Certificate of Need (CON)


We assist our healthcare clients with regulatory counseling, due diligence, and litigation relating to CON matters throughout the country. Whenever a healthcare facility is contemplating a change of ownership, CON due diligence will be necessary, and reporting and registration requirements will be implicated. We are here to help, having routinely handled all of the regulatory aspects of large, national chain acquisitions and reorganizations. In addition, when providers seek to expand or provide new services, they often must first obtain CON approval or state waivers from CON requirements. Our healthcare attorneys routinely counsel on these CON regulatory issues, helping fashion creative ways to comply with CON requirements. When our healthcare clients face CON challenges from competitors or need to challenge a competitor, our CON litigators can handle all aspects of administrative and judicial litigation.

Our clients benefit from our attorney expertise and thought leadership which we are regularly asked to contribute to industry publications and government entities. Several of our attorneys are contributing authors to the Fifty State Survey of Certificate of Need and Licensure: Nursing Homes, Assisted Living, Home Health, and Hospice; American Health Lawyers Association. Our attorneys have also been appointed by the Department of Community Health, Division of Health Planning, to serve on a technical advisory committee charged with recommending changes to the inpatient healthcare delivery system.


  • Served as co-first-chair over three-week bench trial appealing award of certificate of need to develop home health facility. Argued pre-trial motions, conducted witness examinations, and presented closing argument. Prior to trial, managed extensive electronic discovery, conducted depositions, and engaged in substantial motions practice.

  • Representation of a national medical practice and management company in the establishment of physician-owned single specialty ambulatory surgery centers and submissions of requests for letters of non-reviewability including advice regarding applicable corporate structures to address federal and state laws.

  • Representation of a Georgia medical practice in formation and structure issues related to relocation of a medical practice and establishment of a physician-owned single specialty ambulatory surgery centers and submissions of requests for letters of non-reviewability including advice regarding applicable corporate structures applicable to the involvement of other non-specialists and related specialty physicians.

  • Assisted numerous nursing facilities in obtaining CON approval for relocation, and advised on related Medicaid reimbursement matters.

  • For a healthcare client facing forced closure for relocating without obtaining government approvals, we implemented a strategy to form a new company to apply for the necessary approvals. Over the objections of competitors, we were able to obtain licensure approval, keep the client operational the entire time, and successfully defend litigation challenging the new approval process.

  • Gained CON approval for a new CyberKnife megavoltage cancer service.

  • Represented an existing ambulatory surgery center in successfully challenging a competitor’s application for a CON to develop an orthopedic surgery center. (The Surgery Ctr. v. Hughston Surgical Inst., 293 Ga. App. 879 (2008)).

  • Successfully litigated and resolved CON competitive batch appeals relating to expansion of home health agency services.

  • Gained CON approval for a new cancer center over objections and administrative appeals by two competitors.

  • Successfully represented multiple health systems, after extensive appeals in obtaining the certificate of need permitting them to establish hospitals in Roswell, Ga. (now North Fulton Hospital) and Pleasant, SC.

  • Obtained Certificate of Need approval and initial licensure and Medicaid enrollment of one of the nation’s first assisted living projects funded with affordable housing tax credits.

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