Concierge medicine is no longer a niche offering for a narrow slice of high-net-worth patients. It has become a rapidly expanding care delivery model drawing in established practices, entrepreneurial physicians, employers, and private equity-backed platforms. What the model's appeal can obscure is a basic reality: concierge medicine is still the delivery of medical services. A membership program may look and feel like a consumer subscription business, but it remains subject to licensure rules, privacy laws, reimbursement requirements, fraud and abuse constraints, consumer protection laws, and, in many states, restrictions on who may own, control, or share in the economics of a medical practice. A well-structured model supports growth and enterprise value. A poorly structured one creates exposure that tends to surface at the worst possible moment: during a financing, a sale, or a regulatory inquiry. The Concierge Medicine Playbook maps the decisions that separate the two, how a membership fee is defined, who owns and manages the practice, and whether the platform holds up under buy-side scrutiny.

Co-chair of Barnes & Thornburg’s Private Funds and Asset Management Group

Scott Beal

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The Concierge Medicine Playbook

Physicians and practice owners converting an existing panel, launching a concierge or direct primary care model, or weighing Medicare participation against opt-out Health systems evaluating membership offerings, employed-physician arrangements, or affiliations with concierge practices Investors and platform operators structuring MSO relationships, pursuing add-on acquisitions, or preparing a platform for sale In-house counsel and compliance leaders responsible for membership agreements, patient communications, marketing review, and multi-state telehealth compliance

Who Should Read This

Inside the Playbook

Barnes & Thornburg stands out because of our deep healthcare and life sciences industry knowledge, paired with our practical and innovative advice. With more than 130 Healthcare Industry Practice attorneys in the firm, located across the country in 26 offices, we offer clients access to unmatched experience and subject-matter expertise. Many of our healthcare attorneys have worked for federal and state regulatory and enforcement agencies, healthcare and life sciences companies, and hospitals and health systems. This allows us to understand the unique challenges of our clients and provide valuable guidance through the maze of complex statutes, shifting regulations, and compliance program needs on matters involving:

Legal, Regulatory, and Transactional Considerations for Physicians, Health Systems, and Investors

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Medicare and Medicaid Internal and government investigations Complex litigation (including commercial, criminal, and civil FCA litigation) Data privacy and healthcare technology requirements

Managed care contracting Payor disputes Audits and reimbursement Operational and regulatory questions

Mergers and acquisitions Legal and compliance issues

We provide trusted guidance to your varied needs while minimizing risk and meeting business objectives. Our healthcare team includes more than 20 former U.S. Attorneys and Assistant U.S. Attorneys, along with a former supervisor and founding member of the DOJ’s Medicare Strike Force. Additionally, we have significant experience representing healthcare providers, hospitals, health systems, clinical labs, pharmacies, PBMs, nursing homes, behavioral health organizations, health IT companies, pharmaceutical and medical device manufacturers, and others.

Model diversity and why the legal analysis shifts with the fee, the payor mix, and Medicare participation Membership agreements and the patient communications that have to match them Professional entities, MSO structures, and CPOM compliance HIPAA, FTC, Anti-Kickback and Stark, and multi-state telehealth risk M&A structures, revenue quality, and diligence beyond the financials

Launching a new practice, refining an existing model, preparing for sale, evaluating an acquisition — in each case, the questions raised here are far cheaper to answer now than to litigate, renegotiate, or explain to a buyer later.

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