While Karl has broad health industry experience, Karl’s practice has emphasized hospitals, health systems and academic medical centers. In this segment, his clients include investor-owned, religiously affiliated, and nonprofit organizations operating general acute care hospitals and specialty hospitals (long-term acute care, inpatient rehabilitation, psychiatric and children's hospitals). He has substantial experience in structuring, negotiating and documenting a variety of complex business transactions, including mergers and acquisitions, joint ventures, management agreements, academic affiliations and contractual relationships among providers and with third-party payors. Karl assists clients in responding to the myriad health industry changes resulting from the Affordable Care Act; building on his experience in the 1990s, Karl continues to be involved in the development of integrated provider networks, such as accountable care organizations (ACOs) participating in the Medicare Shared Savings Program.

Karl is a recognized authority on the Anti-Kickback Statute and the Stark Law, and his guidance is often sought as his clients develop or assess various arrangements with physicians, such as integrated delivery systems, ACOs, joint ventures, physician recruitment, practice acquisitions, employment arrangements, and exclusive provider agreements. He also advises health care industry clients on business and nonprofit corporate law issues and regulatory issues, such as facility and physician licensing, the corporate practice of medicine, health information privacy, medical staff credentialing, professional liability insurance, patient care and informed consent.