<SEC-DOCUMENT>0001193125-17-255929.txt : 20180223
<SEC-HEADER>0001193125-17-255929.hdr.sgml : 20180223
<ACCEPTANCE-DATETIME>20170811160706
<PRIVATE-TO-PUBLIC>
ACCESSION NUMBER:		0001193125-17-255929
CONFORMED SUBMISSION TYPE:	CORRESP
PUBLIC DOCUMENT COUNT:		2
FILED AS OF DATE:		20170811

FILER:

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			MEDNAX, INC.
		CENTRAL INDEX KEY:			0000893949
		STANDARD INDUSTRIAL CLASSIFICATION:	SERVICES-HOSPITALS [8060]
		IRS NUMBER:				263667538
		STATE OF INCORPORATION:			FL
		FISCAL YEAR END:			1231

	FILING VALUES:
		FORM TYPE:		CORRESP

	BUSINESS ADDRESS:	
		STREET 1:		1301 CONCORD TERRACE
		CITY:			SUNRISE
		STATE:			FL
		ZIP:			33323
		BUSINESS PHONE:		9543840175

	MAIL ADDRESS:	
		STREET 1:		1301 CONCORD TERRACE
		CITY:			SUNRISE
		STATE:			FL
		ZIP:			33323

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	PEDIATRIX MEDICAL GROUP INC
		DATE OF NAME CHANGE:	19950801
</SEC-HEADER>
<DOCUMENT>
<TYPE>CORRESP
<SEQUENCE>1
<FILENAME>filename1.htm
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<TITLE>CORRESP</TITLE>
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 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>CONFIDENTIAL TREATMENT REQUESTED </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">CONFIDENTIAL INFORMATION OMITTED HEREIN HAS BEEN SUBMITTED SEPARATELY TO THE SECURITIES </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">AND EXCHANGE COMMISSION PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT. SUCH </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">OMISSIONS ARE DENOTED BY BRACKETED ASTERISKS &#147;[***]&#148; </P> <P STYLE="font-size:12pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<P STYLE="margin-top:0pt;margin-bottom:0pt" ALIGN="center">


<IMG SRC="g439410g30i46.jpg" ALT="LOGO">
 </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">August&nbsp;11, 2017 </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman"><U>Via
EDGAR Submission </U></P> <P STYLE="margin-top:12pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Mr.&nbsp;Carlos Pacho </P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Senior
Assistant Chief Accountant </P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Securities and Exchange Commission </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Division of Corporation Finance </P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">100 F Street, N.E. </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Mail Stop 3720 </P> <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Washington, DC 20549 </P>
<P STYLE="font-size:12pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
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<TD WIDTH="4%" VALIGN="top" ALIGN="left"><B>Re:</B></TD>
<TD ALIGN="left" VALIGN="top"><B>MEDNAX, Inc. </B></TD></TR></TABLE> <P STYLE="margin-top:0pt; margin-bottom:0pt; margin-left:4%; font-size:10pt; font-family:Times New Roman"><B>Form 10-K for the Fiscal Year Ended December&nbsp;31, 2016 </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; margin-left:4%; font-size:10pt; font-family:Times New Roman"><B>Filed February&nbsp;10, 2017 </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; margin-left:4%; font-size:10pt; font-family:Times New Roman"><B>File No.&nbsp;001-12111 </B></P> <P STYLE="margin-top:12pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">Dear
Mr.&nbsp;Pacho: </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">This letter is in response to the Staff&#146;s comment, set forth in your letter dated July&nbsp;28, 2017 (the
&#147;<B>Comment Letter</B>&#148;), addressed to Vivian Lopez-Blanco as Chief Financial Officer of MEDNAX, Inc. (the &#147;<B>Company</B>&#148;), relating to the Company&#146;s Annual Report on Form 10-K for the year ended December&nbsp;31, 2016.
</P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">In accordance with Rule 83 of the Securities and Exchange Commission&#146;s Rules on Information and Requests
(17&nbsp;C.F.R.&nbsp;&#167;&nbsp;200.83) (&#147;<B>Rule 83</B>&#148;), the Company requests confidential treatment of the highlighted and bracketed portions (the &#147;<B>Confidential Material</B>&#148;) of this response letter. Please promptly
inform the Company of any request for the Confidential Material made pursuant to the Freedom of Information Act or otherwise so that the Company may substantiate the foregoing request for confidential treatment in accordance with Rule 83. Any such
notice may be directed to Dominic J. Andreano, General Counsel of the Company, at MEDNAX, Inc., 1301 Concord Terrace, Sunrise, Florida 33323 or at (954)&nbsp;384-0175. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">Pursuant to Rule 83, a copy of the redacted response letter is also being delivered to the Freedom of Information Act Officer of the
Securities and Exchange Commission. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">The Staff&#146;s comment is set forth below for ease of reference. In the response below, references
to &#147;we&#148;, &#147;our&#148; and &#147;us&#148; refer to the Company. </P> <P STYLE="margin-top:18pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman"><B><U>Segment Reporting, page 73 </U></B></P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman"><B><I>1. We note you aggregate your operations into a single reportable segment for purposes of presenting financial information in accordance
with the accounting guidance for segment reporting. Please identify your operating segments, including their respective </I></B></P>

