Playbooks

Healthcare niches

The same core doctrine, run through twelve fields that each break in a different place, with twelve different pressure points.

The core rules are the same for everyone. Where they break is not. A dental practice fights over who is allowed to own the chair. A home health agency runs into the anti-kickback statute the moment it takes its first Medicare patient. An ABA clinic lives or dies on payer credentialing. Same doctrine, twelve different pressure points.

Each page below takes one field and names its specific version of the problem: the ownership rule that applies, the reimbursement trap that shapes the entity, and the mistake that field makes most. Pick the field closest to yours. If none fits exactly, read the nearest one; the failure modes rhyme.

Inside this hub

ABA therapy: the niche where the funding source runs the structure

Applied behavior analysis inherits every rule on the healthcare structuring core page. What's actually specific to ABA: licensure that varies by state, revenue concentrated in Medicaid and insurance mandates, and the compliance work that starts the day the entity is formed.

Skilled nursing: the deal that can die at the CHOW desk

Everything on the healthcare structuring core applies here. What's specific to skilled nursing: CMS certification that doesn't transfer like an ordinary asset, successor liability for the facility's own history, and a False Claims Act exposure that scales with bed count.

Home care and home health: two businesses wearing one name

Everything on the healthcare structuring core applies. What's specific here: medical home health and non-medical home care are regulated as almost entirely different businesses, and a handful of states won't let you enter the medical side at all without proving the public needs you.

Hospice: the cap that turns growth into a repayment bill

Everything on the healthcare structuring core applies. What's specific to hospice: an aggregate annual payment cap that has nothing to do with billing accuracy, and a compliance flashpoint built into the benefit itself.

Assisted living: the niche that isn't federally regulated the way you'd expect

Everything on the healthcare structuring core applies. What's specific to assisted living: it mostly sits outside CMS certification entirely, which means the resident agreement, not a federal provider contract, is the document actually carrying the compliance and liability weight.

Med spas: the entity split most owners never make

Everything on the healthcare structuring core applies. What's specific here: most med spas run their entire revenue through a physician-owned structure that only a fraction of their services actually require, and the 2026 CPOM tightening lands hardest on exactly the absentee-physician pattern this niche is built on.

Behavioral health: one roof, several licensing regimes at once

Everything on the healthcare structuring core applies. What's specific here: a practice mixing psychiatrists with therapists is often satisfying two separate ownership statutes simultaneously, and telehealth means the patient's state, not the practice's, decides who has to be licensed where.

Dental: the practice that taught the rest of healthcare its own playbook

Everything on the healthcare structuring core applies. What's specific to dental: the DSO model this niche pioneered is now the template every other healthcare vertical copies, and dentistry's own ownership rules are often looser than physician CPOM, which changes what actually needs a friendly-PC wrapper.

Substance use treatment: the kickback law that doesn't care about your payor mix

Everything on the healthcare structuring core applies. What's specific here: the federal statute built for this industry specifically reaches private-pay and commercial-insurance arrangements the ordinary Anti-Kickback Statute never touches, which changes how every referral and marketing agreement has to be drafted.

Physical and occupational therapy: the trap is who's referring, not who's treating

Everything on the healthcare structuring core applies. What's specific here: a physician who owns the in-house therapy service referring their own patients to it triggers Stark Law self-referral scrutiny that most physician-owned setups don't actually satisfy the way they assume.

IDD group homes: the growth ceiling that has nothing to do with demand

Everything on the healthcare structuring core applies. What's specific here: funding is often capped by the state regardless of actual need, and the propco-opco split this site recommends everywhere else needs its lease priced specifically to survive Medicaid's related-party scrutiny.

Pharmacy: the license that shows up the moment you start moving product between locations

Everything on the healthcare structuring core applies. What's specific here: pharmacist-ownership rules are often the oldest, strictest professional-ownership restriction on the books, and growing past a single dispensing counter can trigger a completely separate wholesale distributor license nobody planned for.

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