Which of the following is considered a substantial risk for health care compliance?

Not having written contracts with physicians is considered a substantial risk for healthcare compliance because it can lead to a lack of clarity regarding the expectations and obligations of both parties involved. Written contracts are essential in healthcare to ensure that all agreements are documented, including compensation, services provided, and compliance with federal and state regulations. Without these contracts, there may be ambiguities that could lead to violations of the Stark Law, Anti-Kickback Statute, or other regulatory requirements designed to prevent fraud and abuse.

Furthermore, written agreements help to establish the legitimacy of the physician's role and the services rendered, which is crucial for compliance audits and potential legal scrutiny. In the absence of these formalized agreements, healthcare organizations may unknowingly engage in practices that could be perceived as improper arrangements, possibly resulting in severe penalties or loss of licensure.

The other choices do not present the same level of risk. Paying fair market rates is a compliance best practice, offering free consultations can be a permissible part of marketing strategies if properly managed, and providing tax assistance typically does not directly relate to compliance risks in the healthcare context. Thus, failing to maintain necessary written contracts places a healthcare provider at a significant risk of non-compliance.