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Private Equity Health Care Acquisitions – March 2021

In light of the growing investor interest in health care and the risks associated with private equity ownership of health care companies, the Private Equity Stakeholder Project will be tracking private equity-backed health care acquisitions. Below is a list of private equity health care buyouts and add-on acquisitions completed during March 2021. We will continue to track acquisitions on a monthly basis.

See February 2021 acquisitions here.

Epselon – GTCR

Private equity firm GTCR is creating a new platform for health care investments called Epselon Global. Epselon will focus on acquiring health care companies to “build a market-leading healthcare business,” though the specific subsector of health care has not been made public.[i]

GTCR is a prolific health care investor, with at least 11 current health care portfolio companies and almost 50 past investments.[ii] Multiple GTCR health care companies have made headlines for lawsuits alleging cancer-causing emissions, poor medical care, billing fraud, and other issues. GTCR’s checkered history in health care raises questions about how the firm will ensure that Epselon does not run afoul of the law.

Frequent GTCR partners Michael Mulhern and Phil Macnabb will co-invest and lead Epselon. Mulhern and Macnabb have held senior executive roles at multiple GTCR companies, including Sterigenics (aka Sotera Health).[iii]

Sterigenics is a medical device sterilization company. In the last two years it has been sued over 800 times for emitting ethylene oxide, a cancer-causing gas, in excess of permissible limits. Most recently, the New Mexico Attorney General filed suit in January this year.[iv]

GTCR has owned Sterigenics since 2011. Warburg Pincus recapitalized the company in 2015, becoming the majority owner with GTCR staying on with a minority stake.[v]

Ethylene oxide has long been on the federal list of carcinogens, but in 2016 the EPA released conclusive evidence linking the gas to breast cancer, leukemia and lymphomas at extremely low levels of exposure, and reclassified it as a “known” carcinogen.[vi] Beginning in October 2016, the Warburg Pincus and GTCR-led ownership group began taking debt-financed dividends from Sterigenics totaling approximately $1.17 billion.[vii]

Some of the pending lawsuits against Sterigenics allege that Sterigenics’ owners intentionally began moving money out of the company through the dividend recapitalizations in order to insulate their capital from potential lawsuits related to the emissions.[viii]

Warburg Pincus and GTCR took Sterigenics public in November 2020 but have retained a controlling stake in the company.[ix]

GTCR also previously owned Correct Care Solutions (CCS), a health care company operating in prisons and detention centers.[x] CCS, which is now known as Wellpath, has been sued at least 1,395 times in federal courts for a range of allegations including wrongful death, malpractice and inadequate medical care.[xi]

Curo Health Services, a home health and hospice company that GTCR formed in 2010, [xii] has also faced legal trouble. In 2017, Curo paid a $12.2 million settlement to the US Department of Justice for allegedly engaging in illegal kickback schemes during GTCR’s ownership.[xiii]

Genesis HealthCare – Pinta Capital Partners

Nursing home giant Genesis HealthCare has voluntarily delisted from the New York Stock Exchange after receiving a $50 million cash infusion from private equity-owned ReGen Healthcare.[xiv] Genesis operates more than 325 nursing homes and assisted-living centers in 24 states.[xv]

ReGen is owned by private equity firm Pinta Capital Partners. The investment gives Pinta a 25% ownership stake with options to increase its share to 43% by April 15. Pinta has appointed two new directors to the Genesis’s board including David Harrington, a founding principal at Pinta.[xvi]

Pinta’s investment in Genesis comes at a time when private equity ownership of nursing homes faces pronounced scrutiny. New research has shown that private equity-owned nursing homes have higher mortality rates and declines in patient wellbeing.[xvii]

Following Genesis’s announcement, Sen. Elizabeth Warren wrote a letter to Genesis raising concern about the transaction and highlighting large payouts made to its now-departed CEO despite declining financial condition.[xviii]

March2021 Private Equity Health Care Acquisitions:

