Peter Armstrong Egan

/My focus

I help healthcare providers structure transactions to comply with federal and state fraud and abuse laws and regulatory issues. I also regularly advise healthcare management companies and their provider clients on whether proposed services and compensation methodologies are permissible under state law.

The behavioral health field is in a state of unprecedented transformation, as integrated care models are becoming a priority across the country. I lead the firm’s behavioral health team, bringing cross-disciplinary skills to solve regulatory, M&A, investment and supportive housing issues for our clients.

With considerable experience representing hospitals and medical centers on all types of corporate and regulatory matters, I provide strategic advice on physician alignment issues. My experience with faculty practice plans, “captive” practices and compensation pooling arrangements helps clients understand all available options.

Clients turn to my team for compliance counseling advice. My work in this area includes investigating potential fraud and abuse matters, making disclosures to the United States Attorney’s Office to preempt whistleblower claims, and preparing self-disclosures under the Stark Law.

My M&A experience also includes whole hospital mergers and affiliations, private equity transactions, and the purchase and sale of licensed facilities such as nursing homes and ambulatory surgery centers.

/Representative experience

• Representation of religious not-for-profit in the development of multiple properties, including developments that will include supportive housing (ongoing)
• Representation of multi-state telepsychiatry provider on regulatory and corporate practice of medicine issues 
• Representation of multiple de novo ambulatory surgery centers in New York and their related private placements
• Represented large orthopedic practice in its sale to an academic medical center
• Represented out-of-state ambulatory surgery center client in its joint venture with a New York hospital
• Representation of intellectual and developmental disabilities provider in supportive housing projects (ongoing)
• Representation of multi-state nursing home operator in the sale of a NYC skilled nursing facility (ongoing)
• Representation of a multi-specialty practice in its acquisition of a 150-physician specialty practice
• Representation of multi-state IVF provider in connection with regulatory and corporate practice issues
• Representation of health system in its transfer of ownership of an OPWDD licensed agency
• Representation of management company in multi-state roll-out of nutrition services practice
• Representation of an OPWDD provider in its affiliation with a larger OPWDD system 
• Representation of New York Community Hospital in its affiliation with Maimonides Medical Center
• Representation of Federally Qualified Health Center in acquiring mental health clinic that also provides affordable housing
• Representation of NYC–based orthopedic practice in its sale to a private equity backed practice
• Representation of NYC hospital in $20 million new markets tax credit transaction, to build a new state-of-the-art behavioral health emergency room and medical education training facility
• Representation of academic medical center restructuring and developing its portfolio of ambulatory surgery centers
• Representation of large radiology group in joint venture with regional health system
• Representation of academic medical center in joint venture with large multi-specialty practice to operate radiation oncology facility
• Representation of NYC behavioral healthcare IPA to acquire telehealth platform and make telehealth services available to its members
• Representation of a large behavioral healthcare IPA in contract negotiations with an Innovator ACO
• Representation of a Care Coordination Organization/Health Home for people with intellectual and developmental disabilities (this is a new model for coordinating community-based services with medical and mental health services)
• Representation of large NYC social services agency merging with a developmental disabilities provider
• Representation of developmental disabilities service provider in supportive housing project
• Represented a for-profit healthcare company in restructuring approximately $555 million of secured and unsecured debt, including the sale of one facility and a new equity investment
• Representation of for-profit substance abuse treatment provider entering New York State
• Prepared co-management agreement between an academic medical center and its employed and voluntary orthopedic surgeons to manage the medical center’s ambulatory surgery center
• Representation of federally qualified health center in its acquisition of a mental health clinic
• Representation of NYC social services organization in OMIG audit and repayment negotiations
• Represented a health system in the $35 million sale of two nursing homes
• Represented a university’s medical school in the sale of a clinic to a California municipality, to be operated as a Federally Qualified Health Center
• Represented an academic hospital in a transaction with a for-profit medical school to finance a multimillion-dollar refurbishment of a medical education center
• Represented a nationwide franchisor with respect to opening medical locations and operational issues, in light of corporate practice of medicine rules
• Represented a 600+ physician practice in its affiliation with a world-renowned cancer treatment center and the development and construction of a new cancer treatment facility on the practice’s campus
• Represented a consortium of social service organizations to provide HCBS waiver services
• Represented a large academic medical center in the acquisition of multiple cardiology practices, including an out-of-state practice
• Represented a large social services organization in its merger discussions with a substance-abuse provider that also provided affordable housing
• Represented a large developmental disabilities provider in creating a “captive” practice to provide article 16 services at offsite locations
• Represented the surviving entity in the consolidation of two mental health providers and an affordable housing organization

/Looking ahead

The focus on best practices and protocols will continue, with an emphasis on mental health and substance abuse treatment. Separately, industry participants are improving their use of IT systems to drive clinical integration, quality improvement and better financial performance. We are assisting clients with strategic decisions and legal structures to take advantage of this information revolution.

