The triage table
Ranges are directional and vary enormously by market and firm.
The five specialties you’ll need
Healthcare regulatory. The most important and the hardest to substitute. CPOM, fee-splitting, Stark, AKS, licensure, payer contracting, billing compliance. Must be licensed in each state you operate in, or working with local counsel there. Corporate. Formation, governance, financings, M&A. Can be a generalist if they coordinate with healthcare regulatory on anything touching the PC. Employment. Clinician agreements, restrictive covenants, classification, terminations. Increasingly important as physician noncompete law diverges by state. Privacy and data security. HIPAA, breach response, state privacy laws, vendor agreements. Litigation. Not until you need it, but know who you’d call.How to tell if a healthcare lawyer is the real thing
Ask these in the first call:- “What’s the CPOM posture in [my state], and what’s changed in the last two years?” A specialist answers immediately and mentions the 2025–2026 legislative wave. A generalist asks what CPOM stands for.
- “How would you structure the management fee here, and why?” You want a discussion of flat versus cost-plus versus percentage tied to your state’s fee-splitting rule, not “whatever you prefer.”
- “How many MSO-PC structures have you built in this state?”
- “Who represents the clinician-owner?” The right answer is someone else, and they should have their own counsel. A lawyer who offers to represent both sides is telling you something.
- “How do you keep clients current as the law changes?”
Where a template is genuinely fine
Not everything needs counsel:- Standard vendor NDAs and services agreements
- Basic employment offer letters for non-clinical MSO staff
- Ordinary commercial leases (reviewed, not necessarily drafted)
- Routine formation filings in non-pre-approval states, if the professional entity requirements are clear
- The MSA, ever
- The stock transfer restriction agreement, ever
- Clinician employment agreements, because restrictive covenants and malpractice provisions are state-specific and the law is moving
- Anything involving a referral source
- Anything in a state you haven’t operated in before
Managing the cost
Scope engagements tightly. “Review this MSA against Colorado law and flag issues” costs less than “advise us on our structure.” Reuse. A well-built base MSA plus state riders means state four costs a fraction of state one. Ask your counsel to build for reuse from the beginning. Batch questions. Keep a running list rather than emailing each one as it arises. Use fixed fees where possible. Formation, standard agreements, and state entries are often quotable. Do your own homework first. Arriving with your state’s page, the specific statute, and a concrete question is far cheaper than arriving with “how does this work?” Know when to defer. An FMV study can often wait until your first raise, unless your fee structure is aggressive or your state is strict.The standing bench
By the time you’re multi-state, you want:- One primary healthcare regulatory firm that knows your structure and coordinates local counsel
- Local healthcare counsel in each strict state, or a national firm with real coverage
- Corporate counsel for financings
- Employment counsel on call
- Privacy counsel identified before you need them at 6pm on a Friday
- An annual review of the agreement stack, calendared
The clinician’s counsel
The three things worth calling about immediately
If any of these happens, stop and call before responding:- A subpoena, civil investigative demand, or government inquiry. Never respond without counsel. What you say first shapes everything after.
- A licensing board inquiry directed at your clinician-owner. Both the entity and the clinician need counsel, and they may need different counsel.
- A discovered overpayment or billing error. The 60-day clock starts on identification, and how you quantify and self-disclose materially affects exposure.