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The Anti-Kickback Statute (“AKS”) remains one of the most complex and heavily enforced healthcare laws. As enforcement intensifies, healthcare organizations must move beyond reactive compliance and embed AKS risk management into everyday operations.

Executives, investors, operators, and compliance officers share responsibility for maintaining compliance. By taking proactive, practical steps, stakeholders can protect enterprise value, reduce exposure, and demonstrate to regulators that compliance is a core part of the business model—not an afterthought.

Every healthcare organization has unique risk points based on its structure, service lines, and financial relationships. A strong compliance

The Anti-Kickback Statute (“AKS”) is broad enough to capture almost any financial arrangement in healthcare. While safe harbors protect certain transactions, other business models routinely attract regulatory scrutiny. These high-risk arrangements share a common theme - they create financial incentives that can influence referrals, physician decision-making, or utilization of federally reimbursed services.

Executives, investors, operators, and compliance officers need to know where these risks lie. By identifying the most common red flags, stakeholders can structure deals more carefully, strengthen compliance programs, and avoid costly enforcement actions.

Marketing plays an important role in expanding patient acc

Healthcare transactions often involve two of the most significant federal fraud and abuse laws: the physician self-referral law, commonly known as the Stark Law, and the Anti-Kickback Statute (“AKS”). Both regulate financial relationships in healthcare, both carry serious penalties for violations, and both frequently arise in the same deals. But they operate differently, and confusing them can leave organizations exposed.

Executives, investors, operators, and compliance officers need to understand the distinctions between these statutes, how they interact, and why compliance with one does not guarantee compliance with the other.

The Stark Law prohibits physicians from referring Medicare patients for certain designated

The Anti-Kickback Statute (“AKS”) sets the rules of the road for financial relationships in healthcare. But enforcement priorities shift over time as new business models emerge, healthcare delivery evolves, and regulators sharpen their focus. For executives, investors, operators, and compliance officers, understanding current enforcement trends is just as important as knowing the statute itself.

In recent years, the U.S. Department of Justice (“DOJ”) and the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) have expanded investigations, brought more cases, and coordinated with whistleblowers at record levels. These efforts signal where the government sees the greatest risk — and where healthcare stakeholders must exercise the most caut

The Anti-Kickback Statute (“AKS”) casts a wide net over financial relationships in healthcare. Without limits, the statute could chill legitimate business arrangements that support patient care and innovation. To balance enforcement with practical business realities, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) has established a series of “safe harbors.” These regulatory provisions protect specific types of arrangements from AKS liability if stakeholders satisfy all requirements.

Understanding how safe harbors work, and where arrangements fall short, is essential for structuring deals with confidence.

Safe harbors provide clarity in an otherwise uncertain environment. When

The Anti-Kickback Statute (“AKS”), is one of the most important healthcare laws in the United States, affecting stakeholders across the healthcare industry. Lawmakers designed the AKS to protect patients and federal healthcare programs from financial conflicts of interest, and they drafted it broadly to give regulators powerful enforcement authority.

With heightened U.S. Department of Justice (“DOJ”) and U.S. Department of Health and Human Services Office of Inspector General (“OIG”) enforcement, increased whistleblower activity, and the rapid growth of telehealth, private equity-backed platforms, and value-based care models, understanding AKS risk is essential, whether you’re structuring an acquisition, negotiating c

Michigan’s Certificate of Need (CON) regulations offer tailored provisions that reflect the operational realities of rural and micropolitan markets. Lower volume thresholds, wider relocation limits, and expanded planning‑area definitions let community hospitals and clinics plan new services or modernize facilities with greater flexibility. When governing boards consider an Operation Room (OR) build‑out, imaging upgrade, or replacement hospital, these rural allowances strengthen both the regulatory case and the project’s financial profile. The following is a guide to the advantages that rural applicants can leverage when applying for a CON in Michigan.

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Whether you’re launching a new healthcare service, acquiring a facility, or expanding operations, navigating Michigan’s Certificate of Need (CON) process is a critical step. At Mooradian Law, we’ve helped providers across the state move through this complex regulatory landscape with clarity and confidence.

From initial planning to post-approval implementation, understanding how to position your project for success can save time, reduce risk, and prevent costly delays. Based on our experience and insights from Michigan Department of Health and Human Services (MDHHS) data, we’ve

This post concludes our Healthcare Transactions Series, where we have explored the legal, operational, and strategic issues that matter most to providers, investors, and entrepreneurs in the healthcare space.