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 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>CONFIDENTIAL TREATMENT REQUESTED </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">CONFIDENTIAL INFORMATION OMITTED HEREIN HAS BEEN SUBMITTED SEPARATELY TO THE SECURITIES </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">AND EXCHANGE COMMISSION PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT. SUCH </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">OMISSIONS ARE DENOTED BY BRACKETED ASTERISKS &#147;[***]&#148; </P> <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P>
 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman"><B><I>
primary practice group or region, as applicable. Please explain to us, in detail, how your current aggregation approach is consistent with the overall objectives of ASC&nbsp;280-10-10-1 and the
quantitative and qualitative factors cited in ASC 280-10-50-11. In this regard, we note from your earnings call that you addressed dissimilarities among your practice groups with respect to EBITDA, fixed cost infrastructure, technology (i.e., vRAD),
internal bonus eligibility threshold established for each practice, and payor mix, among others. </I></B></P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">The Company uses the management
approach, in accordance with ASC 280, <I>Segment Reporting</I>, to determine its operating segments. Operating segments are considered based on components of the entity that engage in business activities from which it earns revenue and incurs
expenses, whose operating results are regularly reviewed by the Company&#146;s chief operating decision maker when making decisions about resource allocation and for which discrete financial information is available. Based on this criterion,
historically, the Company had managed its operations and provided services in the specialty and subspecialty areas of pediatrics and anesthesia, and these had historically been deemed as the Company&#146;s two primary operating segments for which
the aggregation criteria had historically been met. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">During 2015, a realignment of the Company&#146;s operations began with the goal of
moving away from this practice specialty focus of pediatrics and anesthesia. Effective January&nbsp;1, 2016, the Company began operating these physician specialties and subspecialties under one unified organization, ultimately named &#147;MEDNAX
National Medical Group,&#148; in order to enable the Company to support its hospital and health system partners, through blended markets, united relationships and shared resources across the country. These shared resources include both clinical and
administrative services that support the overall organization. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">This strategy allowed the Company to emphasize its ability as
&#147;MEDNAX, Health Solutions Partner&#148; to provide a diverse array of pediatric and anesthesia services to its hospital and health system partners nationwide. As one company, one brand, one voice, the Company was able to better utilize its many
strengths across the organization to improve performance and customer satisfaction, both clinically and operationally. Aligning all of the Company&#146;s pediatric and anesthesia service lines allowed the Company to bring all of its strengths to
bear as a true multi-solutions provider to its clinicians, patients and partners to stay ahead of the constantly changing healthcare environment. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">During 2015, the Company added another physician specialty, radiology services, through its acquisition of Virtual Radiologic Corporation
(&#147;vRad&#148;). The long-term plan for integration of this service line is still underway from the management approach perspective, so it was considered as a separate operating segment for purposes of the segment reporting analysis for 2015 and
2016 and will continue to be analyzed as a separate operating segment as the long-term plan for this service line remains under development. The goal will be to fully integrate the radiology service line into the MEDNAX National Medical Group
physician services organization as it develops and continues to grow. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">In 2014, prior to the addition of radiology services, the Company
added a revenue cycle management and patient financial lifecycle solutions company whose primary services include billing, coding and collections. The Company utilizes the services at its affiliated physician practices as an extension of its revenue
cycle management department and also provides services to external customers. All intercompany activity is eliminated in the Company&#146;s financial statements. Additional acquisitions under this service
</P>