Buyouts

Company NamePE FirmType
The Eye Health GroupBeverly CapitalEye care
GingerBlackstone Group (growth equity)Behavioral health
RenalogicCarrick Capital PartnersRenal risk management services
ViaQuestCouncil CapitalBehavioral health
ECLAT Health SolutionsGulf CapitalRevenue Cycle Management
Hansei SolutionsGulf CapitalRevenue Cycle Management
Cordis (of Cardinal Health)Hellman & FriedmanMedical Devices
Cherry Tree DentalICV PartnersDental services
Refac Optical GroupLincoln Road AdvisorsEye care
Advent Home MedicalNew Harbor CapitalMedical supplies
NDCPlatinum EquityHealth care supply chain
Regent Surgical HealthTowerBrook Capital Partners, AscensionAmbulatory surgery centers
It’s Never 2 LateVista Equity Partners (growth equity)Elder care
HealthPRO HeritageWellspring Capital ManagementContract therapy for SNFs, home health
FoodScienceWind Point PartnersNutritional supplements

Add-on Acquisitions

Company NamePE FirmAcquiring EntityType
A Step Ahead Autism SolutionsABRY PartnersLighthouse Autism CenteBehavioral health
American Preclinical ServicesArchiMed and Ares CapitalNorth American Science AssociatesCRO
Bio-OptronicsAres Capital, Audax Group, Genstar Capital and Linden Capital PartnersAdvarraHealth tech
Advantage Medical (California)Ares Private Equity GroupConvergint TechnologiesHealth care security tech
MAXhealthArsenal Capital PartnersBest Value HealthcarePrimary care centers
Digestive Disease AssociatesAudax GroupGastro HealthGastroenterology
BlueMed Medical SuppliesAudax GroupAspen Surgical ProductsMedical supplies
Reign DentalBlue Sea CapitalDECA Dental GroupDental services
Harbor PsychologistCenterbridge PartnersCommunity Psychiatry ManagementBehavioral health
BTG Specialty PharmaceuticalsCharterhouse Capital Partners, Mérieux Equity Partners and Partners GroupSERBPharmaceuticals
ViruDefenseClearlake Capital GroupTeam TechnologiesMedical supplies
PatientPingClearlake Capital GroupAprissHealth tech
himagine solutionsEverstone Capital, Goldman Sachs Merchant Banking DivisionOmega Healthcare Management ServicesHealthcare outsourcing services
EBS HealthcareFive Arrows Capital PartnersThe Stepping Stones GroupBehavioral health
Performance Therapy CenterGreat Point PartnerSpine & Sport Physical TherapyPhysical therapy
Total Body Rehab: Orthopedic and Hand TherapyGryphon Investors, Harris Preston & PartnersPhysical Rehabilitation NetworkPhysical therapy
Three ATI Physical Therapy clinics in CAHarris Preston & Partners, Gryphon InvestorsPhysical Rehabilitation NetworkPhysical therapy
Vitaldyne MedicalInverness GrahamCatheter & Medical DesignMedical supplies
Wine Country Occupational MedicineKain CapitalAkeso Medical HoldingsOccupational medicine
Outcome HealthL Catterton, Searchlight Capital Partners and Silver Point CapitalPatientPointHealth tech
Associated Urological SpecialistsLee Equity PartnersSolaris HealthUrology
CE Resources, IncLeichtman Capital PartnersTherapeutic Research CenterMedical education
CompuClaimLevel Equity, Radian CapitalLock8 PartnersHealth tech
Pinellas Cancer CenterM33 Growth, Havencrest Capital Management, ROCA PartnersThe Oncology Institute of Hope and InnovationOncology
Advanced Plan For HealthMarlin Equity PartnersVirgin PulseHealth tech
Sandcastle CentersMBF Healthcare PartnersAcorn HealthBehavioral health
KamanaMcCarthy CapitalTriage StaffingStaffing tech
Downtown Women’s Health CareNaviMed CapitalVelocity Clinical ResearchWomen’s health
Diamond Pharma ServicesOdyssey Investment PartnersProPharma GroupPharmaceuticals
Dunn Regulatory AssociatesOnex, TowerBrook Capital PartnersAcacium GroupHealth care consulting
Everwell Specialty PharmacyOsceola CapitalRevelation Pharma CorpPharmaceuticals
Cobius Healthcare SolutionsParthenon Capital PartnersMROHealth tech
Archetype InnovationsRevelstoke Capital PartnersCarrusHealth tech
Honeybee HealthRosewood Private InvestmentsINW Innovations in Nutrition + WellnessHealth tech
180 Health PartnersSunwater Capital, Equality Asset ManagementMindoulaBehavioral health
Harlingen Family DentistrySurge Private EquityAccess Dental ManagementDental services
Allen’s PharmaServSverica Capital ManagementProcare LtcPharmacy services
CasambaThe Carlyle Group, Level Equity and Silversmith Capital PartnersNet HealthHealth tech
NBN InfusionsThe Halifax GroupPromptCareHome health
iTakeControlThe Riverside CompanyRed Nucleus SolutionsHealth tech
PROHealth Home CareThe Riverside CompanyBest Life BrandsSenior care
Alliance Home Health Care & Hospice CareVistria GroupMission HealthcareHome health
Austin GastroenterologyWaud Capital PartnersTexas Digestive Disease ConsultantsGastroenterology
Children’s Center For Growth and DevelopmentWaud Capital PartnersIvy RehabBehavioral health
Digestive Health Specialists PAWebster Equity PartnersOne GIGastroenterology
Dayton GastroenterologyWebster Equity PartnersOne GIGastroenterology
Partners in Drug Abuse Rehabilitation CounselingWebster Equity Partners, BPEA Private EquityBayMark Health ServicesBehavioral health

