Justin M. Puleo

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, GRSM50 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 Healthcare Law, 2023-2025*
• 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: http://www.superlawyers.com/about/selection_process.html.}