Group Practice with Neal Goldstein

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.

In this episode of Group Practice, Neal Goldstein interviews Dr. Richard Harris, founding member and longtime CEO of Uropartners, about building one of the nation’s premier independent urology groups and the leadership principles behind its success.  Dr. Harris recounts the challenging two-year process of merging 11 competing practices into a unified organization—overcoming distrust, strong personalities, and the independent nature of physicians. He discusses Uropartners’ strategic growth through high-quality ancillary services, including a centralized pathology lab, a dedicated urology surgery center, and a comprehensive Advanced Prostate Cancer Center. Each initiative was driven by improving patient care, operational efficiency, and clinical expertise. He also describes launching UroGPO to strengthen purchasing power and innovation across large urology groups, and his national leadership role with Large Urology Group Practice Association. The episode closes with Dr. Harris’s reflections on leadership: vision, integrity, humility, respect for all team members, and leading by example—principles that sustained Uropartners’ culture and long-term success in independent practice.

In this episode of Group Practice, host Neal Goldstein explains the federal Stark Law, the prohibition on physician self-referrals, one of the two major healthcare fraud and abuse laws governing physicians. He describes Stark as a complicated but important statute enacted in 1989 and expanded in 1993 to cover ten “designated health services” (DHS), including imaging, physical therapy, durable medical equipment, and hospital services. Neal emphasizes that Stark is technically a Medicare and Medicaid payment law, but it functions like a fraud and abuse statute because violations require repayment and may trigger liability under the False Claims Act. Neal breaks the law down into its core components as he did in the law school course he taught.  He also discusses how Stark affects not just physicians, but also hospitals with the expansion of the law in 1993, making Stark a two-headed monster in the health care industry.

In this episode of Group Practice, Neal Goldstein explores the business case for physician group consolidation, distinguishing it from mere aggregation. True consolidation, he explains, involves full integration into a unified group practice—legally and operationally—rather than loosely affiliated practices sharing ancillaries.  Neal outlines five primary advantages: (1) central business office efficiencies, allowing groups to hire specialized expertise in billing, revenue cycle, and managed care contracting; (2) increased negotiating leverage with insurers, hospitals, and vendors; (3) enhanced ability to develop and expand ancillary services under Stark-compliant group structures; (4) greater market share through branding, recruitment, and infrastructure investment; and (5) key intangibles, especially camaraderie and the sharing of best practices. He also discusses what gets consolidated—governance, tax ID, billing, financial reporting, and policies—and addresses challenges, including delayed financial rewards compared to private equity deals, administrative strain, cultural shifts, and managing expectations.  Neal concludes with his “autonomy-growth” framework, arguing that well-structured group practice offers the optimal balance between autonomy and sustainable long-term growth.

In this episode of the Group Practice Podcast, Host Neal Goldstein interviews his brother, Dr. Wayne Goldstein, founder of Illinois Bone & Joint Institute (IBJI), which grew from 4 surgeons in 1 location in 1991 to 160 across 40 locations today.  Dr. Goldstein talks about obstacles he faced early on in his career which motivated him to build an independent, physician-led musculoskeletal group. He also reflects on decisions he made in the infancy of IBJI which were key to IBJI’s success.  Among those decisions were hiring the best and brightest out of fellowship, and rewarding quality and hard work versus seniority.  The episode concludes with a memorable story of how Dr. Goldstein’s thought leadership in orthopaedic implant design led to his work with a baseball icon.

In this episode, Neal Goldstein explains how the federal Stark Law (physician self-referral law) shapes the legal definition of a group practice. Stark prohibits physicians from referring Medicare or Medicaid patients for designated health services to entities with which they have a financial relationship—unless an exception applies. The most common exception is the in-office ancillary services exception, which depends on meeting the statutory definition of a group practice. Goldstein highlights two key requirements: the unified business requirement (centralized control over assets, liabilities, billing, and financial reporting) and the single legal entity requirement. CMS makes clear that “loose confederations” or “group practices without walls” do not qualify; true groups must be medically and economically integrated, with interdependent financial interests. Beyond compliance, Goldstein argues that strong structure promotes long-term stability, unity, and competitive resilience. Integrated groups are better positioned to withstand market pressures and advocate effectively.

In this premier episode of Group Practice with Neal Goldstein, Neal shares his background and how he got his start representing physician groups. He also discusses how he developed his expertise in the federal Stark law, which led to him teaching a law school course specifically on Stark. Neal lays out what to expect in future episodes, and explains why he chose the name Group Practice for the podcast. In addition, Neal discusses the thesis of the podcast, which is that private practice is very much alive, and can thrive if physician groups take a more strategic approach to structure and business. Neal’s goal for the podcast is to provide leaders of group practices with valuable information that will serve as a foundation for successful strategies.