/Insights

• “Multi-Entity Structures,” NYSSCPA's Exempt Organizations Conference, New York, NY, December 12, 2023 (Presenter)
• “What to Watch in Behavioral Health: 42 CFR Part 2 Reforms, New York Updates and BH Integration,” NYS Bar Association 2023 Annual Meeting, New York, NY, January 20, 2023 (Panelist)
• “How Government Makes Housing Happen,” NY Alliance Housing Symposium, Webinar, November 3, 2021 (Presenter)
• “The Future of Healthcare,” TerraLex Virtual Meeting, Webinar, May 29, 2020 (Presenter)
• NP Connects: Coronavirus Market Update - Healthcare Industry, Webinar, May 14, 2020 (Presenter)
• “Not For Profit Town Hall-Efforts Around Coronavirus,” New York State Society of CPA’s, Webinar, April 24, 2020 (Presenter)
• “Healthcare Fraud and Abuse Update 2017 and Related Criminal Defense Issues,” New York State Society of CPA’s Forensic Accounting and Litigation Services Conference, New York, NY, May 22, 2018 (Presenter)
• “Not-for-profit mergers and acquisitions: What your organization needs to know”, Interagency Council of Developmental Disability Agencies (IAC), March 6, 2018 (Presenter)
• “What New York Not-For-Profit Providers Should Be Thinking About When Considering a Merger or Affiliation,” Cohn Reznick offices, New York, New York, June 1, 2017 (Presenter)
• “How to Respond to a Government Investigation,” Healthcare Compliance Forum, Nixon Peabody LLP, New York, New York, February 28, 2017 (Presenter)
• “OMIG's 2016–2017 Work Plan and Compliance Initiatives in the Year Ahead,” Healthcare Compliance Forum, Nixon Peabody LLP, New York, New York, June 2, 2016 (Presenter)
• “Internal Investigations: Shining the Spotlight on the Role of the Attorney-Client Privilege,” Healthcare Compliance Forum, Nixon Peabody LLP, New York, New York, March 24, 2015 (Moderator)
• “Self-Disclosing Medicare and Medicaid Overpayments,” Healthcare Compliance Forum, Nixon Peabody LLP, New York, New York, October 7, 2014 (Moderator)
• “A Legal Update,” Cerini & Associates, LLP’s Non Profit Update 2014, June 24, 2014 (Presenter)
• “Meeting the Challenges of Provider Reimbursement: New Payment Models, Implications, and Opportunities,” Connecticut Healthcare Financial Management Association, November 2013 (Presenter)
• “Cuomo’s Executive Order: The Final Shake-Out,” Health & Welfare Council of Long Island, September 11, 2013 (Presenter)
• “Valuation Issues When Selling to Private Equity or Medical Centers,” Adelphi University, November 2012 (Presenter)
• “Employment Pitfalls in Light of Practice Acquisitions,” New York State Radiological Society, October 2012 (Presenter)
• “Not-for-Profit Board Duties in the Era of Health Care Reform,” Health Care Check-up Webinar Series, Nixon Peabody, February 2012 (Co-Presenter)
• “Preparing to Sell Your Business: Now is the Time,” Hot Topics for Middle Market Companies Discussion Series, Nixon Peabody, January 2012 (Panelist)
• “Health Care Fraud & Abuse for Acute Care Providers,” Foundation for Accounting Education’s Healthcare Conference, September 2011 (Presenter)
• “How the Changing Healthcare Environment Affects You and Your Clients,” Nassau County Bar Association, May 2011 (Presenter)
• “Accountable Care Organizations: What you need to know,” Nixon Peabody Webinar, April 21, 2011 (Presenter)
• “Overcoming Legal Obstacles to Implementation of Accountable Care Organizations,” National Forum on Clinical Integration, November 2010 (Presenter)
• “Update on Tax Issues Affecting Not-For-Profits,” SUNY Old Westbury Fiscal Conference, October 2010 (Presenter)
• “Health Care Reform & Its Impact on Your Bottom Line,” The Knowledge Group LLC Webinar, September 2010 (Presenter)
• “Independent Contractor or Employee? Higher Stakes for Many Medical Practices,” Journal of the American College of Radiology, September 2010 (Co-author)