Closing a healthcare transaction is a major milestone—but it’s not the end of the road. Critical post-closing tasks must be addressed to preserve deal value, ensure regulatory compliance, and mitigate post-closing risk. In heavily regulated industries like healthcare, these obligations are not merely best practices—they’re essential. This final installment highlights the key post-closing issues parties should anticipate and common pitfalls to avoid.

This post is part of Mooradian Law’s ongoing Healthcare Transactions Series, where we explore legal, operational, and strategic issues that matter most to providers, investors, and entrepreneurs navigating the healthcare business. In this installment, we’re tackling how you can ensure a smooth closing in healthcare M&A.

Closing is the final step of a healthcare deal when the seller officially transfers ownership to the buyer and the transaction becomes legally effective. This occurs once all parties have fulfilled contractual obligations, executed all transaction documents, dispersed funds, and have any required consents or approvals in hand. Closing logistics demand close attention—last-minute surprises can delay

This post is part of our ongoing Healthcare Transactions Series, where we explore legal, operational, and strategic issues that matter most to providers, investors, and entrepreneurs navigating the healthcare business. Today, we’re tackling a nuanced feature in healthcare M&A - earnouts.

Earnouts—provisions that tie part of the purchase price to post-closing performance—are often used to bridge valuation gaps in deals. While common in general M&A, these arrangements pose unique regulatory risks in healthcare, particularly under the federal Stark Law and Anti-Kickback Statute (AKS).

In transactions where sel

This post is part of Mooradian Law’s ongoing Healthcare Transactions Series, where we explore legal, operational, and strategic issues that matter most to providers, investors, and entrepreneurs navigating the healthcare business.

In this week’s installment, we examine why ensuring a smooth transition for clinical and administrative staff in healthcare M&A is essential to preserving business value and achieving a successful integration. Thoughtful handling of workforce issues helps protect your business from financial, legal, and regulatory risks.

At the outset of the transaction, buyers should assess the target organization’s culture to ensure

This post is part of our ongoing Healthcare Transactions Series, where we explore legal, operational, and strategic issues that matter most to providers, investors, and entrepreneurs navigating the business of healthcare. In this installment, we focus on two foundational—but often misunderstood—regulatory concepts: Fair Market Value (FMV) and Commercial Reasonableness (CR). Whether you’re acquiring a practice, structuring a management agreement, or evaluating physician compensation models, understanding FMV and CR is essential to ensuring your deal is not just financially sound—but also legally defensible.

Fair Market Value

This post is part of Mooradian Law’s Healthcare Transactions Series—a collection of insights designed for healthcare entrepreneurs navigating high-stakes deals in a complex regulatory environment. Whether you’re exploring growth through acquisition, preparing for a sale, or managing post-close integration, our series covers the legal, operational, and compliance factors that are necessary for success. In this installment, we examine the evolving role of private equity in healthcare and what providers need to know before partnering with private-equity-backed investors.

Private equity (PE) continues to make significant inroads into healthcare, fueling everything from large-scale physician practice rollups to real estate acquisitions and joint ventures with health sys

This post is part of Mooradian Law’s ongoing Healthcare Transaction Series, where we break down critical deal terms that shape the success of healthcare business transactions. In our last post, we unpacked the role of representations, warranties, and covenants. Here, we focus on the mechanisms that make those promises enforceable: indemnification and escrows.

Every deal has some uncertainty. But in healthcare, the stakes are often higher. Regulatory complexity and government and commercial payor requirements both add layers of post-closing risk. That’s where indemnification and escrows come in—providing contractual tools to manage exposure long after the ink is dry.

This post is part of Mooradian Law’s ongoing blog series on healthcare transactions. 

At the heart of every well-structured purchase agreement are three foundational elements: representations, warranties, and covenants. These provisions allocate risk, encourage transparency, and ensure alignment between parties from signing through post-closing operations.

Representations are factual assertions made to induce the other party to enter into the agreement. Warranties are assurances that those facts are, and will remain, true—often accompanied by a remedy if they’re not. In practice, these are typically bundled together as “reps and warranties,” though they technically carry

Part of Our Ongoing Healthcare Transactions Series.

