Most healthcare founders think corporate ownership of medical practices is strictly illegal. The truth is much more complex.

Healthcare attorney Neal Goldstein breaks open the state-level laws governing Fee Splitting and the Corporate Practice of Medicine (CPM). In this episode, he strips away the legal fluff to reveal the exact structural workarounds private equity firms use to acquire, manage, and scale medical groups across the United States. If you are trying to understand how modern medical groups are actually financed and structured, this breakdown is for you.

What you will learn:
● Why Fee Splitting and CPM are strictly state-level laws with massive enforcement differences across the country
● The critical difference between statutory licensing laws and evolutional common case law in healthcare compliance
● How the historic Berlin v. Sarah Bush Lincoln case accidentally banned hospitals from employing doctors in Illinois
● The exact mechanics of the “Friendly PC / MSO” contract model used to legally bypass corporate ownership bans
● Why structuring a management fee based on a medical practice’s direct profits triggers massive regulatory risks
● The hidden economic reasons why these antiquated 1990s laws remain on the books despite structural changes in GDP
● A collaborative boardroom framework inspired by hospital medical staffs to balance corporate scale with clinical quality

Timestamps
00:00 — The Stark Reality of Fee Splitting and Corporate Medicine Statutes
01:22 — Statutory Fee Splitting vs Common Law CPM Compliance
03:06 — Navigating Section 22.2 of the Illinois Medical Practice Act
05:00 — The True Policy and History Behind the Corporate Practice of Medicine
07:26 — The Berlin v. Sarah Bush Lincoln Appellate Decision and Fallout
09:58 — State Enforcement Spectrum: High Risk vs Low Risk Jurisdictions
13:36 — How Private Equity Structures Corporate Healthcare Transactions legally
13:54 — The Friendly PC and MSO Legal Agreement Mechanics
16:36 — Fair Market Value Pitfalls in Management Fee Structuring
18:13 — Why Outdated Healthcare Licensing Laws Still Exist on the Books
22:00 — A Better Boardroom Framework for Medical Group Quality Assurance
25:58 — Wrap Up: Private Equity in Modern Medical Group Ownership

Guest Bio:
Neal Goldstein is an expert healthcare transaction attorney specializing in regulatory compliance, medical group mergers and acquisitions, and corporate structuring for group practices. Over a multi-decade legal career, he has advised healthcare systems, physicians, and private equity platforms on navigating the complex intersection of corporate scaling and clinical compliance.

Website: https://www.pfs-law.com/
Website: https://www.goldsteingrouppractice.com/
Website: https://nealtgoldstein.com/
LinkedIn: https://www.linkedin.com/in/neal-t-goldstein-841aa652/

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Disclaimer
This episode is for informational and educational purposes only and does not constitute legal, financial, or medical advice.

Most sleep specialists are just CPAP purveyors. If the mask fails you, they often have no next step. Dr. Len Covello is changing that narrative.
Neal Goldstein sits down with Dr. Len Covello, an otolaryngologist and sleep surgery innovator who developed the sleep surgical program at Powers Health. This episode cracks open the “system failure” in sleep medicine and provides a holistic roadmap for those failing traditional treatments.

What you will learn
● Why the “CPAP or bust” mentality creates a massive blind spot in modern sleep medicine
● The mechanics of Hypoglossal Nerve Stimulation and why it’s a game-changer for moderate to severe apnea
● How common medications like acetazolamide can “trick” the brain into fixing central sleep apnea
● The surprising link between GLP-1 weight loss medications and surgical eligibility for sleep patients
● Why screening in hospitals often leads to “order drift” and how to ensure patients actually get treated
● The “Quarterback” model: why you need a single clinician to own the entire holistic sleep journey
● How to navigate restrictive insurance criteria (BMI and AHI) to get the life-changing surgery you need

Timestamps
00:00 — Introduction: Dr. Len Covello’s 30-year journey in ENT
03:31 — The evolution from traditional ENT to sleep surgery specialist
05:40 — Why the UPPP throat surgery was “justifiably discredited”
07:03 — Hypoglossal Nerve Stimulation: How stimulating the tongue nerve works
11:22 — The CPAP blind spot: why 50% of patients are falling through the cracks
15:54 — Creating a high-quality alternative to the CPAP mask
21:50 — Using GLP-1s and weight management as a bridge to sleep surgery
24:32 — Fixing Central Sleep Apnea with acetazolamide
28:45 — The STOP BANG screening method and why it often fails in hospitals
32:20 — The Sleep Counselor: Why patient navigation is the missing link
34:34 — The financial argument for payers: preventing AFib and heart failure

Guest bio and links
Dr. Len Covello is a board-certified otolaryngologist at Community Hospital in Munster, Indiana (Powers Health). He is a pioneer in sleep surgery and developed a comprehensive program focusing on neurostimulation and holistic airway management. Dr. Covello also consults for financial and medical institutions on the future of sleep technology.
Website: https://www.powershealth.org
LinkedIn:

Show subscribe and platform links
New episodes every week — subscribe so you never miss a conversation on the business of medicine.
Spotify | Apple Podcasts | YouTube

Disclaimer
This episode is for informational and educational purposes only and does not constitute legal, financial, or medical advice.

