Mergers: Best Practices for Combining Medical Practices in California
Are you preparing to combine two established medical practices in California? Mergers can be complicated. A proactive, detail-focused approach is a must. Lynnette Ariathurai is a business lawyer who has the knowledge and experience needed to help professional practices navigate transitions. Here, our California attorney for buying and selling a business highlights key things to know about medical practice mergers.
Medical Practice Mergers: Combining Two Established Practices in California
You Must Confirm the Combined Practices Meet California Legal Requirements
It is crucial that you pay careful attention to our state’s requirements for structuring a group medical practice. California medical practices generally cannot be operated through an ordinary business entity if practicing medicine. The structure must account for the Moscone-Knox Professional Corporation Act, the Medical Practice Act, and California’s corporate practice of medicine doctrine. In many cases, the operating vehicle will be a professional medical corporation owned and controlled by licensed physicians.
Conduct Comprehensive Health Care Specific Due Diligence
Due diligence is an absolute requirement with mergers and acquisitions. Standard business due diligence is not enough for a medical practice merger. Among other things, the parties should review corporate records, ownership ledgers, shareholder agreements, employment contracts, independent contractor arrangements, payer agreements, provider enrollment files, leases, equipment financing, malpractice coverage, billing practices, accounts receivable, patient credit balances, HIPAA policies, referral relationships, and any prior audits or board complaints.
Put a Priority on Patients: Medical Records, Continuity of Care, and More
Patients should always come first. A merger can disrupt patient care if medical records and open treatment issues are not handled carefully. Among other things, the agreement should state who will maintain custody of records, how EHR access will be transferred, how patients will be notified, how pending lab results and referrals will be monitored, and how records requests will be processed after closing. California physicians must also account for medical record retention obligations and patient access rights.
Make Sure that Finances are Handled Properly (Cash-Flow Matters)
A merged practice in California may face serious cash-flow problems if payer contracts, provider numbers, credentialing, billing addresses, tax identification numbers, and reassignment rules are not coordinated in advance. The parties should determine whether contracts can be assigned, whether new enrollments are required, whether Medicare or Medi-Cal notices are triggered, and whether commercial payers will treat the transaction as a change of ownership.
Put Strong, Well-Drafted Governance Documents in Place for Post-Merger
Once two established practices combine, informal understandings are dangerous. The shareholder agreement, bylaws, employment agreements, compensation plan, and buy-sell provisions should address voting rights, management authority, productivity expectations, call obligations, expense allocation, profit distributions, deadlock procedures, physician departures, disability, retirement, termination for cause, and mandatory repurchase rights.
Contact Our California Business Lawyer for Group Medical Practices Today
Lynnette Ariathurai is a California business attorney with extensive experience working with medical practices. If you have any specific questions about medical practice mergers, including combining two established medical practices in California, we can help. Please do not hesitate to contact us today for a confidential consultation. With an office in Fremont, we handle business law issues for medical practices throughout the San Francisco Bay Area.

