Health law attorney Justin M. Puleo represents both traditional providers of healthcare in their critical transactions and expansions and new entrants in telemedicine, telehealth, and digital medicine. From guidance on a multitude of regulatory obligations to structuring joint ventures and private equity investments, Justin draws from his 15+ years of applying regulatory obligations to support healthcare clients’ commercial opportunities and care to patients. He serves as national chair of the Healthcare Regulations, Transactions & Telehealth Practice Group.
Corporate & Regulatory Experience
Mergers & Acquisitions
- Formulated and established several multiparty healthcare joint venture arrangements.
- Closed deal involving a multistate practice and a newly created MSO supporting the same in the area of stem cell therapy.
- Counseled market leader in telehealth in its affiliation with large physician network.
- Provided regulatory counsel and closed joint real estate deal between billion dollar hospital system and surgeon.
- Assisted a multi-campus hospital system with its corporate reorganization to achieve economies of scale; prepared corporate documents effectuating the change and arranged for necessary licensure and payor filings.
- Closed transaction valued at $15 million between large dermatology practice and private equity backed entity.
- Conducted due diligence and prepared stockholder communications pursuant to pharmacy chain’s multimillion-dollar corporate merger with a publicly traded company.
- Prepared multimillion-dollar private placement for investment in an out of network private pay hospital.
- Closed sale of oral surgery practice involving complex scope of practice and financing considerations.
- Closed $3.5 million sale of home health agency with multistate entity.
- Served as buyers counsel in deal acquiring home health company with $15 million in annual revenue.
- Served as sellers counsel in a $250 million blended stock and asset purchase involving multiple parties and over two dozen skilled nursing facilities in two states.
- Representing a 1,000-plus member IPA in potential sale discussions at a nine-digit valuation.
Operational
- Serving as day to day outside counsel to multi-location diagnostic imaging company that is wholly owned by a multibillion-dollar health system.
- Provided timely, creative, and compliant counsel to radiology practice client dealing with market shortage of radiologists.
- Drafted physician employment and vendor contracts on behalf of hospital entities; negotiated same on physician-side for matters involving different parties.
- Negotiated TPA agreement on behalf of IPA client with multiple facilities to optimize operations.
- Reviewed and negotiated clinical trial agreements and other research related agreements on behalf of sponsors and sites; addressed related intellectual property issues.
- Closed $400 million line of credit transaction for borrower client to fund growth of operations.
- Assisting national benefits company enroll nationwide in State Medicaid programs.
Compliance
- Design compliant healthcare joint ventures with a view towards Stark Law, AKS, EKRA, and corporate practice of medicine considerations.
- Reviewing existing agreements strained by COVID-19 States of Emergency to address fair market value and sustainability in a compliant fashion.
- Advising of key opinion leaders regarding clinical research and consulting activities with respect to FDA, CMS, and other related regulation.
- Amended hospital medical staff bylaws to mirror best practices in light of current NC Appellate Case law.
Pre-Litigation Advocacy
- Resolved physician to physician intra-practice and joint venture disputes regarding compensation, competition, quality, and other issues.
- Represented individual and institutional healthcare providers in their efforts to regain in-network status with a large private payor.
- Represented healthcare providers before the North Carolina Medical Board and North Carolina Dental Board pursuant to public complaints and accompanied providers to interviews with board investigators.
- Settled disputes with NC DHHS on behalf of clients pursuant to OAH Contested Case Hearings.
- Worked with NC DHSR to resolve licensure and enrollment issues on behalf of providers.
- Prepared CON applications and counseled clients with respect to CON disputes.
- Represented large regional hospital systems in numerous pre-litigation complex business disputes.
- Author, Guidance for Market Entrants in Telemedicine, GRSM Healthcare Newsroom, March 2024
- Author, The Five W’s of Intellectual Property Assets in Healthcare Business Transactions, Healthcare Pulse and IP Blitz, January 18, 2018
- Author, Increased Scrutiny On Provider enrollment Under the ACA: How the New CMS Proposed Rule Creates Additional Considerations for Heath Care Transactions, Healthcare Law Note, March 24, 2016
- Author, Recent IRS Publication of Final Rule for Tax-Exempt Hospitals Serves as a Reminder of Lesser-Known ACA Compliance Requirements, Healthcare Law Note, January 22, 2015
- Author, “The Affordable Care Act – A Mid-2014 Update,” Prognosis, June 2014
- Speaker, “ASCs: Best Practices from a Legal, Operations, and National Trend Perspective,” presentation before the North Carolina Ambulatory Surgical Center Association, March 15, 2023
- Speaker, “What Every First Year Associate Should Know about a Healthcare Transaction,” presentation before the NCCU School of Law on behalf of the NCBA Health Law Section, January 31, 2017
- Speaker, “King v. Burwell and the Employer Mandate,” presentation before CFOs, HR Directors, and Benefits Administrators at the ACA Reporting Compliance Seminar sponsored by Mass Mutual, August 6, 2015
- Speaker, “ACA Enrollment, Coverage, Mandates, and the Navigator Program,” presentation at the 6th Annual FUNdamentals CLE before the Florida Bar, September 19, 2014
- Speaker, “ACA Enrollment, Coverage, Mandates, and the Navigator Program,” presentation at Campbell Law School before the Wake County Bar Association breakfast CLE series, September 17, 2014
- Speaker, “The Affordable Care Act: Implications for Senior Lawyers,” presentation before the Senior Lawyers Division of the North Carolina Bar Association, May 3, 2014
- Speaker, “The Admissibility of Medical Review Committee Materials: History, Law, and Practical Guidance regarding the Peer Review ‘Privilege,’” prepared presentation for the North Carolina Judicial College seminar at the UNC School of Government, March 27, 2014
Admissions
- North Carolina
- North Carolina Dispute Resolution Commission, Certified Mediator (inactive)
- U.S. Patent and Trademark Office
- U.S. District Court, Eastern District of North Carolina
Memberships
- American Health Lawyers Association
- North Carolina Bar Association, Health Law Section Leadership Council, 2017-2020
- Tenth Judicial District Bar and Wake County Bar Association
Community Involvement
- Duke University Chapel
- Seven Oaks Swim & Racquet Club, Member
- Patriot Boot Camp, 2015
- National High School Mock Trial Tournament, Judge, 2015
- Legal Aid of North Carolina, HHS Certified Marketplace Navigator, 2014
- Legal Aid of North Carolina, 7th Annual Bar Awards and Silent Auction, Announcer, 2014
- The Alexander Family YMCA, Hillsborough St. Raleigh, 2013-18
Education
- J.D., University of North Carolina School of Law, 2011
- Staff writer, First Amendment Law Review
- M.S., University of Oxford, 2006
- B.A., Harvard University, 2005
- Staff editor, Harvard Health Policy Review
Judicial Externship
- Hon. Sam J. Ervin, IV, North Carolina Court of Appeals
Honors
- Best Lawyers in America® Ones to Watch distinction in Health Care Law, 2023-2027*
- Super Lawyers® Rising Star distinction in the field of Healthcare, 2018-2021*
- Mary and Elliott Wood Foundation Graduate Scholar
*A description of the Best Lawyer selection methodologies can be found at: https://www.bestlawyers.com/About/MethodologyBasic.aspx.
*The Super Lawyers® list is issued by Thomson Reuters. A description of the selection methodologies can be found at: https://www.superlawyers.com/about/selection_process.html.