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 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>CONFIDENTIAL TREATMENT REQUESTED </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">CONFIDENTIAL INFORMATION OMITTED HEREIN HAS BEEN SUBMITTED SEPARATELY TO THE SECURITIES </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">AND EXCHANGE COMMISSION PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT. SUCH </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">OMISSIONS ARE DENOTED BY BRACKETED ASTERISKS &#147;[***]&#148; </P> <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P>
 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">
line took place in 2015 and 2016, primarily in the area of third-party receivable solutions that significantly expanded the capabilities of this organization. The Company considers its management
services organization as a separate operating segment. For purposes of the Company&#146;s operating segment analysis, because the operations of this management services operating segment is quantitatively immaterial (4.7% of net revenue for fiscal
year 2016), the operating results have not been separately analyzed. The fundamental principle of the accounting guidance is to ensure that investors are not impacted by the aggregation of operating segments, and the Company believes that the
inclusion of the immaterial operations of its management services operating segment within the Company&#146;s one reportable segment does not impact investors. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">Therefore, the Company has two operating segments consisting of physician services (excluding radiology) and radiology services that require
analysis, and the Company believes it is properly aggregating these two operating segments. The accounting guidance in ASC 280 does not provide any &#147;bright lines&#148; to use when assessing whether two or more operating segments may be
aggregated. The guidance states that two or more operating segments may be aggregated into a single reportable segment if the segments have similar economic characteristics, and if the segments are similar in five specific areas. The Company&#146;s
management has used its judgment to analyze the aggregation criterion, and a summary of management&#146;s assessment is provided below. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman">First, the five
areas specified in the accounting guidance are addressed for the two operating segments as follows: </P> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
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<TD WIDTH="5%">&nbsp;</TD>
<TD WIDTH="2%" VALIGN="top" ALIGN="left">&#149;</TD>
<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">The nature of the products and services </TD></TR></TABLE> <P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">MEDNAX&nbsp;is a national health
solutions partner comprised of the nation&#146;s leading providers of physician services across various specialties and subspecialties. The Company&#146;s affiliated physicians use evidence-based tools, continuous quality initiatives, clinical
research and telemedicine to enhance patient outcomes and provide high-quality, cost-effective care. A majority of physician services provided by the Company are delivered in similar settings, primarily hospital or office-based settings while others
are provided to hospital and other healthcare providers through technology. The Company&#146;s key relationships with its hospital and other healthcare provider partners and customers, third-party payors and collaborating and referring physicians
are considered critical in its physician services provided by its affiliated physician practices. The Company&#146;s hospital partners benefit from the Company&#146;s expertise in managing critical care units and other settings staffed with
physician specialists, including managing variable admission rates, operating costs, complex reimbursement systems and other administrative burdens while certain of the Company&#146;s hospital and other healthcare customers benefit from the vast
subspecialty experience across its affiliated pediatric, anesthesiology and radiology physician population. The Company maintains professional working relationships with third-party payors and in most cases performs the administrative process of
billing and collection. In other cases, the hospital contracts directly with the Company to provide certain services on a fee for service basis with the billing and collection to the third-party payors performed directly by the hospital. </P>
<P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
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<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">The nature of the production process </TD></TR></TABLE> <P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">The Company does not produce a product
and does not believe this criterion is directly applicable. However as a point of clarification, almost all of the Company&#146;s physician services have similar operating requirements (physician employment
</P>

