Private equity has not left healthcare. It has instead pivoted away from the leveraged physician roll-up and toward larger, later-stage, and asset-backed targets. This article examines past and current private equity activity in healthcare. Commentary through the first half of 2026 has described private equity as retreating from healthcare. The data supports a narrower conclusion. Investment in physician practice management companies (PPMCs) has fallen sharply from its 2021 peak, but aggregate private equity deal counts and disclosed capital deployed across the industry have both risen year over year. Private equity has not left healthcare. It has instead pivoted away from…
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Regulators and whistleblowers are increasingly focused on whether physician payments exceed fair market value, lack commercial reasonableness, or vary with referrals. Any of these factors may trigger costly investigations and penalties. In this article, the authors discuss what constitutes a proactive approach to compensation planning. In today’s increasingly rigorous regulatory environment, hospitals and health systems must ensure physician compensation arrangements are “defensible by design,” meaning they are proactively structured to withstand legal scrutiny rather than requiring reactive remediation. Enforcement of the federal Physician Self-Referral Law (“Stark Law”) and Anti-Kickback Statue (AKS), often pursued under the False Claims Act (FCA), has…
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On July 14, 2026, the CMS released its proposed MPFS for CY 2027. According to CMS Administrator Dr. Mehmet Oz, the proposed rule reflects “some of the most significant Medicare reforms in recent years to strengthen primary care, expand accountable care, and modernize physician payment.” This article discusses the CY 2027 MPFS proposed rule’s payment update and significant policy proposals. On July 14, 2026, the Centers for Medicare and Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2027.[1] The proposed rule would decrease both statutory conversion factors used to calculate physician payment, reversing…
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This 28th article of the Unimpeachable Neutrality Series defines intellectual capitalism, traces labor-market capitalism from Smith and Marx to Coase and Baumol, separates the professions from the nurse and the lineman whom robotics will not reach, reads the employment data against its base years, and explains why the petite bourgeoisie Marx said would be swamped is coming back with a CPA license, and why the one asset that cannot be downloaded is an unimpeachably neutral method. In January 2017, I opened a forensic accounting firm with one employee. I had been working alone for a while before that, at a…
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In this article, Michael Pakter, a Certified Fraud Examiner, shares several of the findings contained in the 2026 ACFE Report to the Nations; this report analyzes 2,402 occupational fraud cases investigated in 143 countries and territories and documents losses exceeding $3.4 billion. There are many constants and the author shares his views on why that remains so. For three decades, the Association of Certified Fraud Examiners (ACFE) has published what has become a definitive benchmark study of occupational fraud. In 2026, the ACFE released the 14th edition of its landmark research publication, Occupational Fraud 2026: A Report to the Nations,…
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In this case, the issues before the trial court were: 1) whether Plaintiff was an independent contractor or employee, 2) whether Plaintiff acted in good faith, and 3) the computation of damages. On appeal, the court discussed the standard of review for employment classification and damages. Jarod Kintz, a somewhat famous humorist and self-published author, once said, “Most employees are like interchangeable machine parts. When they show up to work, there is no trace of the person they replaced, and then they leave, they make no lasting impression and it’s as if they were never there.” He was probably joking,…
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QoE engagements have steadily moved downstream as buyers, lenders, and advisors seek greater assurance that the earnings presented by a seller are not only historically accurate, but also recurring and sustainable. Beginning October 1, 2026, QoEs will take on an even more significant role in certain transactions financed through the U.S. SBA. In this article, the author discusses the new SOP. Quality of Earnings (QoE) analyses have become an increasingly important component of financial due diligence in mergers and acquisitions. Historically associated more frequently with private equity and larger middle-market transactions, QoE engagements have steadily moved downstream as buyers, lenders,…
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Multidisciplinary valuation engagements are complex. There are blind spots that, if not addressed, will undermine the valuation. This series is written to identify those blind spots and solve the problem for everybody the easy way. The author’s intent is to support the valuator’s authority and credibility in the courtroom and in all valuation applications. Mixed-discipline assignments can seem much more straightforward than they actually are. For example, valuing an interest in a partnership that holds real estate requires underlying property value and the rest of the balance sheet plus ownership rights, property type, and leverage so you can connect with…
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The U.S. Supreme Court’s plurality decision in the Chapter 13 case, Till v. SCS Credit Corp., could be one of the most significant Supreme Court decisions on reorganization since the passage of the Bankruptcy Code. Many bankruptcy and appellate courts have found the Till decision to be “instructive and informative” in guiding the courts in determining cram down rates for Chapter 11 bankruptcy cases. But the question for experts is: What information do you need to determine the appropriate cram down rate? This article will discuss the Till factors, circumstances of the estate, the nature of the security, and feasibility,…
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In litigation, the issue is whether the expert can explain the analysis, the data, and the judgment that produced the opinion. AI can accelerate parts of that process, but it does not remove the expert’s responsibility for the conclusion. Therefore, the question addressed in this article is where AI can assist without taking ownership away from the expert. A valuation expert can arrive at the stand with years of experience, a detailed model, and a carefully prepared report. However, the expert may stumble when asked to explain an input that came from an AI tool and cannot explain why that…
