services for
which the group is responsible;
(2) A majority of the members of which are
licensed to practice medicine or osteopathy; and
(3) The members of which:
(i) After the end of the 48 month period
beginning after the month in which the HMO for
which the group provides health services becomes a
qualified HMO, as their principal professional
activity (over 50 percent individually) engage in
the coordinated practice of their profession and
as a group responsibility have substantial
responsibility (over 35 percent in the aggregate
of their professional activity) for the delivery
of health services to members of an HMO;
(ii) Pool their income from practice as
members of the group and distribute it among
themselves according to a prearranged salary or
drawing account or other similar plan unrelated to
the provision of specific health services;
(iii) Share health (including medical)
records and substantial portions of major
equipment and of professional, technical, and
(continued...)
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