Corporate Control of Health Care Providers: Latest Trends and Developments
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What are the recent state‑level regulations affecting corporate ownership of health‑care providers?
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Hi, everyone. I'm Rachel Ludwig, a healthcare regulatory partner at DLA Piper in Washington, D.C., and a vice chair of the AHLA Business Law and Governance Practice Group. I'm excited to host this episode of AHLA's Speaking of Health Law podcast, where my expert guests and I will discuss recent regulatory developments related to corporate ownership of healthcare providers. and what balanced regulation might look like. These regulations are generally being implemented currently at the state level and take a variety of shapes and forms, including many HSR or transaction review laws, corporate practice of medicine laws, and other types of laws that restrict or prohibit private equity or other corporate ownership of certain providers.
Today we're going to talk about the recent evolution of these laws, recurring trends, unique current legislation, some unintended consequences, how to build trust, and what the industry is doing to participate and help shape these laws. Now I'll turn it over to our expert guests, John, Regan, and Robbie to introduce themselves, and then we can jump in on the discussion.
Thanks, Rachel. So John Saran, healthcare transactions partner at a Hall and a Knight. I'm actually incoming vice chair for the business governance practice group. Very excited to join the AHLA family and looking forward to the upcoming, you know, annual at the end of June.
I'm Regan Parker. I'm the CEO of the Association for Responsible Healthcare Investment. And we're an association focused on making sure that the narrative around private investment in healthcare is a balanced one and ensuring that regulations don't impact the industry negatively.
How did the surge in post‑COVID health‑care transactions trigger new reporting and ownership laws?
And I'm Robbie Allen. I'm the CEO of a private equity-backed healthcare provider services group called U.S. Heart and Vascular. That's mostly in the cardiovascular space. And part-time, I'm an operating partner in a venture fund that's focused on new healthcare technology called AIF.
Great. Thanks, everybody. So to start the discussion, maybe each of you can talk a little bit about the origins and intent of these regulations and kind of how you've seen these regulations develop over the past couple of years.
Yeah, I'm happy to just kick that off and then others jump in. I think you mentioned state transaction reporting laws, corporate practice of medicine, non-compete restrictions, ownership disclosure. All of these components are not really new for health care generally. In some cases, corporate practice of medicine has been around for 100 years, depending on the state. folks have been reporting transactions to the federal government for some time. If you're enrolled in Medicare, Medicaid, or you use certain payers, you are used to disclosing ownership or giving that information. However, if you look at sort of coming out of COVID, there was a surge of transactions that happened across the country. And there were several transactions that
were involving physician practices or dental practices or certain health systems that just were not getting on state radars, whether it was because maybe that state didn't have a transaction reporting law or it was such a small transaction, did not hit the federal threshold or for whatever reason, it was not hitting state radars. And so you had a large body of people healthcare consolidation out there that was happening and there were obvious consequences to it over time, that was not just getting on the state radars and they weren't understanding sort of the effects that that consolidation had on cost, quality, access to care. And so roughly around 2022, Oregon came onto the scene, passed their state transaction reporting bill, and then it kind of went from there.
But interested in the rest of the panel's thoughts as to sort of how this kind of came about around 21, 22.
I think part of what you have to understand about like a surge in legislation, particularly when it starts to happen at the state level, is that often it can come from headlines, right?
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Chapters
5 chapters
1
What are the recent state‑level regulations affecting corporate ownership of health‑care providers?
0:00–1:59
2
How did the surge in post‑COVID health‑care transactions trigger new reporting and ownership laws?
1:59–14:55
3
What are the three regulatory “buckets” (transaction reporting, corporate practice of medicine, and ownership disclosure) and how do they differ?
14:55–25:38
4
Which states are leading the trend and what specific legislation (e.g., Oregon, California, Indiana) is shaping the landscape?
25:38–35:24
5
What unintended consequences have emerged from these laws, such as provider closures or reduced access in rural areas?
35:24–44:19
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