Integration efforts among providers are back. Whether through greater cooperation between hospitals and physicians in co-management or gain-sharing arrangements, full integration through practice acquisition and employment, or mergers of healthcare systems, providers are identifying some new, and some old, ways of collectively providing care.

But integration, regardless of form, is not without legal risk. Regulators have given mixed signals regarding what type of inte-gration they want to see and what type they find problematic. Although integration activities can trigger many other legal issues, such as tax exemption and employee benefits, this article will examine two areas—contractual integration and full integration—where regulators have commented on integration and what providers can learn from such comments.