Healthcare transactions involving operations in Michigan require a close look at state-specific regulatory issues that go well beyond federal compliance. Michigan’s licensure, Medicaid, Certificate of Need (CON), and corporate practice of medicine (CPOM) rules can significantly influence deal structure, timing, and post-closing operations.

Understanding these regulatory triggers—and planning for them early—can help avoid costly delays, preserve reimbursement streams, and ensure a smooth transition of operations. This post outlines the key Michigan-specific issues to watch in any h

Part of our Healthcare Transactions Series

A well-structured deal can fall apart—or create serious financial exposure—if regulatory issues are overlooked. From hidden Medicare liabilities to illegal ownership structures, healthcare transactions carry unique regulatory risks that don’t exist in most other industries.

In this installment of our healthcare transactions series, we walk through seven critical regulatory issues buyers and sellers need to manage in any healthcare M&A deal. We’ll also share actionable tips for keeping your transaction compliant, efficient, and on track to close.

The Stark Law and Anti-Kickback Statute (AKS) are two of the biggest landmines i

Structuring a healthcare M&A transaction is not just a legal formality—it is a strategic decision that affects liability exposure, regulatory compliance, tax outcomes, and long-term operational success. Whether a deal is structured as an asset purchase, stock purchase, or merger, each option carries distinct advantages and risks. This post examines the key factors that drive transaction structuring

This post is part of our ongoing healthcare transactions series, where we provide practical insights to help buyers and investors navigate complex healthcare deals.

 1. Prioritizing Business and Operational Goals

Before selecting a structure, buyers and sellers must clearly def

Due diligence is a critical step in any healthcare transaction, but it does not have to be prohibitively expensive. While thorough financial, legal, and regulatory review is necessary to mitigate risk, buyers can take a strategic and cost-conscious approach without compromising quality.

This post is part of our ongoing healthcare transactions series, where we provide practical insights to help buyers and investors navigate complex healthcare deals. Here, we explore how to streamline due diligence while managing costs effectively.

Not all due diligence issues carry the same level of risk. Rather than conducting an exhaustive review of every document, buyers should focus their resources on high-impact areas that

Due diligence is the backbone of successful healthcare transactions. Whether acquiring a medical practice, healthcare facility, or other type of healthcare business, a thorough legal and financial review is essential to avoid compliance pitfalls and financial risks. Overlooking a single issue—such as improper Medicare billing or an undisclosed liability—could lead to costly consequences, including legal exposure and regulatory fines.

This post is the first in our series on healthcare transactions, where we will explore key legal and financial considerations for buyers and sellers in the healthcare industry. Stay tuned for upcoming posts on structuring deals, navigating regulatory approvals, and mitigating post-transaction risks.

What Is Due Diligence?

Management Services Organizations (MSOs) have become an essential tool for structuring healthcare businesses, particularly in states with strict corporate practice of medicine (CPOM) laws. By providing administrative and management services to healthcare providers, MSOs allow physicians and other healthcare professionals to focus on patient care while separately managing business operations.

However, MSO structures must be carefully designed to mitigate legal risks, including CPOM restrictions, fee-splitting prohibitions, and—when government healthcare programs are involved—compliance with the Anti-Kickback Statute and Stark Law. Below, we outline key legal considerations and best practices for structuring an MSO in compliance with federal and state regulations.

Skilled Nursing Facilities (SNFs) must navigate an increasingly complex regulatory environment, and the latest changes from the Centers for Medicare & Medicaid Services (CMS) are no exception. As part of its ongoing efforts to enhance transparency and oversight, CMS has updated Form CMS-855A, requiring SNFs to undergo an off-cycle revalidation by May 1, 2025.

Failure to comply with these new requirements could jeopardize Medicare billing privileges, disrupt cash flow, and force facilities into a costly reapplication process. Below, we break down what’s changing, how to stay compliant, and steps your facility should take now to avoid any billing suspensions.

Why the Change? Increased Scrutiny on SNF Ownership

CMS has intensified its focus on

Expanding or modifying healthcare services in Michigan often requires compliance with Certificate of Need (CON) regulations. These rules are designed to control costs and ensure equitable access to services, but the application process can be complex and time-sensitive. At Mooradian Law, we help healthcare providers navigate the CON process efficiently, minimizing risks and delays. This guide provides an overview of Michigan’s CON program and how to streamline your application. 

Michigan’s CON program ensures that healthcare services are developed based on community needs while controlling costs and preventing duplication. Healthcare providers must