Indiana’s Healthcare Reporting Law to Give Private Equity Pause

In this article for Bloomberg Law, Will Richmond, Dennis Williams and Alexa Auger discuss Indiana's new state law that will expand existing oversight of private equity investments in the healthcare sector and require extensive ownership disclosure reporting for owners and private equity investors. 

Indiana recently passed a law that imposes reporting requirements for certain healthcare entities—some of which took effect on July 1. Indiana is one of many states this year that have proposed or passed legislation designed to increase healthcare industry oversight, particularly on private equity investors. HB 1666 adds to the growing list of regulations that investors and practitioners should evaluate when considering new business ventures.

Enacted in May, the law strengthens the Indiana attorney general’s oversight of healthcare consolidation; adds a carveout to the state’s existing transaction review requirement for practitioner-owned practices; and mandates ownership disclosure reporting for private equity investors and other owners of healthcare entities, hospitals, pharmacy benefit managers, and insurers.

Indiana’s existing transaction review law, enacted last year, requires 90 days’ pre-closing notice to the attorney general for mergers and acquisitions involving a healthcare entity with total assets of at least $10 million.

The new law doesn’t alter that basic framework, though earlier versions proposed a more robust expansion and would have enabled the attorney general to approve or deny certain transactions regardless of transaction value. That consent right was removed from the final bill.

The final version preserves the existing notice structure and shifts focus to enhancing ownership transparency for private equity and other investors. Notably, the law is silent on whether management services organizations are subject to the existing transaction review requirement.

While Indiana’s transaction review process remains less burdensome than other states such as Oregon and California, the new disclosure requirements signal that oversight of private equity investments into healthcare entities remains a priority.

The new law grants a reprieve to certain practitioner-owned healthcare providers for the existing 90-day pre-closing notice requirement by excluding healthcare providers that are majority-owned, or would be majority-owned, by a practitioner who is licensed in Indiana and routinely provides healthcare services for the practice.

The law also expands the Indiana attorney general’s investigative powers. As of July 1, the attorney general may investigate the market concentration of healthcare entities, including by using civil investigative demands.

The law doesn’t set specific limits on the attorney general’s authority to conduct these investigations or what information may be requested during them. With this provision’s effective date behind us, any action or inaction by the attorney general under this power should be monitored closely.

HB 1666 also significantly expands ownership disclosure and reporting duties for hospitals, healthcare entities, and PBMs.

Healthcare entities (effective Jan. 1, 2026). Healthcare entities, which include any entity that provides healthcare services—except for hospitals, insurers, PBMs, and third-party administrators, which have separate requirements—must report ownership information in the biannual report to the secretary of state that is required for all Indiana business entities.

The disclosure must include the name of each person or entity that has an ownership interest of at least 5%, a controlling interest, or interest as a private equity partner. It also must include ownership stake, certain identifying information for each person or entity, and ownership information for healthcare practitioners of the entity that have any ownership interest—even if less than 5%.

Hospitals (effective July 1, 2025). Hospitals, which are already required to submit an annual report to the state, will have expanded disclosure requirements that include the information outlined above for healthcare entities. Failure to file the report can result in a fine of $1,000 per day for each day the report is past due.

Insurers, third party administrators, and PBMs (effective July 1, 2025). The law also requires insurers, health maintenance organizations, managed care organizations, PBMs, and third-party administrators to file ownership disclosure reports with the department of insurance before Sept. 1 of each year that include similar ownership information to those required for healthcare entities and hospitals. Failure to comply with the requirement can result in a fine of $1,000 per day for each day the report is past due.

Private equity and other investors with current interests in or plans to acquire any of the specified healthcare entities should evaluate these requirements to determine whether they must be included in the entity’s ongoing ownership reporting. The law requires a “private equity partner” to be disclosed, but it doesn’t clearly outline the scope of this disclosure with respect to limited partners and other fund investment entities.

Careful consideration of information to disclose is important, as these reports will be published annually on the state department’s website. Although the law prohibits the state department from publishing the name of a person or entity with an ownership stake, it is unclear whether other identifying information will be made publicly available.

HB 1666 leaves Indiana’s existing transaction review framework intact—90-day pre-close notice to the attorney general is still required, but there is no approval requirement and practitioner-owned and operated healthcare entities are now exempt from the filing requirement in some instances.

Still, the law imposes new reporting burdens and authorizes the attorney general to investigate market concentration. When considering an investment into an Indiana healthcare entity, investors and owners should assess the applicability of Indiana’s transaction review requirements and evaluate the impact of potential market concentration investigations and increased reporting requirements.

Many state legislatures introduced bills in the 2025 legislative session that demonstrate a continued focus on regulation of healthcare industry investment and private equity’s role in health-care consolidation. These efforts generally have prioritized oversight measures that include transaction approval requirements (Massachusetts and New Mexico), ownership disclosure reporting (Indiana and Minnesota), and corporate-practice-of-medicine restrictions (Oregon and California).

Although some of the bills failed, others were enacted or are still pending. Oregon and Massachusetts have both enacted new laws this year, and California has legislation that would expand its transaction oversight.

Transaction review laws and other state oversight measures are key considerations in the diligence process for healthcare transactions, and legislative developments should be monitored going forward.