In this episode of Group Practice, host Neal Goldstein explains the federal Stark Law, the prohibition on physician self-referrals, one of the two major healthcare fraud and abuse laws governing physicians. He describes Stark as a complicated but important statute enacted in 1989 and expanded in 1993 to cover ten “designated health services” (DHS), including imaging, physical therapy, durable medical equipment, and hospital services. Neal emphasizes that Stark is technically a Medicare and Medicaid payment law, but it functions like a fraud and abuse statute because violations require repayment and may trigger liability under the False Claims Act. Neal breaks the law down into its core components as he did in the law school course he taught. He also discusses how Stark affects not just physicians, but also hospitals with the expansion of the law in 1993, making Stark a two-headed monster in the health care industry.

In this episode of Group Practice, Neal Goldstein explores the business case for physician group consolidation, distinguishing it from mere aggregation. True consolidation, he explains, involves full integration into a unified group practice—legally and operationally—rather than loosely affiliated practices sharing ancillaries. Neal outlines five primary advantages: (1) central business office efficiencies, allowing groups to hire specialized expertise in billing, revenue cycle, and managed care contracting; (2) increased negotiating leverage with insurers, hospitals, and vendors; (3) enhanced ability to develop and expand ancillary services under Stark-compliant group structures; (4) greater market share through branding, recruitment, and infrastructure investment; and (5) key intangibles, especially camaraderie and the sharing of best practices. He also discusses what gets consolidated—governance, tax ID, billing, financial reporting, and policies—and addresses challenges, including delayed financial rewards compared to private equity deals, administrative strain, cultural shifts, and managing expectations. Neal concludes with his “autonomy-growth” framework, arguing that well-structured group practice offers the optimal balance between autonomy and sustainable long-term growth.

In this episode of the Group Practice Podcast, Host Neal Goldstein interviews his brother, Dr. Wayne Goldstein, founder of Illinois Bone & Joint Institute (IBJI), which grew from 4 surgeons in 1 location in 1991 to 160 across 40 locations today. Dr. Goldstein talks about obstacles he faced early on in his career which motivated him to build an independent, physician-led musculoskeletal group. He also reflects on decisions he made in the infancy of IBJI which were key to IBJI’s success. Among those decisions were hiring the best and brightest out of fellowship, and rewarding quality and hard work versus seniority. The episode concludes with a memorable story of how Dr. Goldstein’s thought leadership in orthopaedic implant design led to his work with a baseball icon.