The four entities
Each entity owns a specific role. No entity bills for work another entity does. No equity crosses lines that couldn't stand an OIG audit.
SolvingHealth LLC
Colorado LLC. Owns all technology IP (CareOS, ClinicalSwipe, Sage, AI infrastructure). Licenses the stack to operating entities at flat FMV rates. Zero clinical control.
Altru.care
Physician-owned Professional Corporation. 50-state licensed. Delivers all clinical care. Bills Medicare Part B under its own NPI. Holds the clinical relationships.
SurgeonValue Inc
Delaware C corporation. Software for orthopedic surgeons. Flat per-encounter pricing. Surgeons bill under their own NPIs. Not an MSO, not a provider.
co-op.care LCA
Colorado Limited Cooperative Association. Worker-owned. Delivers companion care. Separate from all technology and clinical entities.
Next 30 days
Blocks first revenue (target: May 17, 2026)1 · IRS §213(d) LMN opinion
Altru.care2 · CMS 855I disclosure language & enrollment structure
Altru.care3 · Entity formation — PC vs PLLC in Colorado
Altru.careDays 30–90
Blocks scale (target: July 17, 2026)4 · Incident-to billing across state lines
Altru.care5 · MSO management fee FMV benchmark
SolvingHealth ↔ Altru.care6 · SurgeonValue CJR-X gainsharing separation
SurgeonValueMonth 4+
Phase 2 unlocks7 · Direct supervision model requirements
Altru.care8 · Co-op.care → Altru.care referral interface
co-op.care ↔ Altru.careFull compliance status
Living document. Updated whenever a structural change clears counsel. Green items are settled and documented; yellow items are in Ryan's queue.
| Area | Entity | Status | Tier |
|---|---|---|---|
| Colorado DPC statute (HB 17-1115) | Altru.care | Clear | — |
| Membership vs Medicare FFS separation | Altru.care | Clear | — |
| AI governance & physician attestation | SolvingHealth | Clear | — |
| HIPAA Business Associate stack | SolvingHealth | Clear | — |
| MSO-PC structural separation | SH ↔ Altru.care | Clear | — |
| Platform vs MSO scope | SurgeonValue | Clear | — |
| Flat per-encounter pricing (no revenue share) | SurgeonValue | Clear | — |
| Non-paid resource directory | SurgeonValue | Clear | — |
| Sanctioned EHR integration (SMART on FHIR) | SurgeonValue | Clear | — |
| Anti-rubber-stamp attestation (Fix 1) | ClinicalSwipe | Clear | — |
| IRS §213(d) LMN opinion | Altru.care | Yellow | Tier 1 |
| CMS 855I disclosure language | Altru.care | Yellow | Tier 1 |
| Entity formation (PC vs PLLC) | Altru.care | Yellow | Tier 1 |
| Incident-to billing across state lines | Altru.care | Yellow | Tier 2 |
| MSO management fee FMV benchmark | SH ↔ Altru.care | Yellow | Tier 2 |
| CJR-X gainsharing separation | SurgeonValue | Yellow | Tier 2 |
| Direct supervision model | Altru.care | Yellow | Tier 3 |
| Co-op.care referral interface (joint memo) | co-op ↔ Altru.care | Yellow | Tier 3 |
Ten GREEN, eight YELLOW, zero RED as of April 17, 2026.
Public entity pages
Each operating entity publishes its own legal architecture at /legal on its primary domain. Yellow items on each page map to the numbered decisions above.
altru.care/legal
DPC architecture, membership vs FFS separation, MSO-PC structure. 5 GREEN, 4 YELLOW.
surgeonvalue.com/legal
AKS/Stark architecture, flat per-encounter pricing, non-paid referral directory. 6 GREEN, 2 YELLOW.
Primary sources
- Colorado HB 17-1115 — Direct primary care agreements are not insurance.
- 42 USC § 1320a-7b(b) — Anti-Kickback Statute.
- 42 CFR § 1001.952(d) — AKS safe harbor for personal services and management contracts.
- 42 USC § 1395nn — Physician Self-Referral Law (Stark).
- 42 CFR § 410.26 — Services and supplies incident to a physician's services.
- 42 CFR § 405.440 — Conditions for private contracts with Medicare beneficiaries.
- IRC § 213(d) — Medical expense definition for HSA/FSA.
- OIG Advisory Opinion 25-03 — Flat per-service compensation frameworks.
- OIG General Guidance on Gainsharing — Structural separation from platform fees.
- CMS MLN MM11043 — Chronic Care Management services documentation.
- CMS CY 2026 PFS Final Rule — General supervision expansion.
- CMS CJR-X Proposed Rule (2026) — Mandatory episode-based payment, major joint replacement.
- 45 CFR Parts 160 & 164 — HIPAA Privacy and Security Rules.
For counsel and partners
Ryan handles Altru.care, SolvingHealth LLC, and SurgeonValue matters. Jason Wiener handles co-op.care cooperative matters. The two coordinate only on the referral-interface memo.
For direct access to the legal architecture team: legal@solvinghealth.com