Parker Hudson’s ability to effectively steer healthcare finance transactions to successful closings has made us a trusted partner in the industry, known for our commitment to delivering superior client service coupled with exceptional legal analysis and a solution-oriented, closing-centric mentality. From our front-end structuring guidance to our attentive ongoing support during the closing process and life of a deal, we focus on providing risk mitigation strategies to our clients while balancing the practical, business focus that borrowers require.

Founded over 25 years ago, Parker Hudson’s healthcare finance practice has grown to become a nationally recognized leader in the healthcare finance space. Our highly skilled healthcare finance practitioners have closed more than 200 deals across nearly all 50 states, supported by more than 30 sponsors, and for a diverse client base that includes national and regional banks and private credit lenders.

The healthcare finance team at Parker Hudson brings unparalleled knowledge of the market and its players to every transaction, handling deals in the upper, middle, and lower-middle markets. We have extensive experience in asset-based lending (ABL) and cash flow financings, acquisition finance and real estate finance.

In addition to our extensive knowledge of the finance industry, our healthcare finance clients also benefit from access to the firm’s healthcare regulatory and transactional attorneys, corporate attorneys, real estate attorneys, and tax specialists, ensuring that, if needed, each transaction is fully supported by subject matter experts. Additionally, we offer full lifecycle support with the assistance of our highly experienced restructuring practitioners.

Our experience includes:

  • Closing over 60 ABL loan transactions where our lender client provided financing to skilled nursing facility operators, oftentimes at facilities subject to HUD 232 financing and involving the HUD approval process and HUD intercreditor/cash management dynamics.
  • Structuring and closing myriad credit facilities to management services organizations in physician practice management transactions involving the attendant analysis of applicable state corporate practice of medicine laws.
  • Advising clients on potential and existing credits with DOJ, OIG and other investigations and CMS and other audits, including analysis of False Claims Act cases and the potential for Medicare and Medicaid recoupments.
  • Closing transactions in almost every sector of the healthcare space, including skilled nursing, acute care hospitals and health systems, home health, hospice, inpatient rehab, diagnostic imaging, long-term acute care, wound care, physician practice management, healthcare staffing, laboratories, urgent care, pharmaceutical distributors, independent pharmacies, for-profit and non-profit behavioral wellness centers, correctional healthcare, healthcare software providers, and manufacturers and distributors of medical devices.

  • Represented a national bank’s specialty healthcare group, as lender, in a secured revolving and term loan facility to a sponsor-backed, multi-state diagnostic imaging company. We originally documented this as an asset-based transaction, then over a seven-year period documented the borrowers’ post-default workout and forbearance, including sponsor credit enhancement, before later redocumenting the facility as a cash flow transaction. The transaction involved extensive legal and regulatory diligence, with a structure including management arrangements and joint ventures requiring analysis of federal Anti-Kickback Statute, Stark Law, Medicare Anti-Markup Rule, and state corporate practice of medicine issues.
  • Represented a non-bank specialty healthcare lender with respect to a senior secured ABL credit facility to a not-for-profit safety net hospital closed in connection with the acquisition by a Georgia county from a local hospital authority of the underlying real estate and related hospital lease to the borrower and defeasance of hospital authority bonds. Parker Hudson’s Healthcare practice group was actively engaged to ensure compliance with, or exemption from, the Georgia Hospital Acquisition Act and CON requirements in connection with restructuring transactions.
  • Represented a specialty healthcare group at a national bank, as agent, in ABL senior secured credit facility in connection with stock acquisition of multi-state IRF and LTCH provider by sponsor. The transaction involved extensive regulatory and compliance analysis conducted in concert with Parker Hudson’s Healthcare practice group and the negotiation of complex intercreditor agreements with both the REIT and term lender.
  • Represented a non-bank specialty healthcare lender in senior secured ABL credit facility to provider of products for joint replacement, including hip and knee implants and robotic-assisted technology platform. The transaction involved extensive collaboration with Parker Hudson’s Healthcare practice group in assessing regulatory issues applicable to medical device manufacturers and extensive negotiations of an intercreditor agreement with the term lender.
  • Represented a non-bank specialty healthcare lender in connection with a secured asset-based revolving credit facility to a pharmaceutical claims processing company. The transaction involved substantial contractual and legal analysis and related documentation regarding the rights of an intermediary network to healthcare receivables.
  • Represented a non-bank specialty healthcare lender in connection with a secured asset-based revolving credit facility to a company that provided infusion services and respiratory clinical care. In connection with the transaction, Parker Hudson conducted extensive analysis relating to an existing joint venture relationship of the borrowers.
  • Routinely represent specialty healthcare lenders (both bank and non-bank) in their role as secured working capital lender to SNF operators in connection with term financing to the underlying propco, including HUD Section 232 financing. In these transactions, we negotiate credit facility documentation with the SNF operator and its counsel and engage with an array of documentation (including intercreditor agreement) with the underlying propco lender and its counsel and, in the case of HUD financing to the propco, HUD and its attorneys. Due to Parker Hudson’s consistent presence in this market, we have developed good and effective working relationships with a number of lawyers whose practices involve the representation of significant national players in the HUD Section 232 financing space, thereby facilitating a smoother HUD approval process.
  • Represented a non-bank specialty healthcare lender, as agent and sole lender, in providing an asset-based senior secured revolving credit facility to a not-for-profit two-hospital integrated healthcare system. The transaction required the negotiation of intercreditor agreements with the borrowers' primary pharmacy suppliers and involved significant input and guidance from Parker Hudson's Healthcare practice group in analyzing, and enabling our client to assess, the categories of reimbursement (including DSH, UPL and FMP) payable to the borrowers by various third-party payors.
  • Doug Nail and Sarah Proctor, Co-Presenters, "Accounts Receivable Essentials Mostly Explained…Not Losing your Religion when the Operator tells you there is going to be AR Financing on a HUD Deal," Healthcare Mortgagee Advisory Council (HMAC) Annual Conference (November 13, 2023)
  • Doug Nail, Speaker, “Accounts Receivable Financing Roundtable,” HUD AR Loans conference call (July 2022)
  • Doug Nail, Sarah Proctor and Kelley Gass, Co-Presenters, "HUD 232 Financing/AR Lending" (May 10, 2022)
  • Doug Nail, Author, "COVID-19 Relief And Its Impact On Secured Healthcare Lenders," The Secured Lender (April 2021)
  • Doug Nail, Panelist, "Revised form of HUD Intercreditor Agreement for use in skilled nursing facility financings," Georgia Institute of Continuing Legal Education Secured Lending Seminar (February 6, 2014)
  • Doug Nail, Speaker and Author, "Healthcare Finance - Issues for the Secured Lender," Georgia Institute of Continuing Legal Education Secured Lending Seminar (2012)

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Douglas A. Nail
Douglas A. Nail

Partner

Sarah E. Proctor
Sarah E. Proctor

Partner