Today’s transactions and contractual arrangements among health care providers are made up of increasingly sophisticated, multi-faceted structures, which have evolved with reforms in reimbursement and delivery systems, transformation in the marketplace, and surges in enforcement activity. The complexity of these financial relationships creates additional regulatory compliance challenges. Discussion will focus on fair market value and commercial reasonableness issues arising out of referring provider transactions and contractual relationships, with an examination of business and compensation valuation theory and methodology.