Physician Letter of Agreement
Men’s Health Educational Video Program
We look forward to collaborating with you on a successful Men’s Health Educational Video Program. The purpose of this Letter of Agreement is to document the purpose, terms, and intentions for this educational video program.
The Educational Video Program is an educational initiative presented by you and Coloplast (“the Parties”) to provide education on the topics of erectile dysfunction and/or stress urinary incontinence. Physicians will have the option to utilize these videos by providing them to men via, secure text, e-mails, a posting on their website and or social media accounts. The video application and production assistance services will be provided by the Third -Party Vendor, Cyrano. Coloplast will sponsor the program and thus the Coloplast logo will be present on the Men’s Health Urological videos.
The Parties will equally contribute goods and/or services to the planning and execution of the Educational Video Program. The fair market monetary value of Coloplast’s contributions cannot exceed the value of your contributions.
You will not be compensated (either directly or indirectly) by Coloplast for the time that you will spend planning and executing the Educational Video Program. No money or invoices will be exchanged between the Parties for the Educational Video Program.
Materials to be used for the Educational Video Program will be provided by the Parties. Coloplast will provide a banner ad that may not be removed, the practice will be able to add physician’s name and/or practice logo. All comments and education must be on label.
The Parties acknowledge and agree that it is their intent to comply at all times with applicable federal and state statutes, laws, rules and regulations, specifically including, but not limited to, the federal Anti-Kickback Statute (42 USC 1320a-7b), the federal Physician Self-Referral “Stark” Law (42 USC 1320nn), the federal False Claims Act (31
USC 3729-3733), the federal Physician Payments Sunshine Act (the “Sunshine Act” is a section of the Patient Protection and Affordable Care Act), and the federal Civil Monetary Penalties Law (42 USC 1320a-7a).
Your engagement and participation in the Educational Video Program is not offered, solicited, or contingent upon the current or future use of Coloplast products, to induce a referral or a patient, or otherwise for the purpose of generating business which is reimbursable under a federal healthcare program.
This Letter of Agreement is effective for a one-year period from the date of receipt.
Please contact Coloplast as soon as possible if you do not wish to participate in the Educational Video Program in accordance with the terms described in this Letter of Agreement. If you choose to proceed with participating in the Educational Video Program, the terms described in this Letter of Agreement will apply.
Thank you in advance for your collaboration on a successful Educational Video Awareness
Ver. 1 (3/2019) PM-07511 – Rev Aug 4, 2020