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This article provides practical takeaways for valuing U.S. IP involving AI, machine learning, and LLMs. It is not a fulsome valuation methodology. It is a set of warnings; legal scope, technical substance, transferability, detectability, and enforcement can radically change the value of an AI-related IP asset. The gold rush for artificial intelligence (AI)-related intellectual property (IP) has made it difficult to separate genuinely valuable assets from expensive paperwork. Changing law, buried prior art, weak secrecy, poor drafting, and shifting market demand can make AI-related IP assets worth far less than they appear. The answer is not simply to count patent…
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The problem begins when DSO answers one question while valuation requires another. DSO tells us how quickly receivables have been collected on average. Business valuation asks whether those receivables are likely to become future cash flows as expected. Those questions are related, but they are not the same. The author describes what questions to ask when reviewing DSO metrics. Days sales outstanding (DSO) is one of the most trusted metrics in accounts receivable analysis. Finance professionals use it to monitor collection efficiency, evaluate working capital performance, and identify changes in customer payment behavior. That trust is largely justified. The problem…
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The concept behind my “Grade Me” framework is straightforward: Valuation professionals can improve report quality by reviewing their work from the perspective of an informed reader who does not have the preparer’s background knowledge. A structured 30-minute review can identify issues before they become client concerns or litigation problems. Every valuation report is eventually reviewed by someone other than the person who prepared it. The reviewer may be a firm partner, a client, opposing counsel, a trier of fact, a regulator, a credentialing organization, or another valuation professional. Each reviewer approaches the report with a different perspective, but all are…
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Errors in the enterprise-to-equity bridge may cause cash, debt, working capital, or non-operating assets to be counted twice, omitted entirely, or treated inconsistently among valuation approaches. These errors can be particularly significant in litigation and marital dissolution matters, where the ultimate question is generally the value of a specific ownership interest rather than only the value of the company’s operations. A business valuation may employ an appropriate methodology, a reasonable benefit stream, and a supportable discount rate or market multiple, yet still arrive at an incorrect conclusion of equity value. One of the most common reasons is an error in…
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Parties to litigation proceedings are often required to disclose their personal spending. The information provided to the Court may require certification that the information is complete, true, and accurate under penalty of perjury, yet often based, at least in part, on estimates. This article shows how a few simple steps can achieve the desired results without the costs, time, or guesswork. Parties to litigation proceedings are often required to disclose their personal spending. The information provided to the Court may require certification that the information is complete, true, and accurate under penalty of perjury, yet often based, at least in…
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Gray divorce demands genuine collaboration among professionals who each hold a distinct piece of the client’s financial and legal picture. When these professionals operate in silos, critical details fall through the cracks. Conversely, when the team functions as a cohesive unit, clients are far better positioned to reach divorce settlements that are not only legally sound, but financially sustainable. The author shares the importance of embracing a collaborative approach for these more mature clients. Gray divorce, generally defined as a divorce at age 50 or later, has become one of the most consequential and complex transitions clients bring to their…
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The Internet Crime Complaint Center has issued reports over the past 26 years that detail the types of crimes reported involving the use of the internet. Despite the sense that crime is random and unpredictable, the author finds that is not the case and, in this article, sets forth the commonalities missed. Read Part I here. The Internet Crime Complaint Center (IC3) reports did not first encounter cryptocurrency as a mature asset class. Cryptocurrency appeared as a warning sign, denoted with a simple “various payments” summary as a payment mechanism for ransomware and later appearing inside other crime types. Long…
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Few issues generate more spirited conversation among valuation practitioners than the debate over whether to use Excel or a valuation software package. The author opines that the decision today is not a simple build-versus-buy issue. The issue is how to combine specialized business valuation software with requisite integrated databases and supervised AI tools for the end-user’s and clients’ benefit. Few issues generate more spirited conversation among valuation practitioners than the debate over whether to use Excel or a valuation software package. After all, many practitioners have invested hundreds, or thousands, of hours developing their own spreadsheets, templates, linked databases, and…
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Internet fraud continues to thrive. In this article, the author summarizes the types of fraud and how online fraud will continue to evolve, and what readers can do to recognize what form fraud will take. When the FBI’s Internet Fraud Complaint Center (IFCC, later renamed to IC3) first opened its doors in May 2000, it took in a mere 20,014 complaints in the first partial year of operation.[1] A quarter-century later, it has taken in more than 9 million complaints, with $11.366 billion in cryptocurrency related losses alone in a single year.[2] These annual reports are a chronicle of growing…
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A business valuation is one of the most manipulation-friendly disciplines in professional services. The stakes are high and because of this, someone, somewhere, could find themselves motivated to move the number. For the valuation expert, understanding where legitimate (and permissible) advocacy ends, and intentional distortion begins is not simply an academic exercise. It is a professional survival skill, and increasingly, a legal one. The author discusses four schemes where fraud may occur and describes the red flags professionals need to recognize to identify fraud. The Setup The valuation was delivered to the client and the business appeared healthy. The revenue…