[i]https://www.prnewswire.com/news-releases/gtcr-announces-healthcare-partnership-with-michael-mulhern-and-phil-macnabb-to-form-epselon-global-301240973.html

[ii]https://www.gtcr.com/investments/healthcare/

[iii]https://www.prnewswire.com/news-releases/gtcr-announces-healthcare-partnership-with-michael-mulhern-and-phil-macnabb-to-form-epselon-global-301240973.html

[iv]https://www.medtechdive.com/news/new-mexico-sues-sterigenics-over-ethylene-oxide-emissions/592953/

[v] “Sterigenics International Announces Recapitalization With Warburg Pincus And GTCR,” Press release by Sterigenics, March 2015. https://sterigenics.com/sterigenics-announces-recapitalization-with-warburg-pincus-gtcr/

[vi] United States Environmental Protection Agency, Ethylene oxide, accessed September 2020. https://cfpub.epa.gov/ncea/iris2/chemicalLanding.cfm?substance_nmbr=1025

[vii] For the complete calculation of dividends at Sterigenics, see our report: “Dividend Recapitalizations in Health Care: How Private Equity Raids Critical Health Care Infrastructure for Short Term Profit.”

[viii] Jonathan Bilyk, “EtO plaintiffs: Even before 1st lawsuit filed, Sterigenics moved to put $1.3B ‘out of reach’ of personal injury lawsuits,” Cook County Record, February 4, 2020. https://cookcountyrecord.com/stories/524626117-eto-plaintiffs-even-before-1st-lawsuit-filed-sterigenics-moved-to-put-1-3b-out-of-reach-of-personal-injury-lawsuits

[ix]https://investors.soterahealth.com/node/7231/html

[x]https://www.gtcr.com/investments/past-investments/#healthcare

[xi]https://www.yahoo.com/lifestyle/leading-profit-prison-immigration-detention-medical-company-sued-least-1395-times-100026407.html

[xii]https://www.reuters.com/article/us-gtcr-curohealth/gtcr-looking-to-sell-u-s-hospice-firm-curo-health-services-sources-idUSKBN0GC20420140812

[xiii]https://www.justice.gov/usao-ndtx/pr/hospice-companies-pay-122-million-settle-kickback-claims

[xiv]https://skillednursingnews.com/2021/03/nursing-home-giant-genesis-to-restructure-voluntarily-delist-from-nyse/

[xv]https://www.nytimes.com/live/2021/03/04/business/stock-market-today/a-struggling-nursing-home-giant-effectively-goes-private-after-a-cash-infusion

[xvi]https://skillednursingnews.com/2021/03/nursing-home-giant-genesis-to-restructure-voluntarily-delist-from-nyse/

[xvii]https://bfi.uchicago.edu/working-paper/does-private-equity-investment-in-healthcare-benefit-patients-evidence-from-nursing-homes/

[xviii]https://www.warren.senate.gov/imo/media/doc/2021.03.16%20Letter%20Response%20to%20Genesis%20Healthcare%20re%20Executive%20Pay%20and%20CARES%20Act%20Funding%20(2).pdf

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