In this episode, Neal Goldstein breaks down the “two hats” physicians wear in private equity transactions: seller and rollover owner/employee. He explains that while most physicians focus heavily on upfront cash, indemnities, and non-competes in the sale, they often don’t pay as much attention to equally critical employment and rollover equity agreements.

Neal highlights why it is important to focus on rollover and employment terms. Rollover equity can represent a substantial portion of total deal value, and its terms—vesting, forfeiture, buyback rights, and valuation—vary widely and directly impact long-term outcomes. He also emphasizes that physicians’ interests diverge based on career stage, productivity, and risk tolerance, making these provisions highly personal.

The episode offers a practical roadmap of what to scrutinize in both employment and rollover agreements, urging physicians to give as much attention to their “second hat” as their first—because that’s where significant financial risk and upside often lie.

In this episode of Group Practice, host Neal Goldstein discusses why private equity (PE) firms are often able to operate more strategically than independent physician groups—and how those groups can adopt similar approaches without selling. Drawing on his experience, Neal explains that PE firms benefit from centralized decision-making, clear performance metrics like EBITDA, and shorter investment horizons that drive disciplined execution.

Neal highlights four areas where he sees PE firms create value: physician staffing (particularly succession planning and strategic hiring), expense management (focusing on eliminating inefficiencies such as excess real estate), deployment of capital (retaining earnings to fund growth), and corporate infrastructure (including strong leadership roles like COO, CFO, and CDO).

The core takeaway is that while PE has advantages, physician groups can improve performance by adopting even a few of these strategic disciplines—particularly around capital reinvestment, operational efficiency, and leadership structure.

In this follow-up episode of Group Practice, host Neal Goldstein addresses listener feedback about non-competes in physician practices. He tackles three key questions: Are non-competes ever appropriate? What’s the point of enforcing them if they’re often struck down? And what alternatives exist?

Neal argues non-competes remain appropriate in several contexts: competing against hospital systems, PE-backed practice sales, groups with exclusive hospital contracts, and specialties with high capital costs. He emphasizes that despite headlines suggesting otherwise, non-competes are still being enforced and represent valuable contractual rights worth protecting.

For practices seeking alternatives, Neal offers practical strategies: conditioning tail coverage on non-competition, structuring severance with clawback provisions, strengthening non-solicitation clauses, and negotiating robust no-hire provisions in hospital contracts.

In this episode of Group Practice, host Neal Goldstein interviews Dr. Lowell Weil, Executive Chairman of Balance Health and formerly the CEO of Weil Foot & Ankle Institute a 53-physician podiatry group founded by his father Dr. Lowell Weil Sr. Dr. Weil discusses the five practice settings for podiatrists: solo/small practices, orthopedic groups, hospital systems, large independent groups, and platform-backed groups like Balance Health.

Dr. Weil highlights the mounting challenges facing small practices – stagnant Medicare reimbursement, rising costs, and physician burnout – and explains how Balance Health addresses these issues by providing operational support, compliance infrastructure, and professional camaraderie while preserving clinical autonomy.

What sets Balance Health apart is its physician-majority ownership structure, with over 150 podiatrist-owners, physician leadership at all levels, and a commitment to hiring and developing young doctors. Dr. Weil emphasizes that patient care, not profit, drives the organization’s mission.

In this episode of Group Practice, host Neal Goldstein welcomes his partner, and leader of PFS’s labor and employment practice, Nora Walsh, for a deep dive into the evolving world of physician non-competes. They explore the common law foundations – reasonableness in time and geography, and protectable interests – and how Illinois’s landmark Fifield case added consideration requirements, later codified in the Freedom to Work Act. The conversation surveys the national landscape: outright bans in California, Minnesota, and others; Texas’s practical buyout approach; Florida’s employer-friendly stance; and recent restrictions for healthcare workers in states like Colorado and Delaware. They also discuss the FTC’s abandoned federal ban and why the current administration may still target healthcare non-competes. Key takeaway: Non-competes have not gone away, but employers and physicians alike need to understand their state’s rules, and the risks of overreaching.

This episode of Group Practice with Neal Goldstein provides an overview of the Anti-Kickback Statute (AKS), a federal fraud and abuse law enacted in 1972 that applies to all federal healthcare programs. Unlike the Stark Law, AKS is an intent-based statute that prohibits knowingly giving or receiving remuneration to induce referrals for federally reimbursable healthcare items or services. The landmark United States v. Greber case established the “one purpose test”— if even one purpose of payment is to induce referrals, the statute is violated. Due to this broad interpretation, safe harbor regulations were created in 1991, protecting compliant arrangements from prosecution. The episode also discusses advisory opinions and the protection those afford. At the conclusion of the episode, Neal explains the “quid pro quo” concept which is at the core of AKS, and he uses a little league sponsorship analogy which was contained in the jury instructions of the TAP Pharmaceutical case.