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 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>CONFIDENTIAL TREATMENT REQUESTED </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">CONFIDENTIAL INFORMATION OMITTED HEREIN HAS BEEN SUBMITTED SEPARATELY TO THE SECURITIES </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">AND EXCHANGE COMMISSION PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT. SUCH </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">OMISSIONS ARE DENOTED BY BRACKETED ASTERISKS &#147;[***]&#148; </P> <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P>
 <P STYLE="margin-top:0pt; margin-bottom:0pt; margin-left:8%; font-size:10pt; font-family:Times New Roman">
or other service contracts, managed care contracting, billing and reimbursement, hospital contracts, etc.) A majority of physician services provided by the Company are delivered in similar
settings, primarily hospital or office-based settings while others are provided to hospital and other healthcare providers through technology. The Company&#146;s service lines are supported by the same shared services at the Company&#146;s
headquarters. </P> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
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<TD WIDTH="2%" VALIGN="top" ALIGN="left">&#149;</TD>
<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">The type or class of customer for their products and services </TD></TR></TABLE> <P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">The Company
provides services primarily to patients that have insurance through organizations with which the Company has contracted. The Company also contracts directly with hospitals or other healthcare providers to provide physician services through its
affiliated physician practices. The Company also provides services to hospitals and other healthcare providers to cover certain specialties through telemedicine and consultative arrangements so that the hospital has access to a network of physicians
with specialty and subspecialty training. The Company receives compensation for professional services provided by its affiliated physicians to hospitals and patients based upon rates for specific services provided, principally from third-party
payors. A significant portion of the Company&#146;s revenue is received from government-sponsored healthcare programs. In order to participate in such government programs, the Company and its affiliated practices must comply with stringent and often
complex enrollment and reimbursement requirements. All the Company&#146;s affiliated physicians are providers under Medicaid or Medicare programs. </P> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
<TD WIDTH="5%">&nbsp;</TD>
<TD WIDTH="2%" VALIGN="top" ALIGN="left">&#149;</TD>
<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">The methods used to distribute their products or provide their services </TD></TR></TABLE> <P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">In
most cases the Company&#146;s affiliated physicians are introduced to patients for a particular consult, treatment or intervention following a referral from another physician, usually an obstetrician, pediatrician, or surgeon. In other cases, the
Company provides services via a telemedicine arrangement, hospital physicians receive diagnoses from the Company&#146;s affiliated physicians, but the hospital or other healthcare provider has the primary contact with the patient. Any hospital-based
physicians must work closely with their hospital partners to preserve existing admission patterns and to identify opportunities to expand key service lines like surgery and labor and delivery by recruiting more admitting physicians such as surgeons
and obstetricians. </P> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
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<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">If applicable, the nature of the regulatory environment </TD></TR></TABLE> <P STYLE="margin-top:6pt; margin-bottom:0pt; margin-left:8%; text-indent:4%; font-size:10pt; font-family:Times New Roman">All of the
Company&#146;s service lines are specific to the healthcare industry and are subject to extensive and complex federal, state and local laws and regulations. Of particular importance are: </P>
<P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
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<TD WIDTH="2%" VALIGN="top" ALIGN="left">&#149;</TD>
<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">Federal laws including the federal False Claims Act; </TD></TR></TABLE> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
<TD WIDTH="14%">&nbsp;</TD>
<TD WIDTH="2%" VALIGN="top" ALIGN="left">&#149;</TD>
<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">Provisions of the Social Security Act such as the &#147;anti-kickback&#148; law and the &#147;Stark Law&#148;; </TD></TR></TABLE> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
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<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">Other provisions of the Social Security Act that impose criminal penalties on healthcare providers to disclose or refund known overpayments; </TD></TR></TABLE>
<P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
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<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">Similar state law provisions pertaining to anti-kickback, fee splitting, self-referral and false claims issues; </TD></TR></TABLE> <P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
<TD WIDTH="14%">&nbsp;</TD>
<TD WIDTH="2%" VALIGN="top" ALIGN="left">&#149;</TD>
<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">Provisions of, and regulations relating to, the Health Insurance Portability and Accountability Act of 1996 (&#147;HIPAA&#148;); and </TD></TR></TABLE>
<P STYLE="font-size:6pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
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<TD WIDTH="2%" VALIGN="top" ALIGN="left">&#149;</TD>
<TD WIDTH="1%" VALIGN="top">&nbsp;</TD>
<TD ALIGN="left" VALIGN="top">Federal and state laws that prohibit providers from billing and receiving payment from Medicaid or Medicare for services unless the services are medically necessary, adequately and accurately documented, and billed
using codes that accurately reflect the type and level of services rendered. </TD></TR></TABLE>

<p Style='page-break-before:always'>
<HR  SIZE="3" style="COLOR:#999999" WIDTH="100%" ALIGN="CENTER">


 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>CONFIDENTIAL TREATMENT REQUESTED </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">CONFIDENTIAL INFORMATION OMITTED HEREIN HAS BEEN SUBMITTED SEPARATELY TO THE SECURITIES </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">AND EXCHANGE COMMISSION PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT. SUCH </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">OMISSIONS ARE DENOTED BY BRACKETED ASTERISKS &#147;[***]&#148; </P> <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P>
 <P STYLE="margin-top:0pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">With respect to similar economic characteristics, the accounting guidance in ASC 280 does not
define the term &#147;similar&#148; and does not provide guidance on the time horizon of historical or future periods to be evaluated. Further, although ASC 280 provides &#147;long-term average gross margins&#148; and &#147;sales trends&#148; as
examples of the measures to be considered, it does not indicate what other measures are acceptable or what would be an acceptable spread between those measures. Accordingly, based on management&#146;s judgment, earnings before interest, taxes and
depreciation and amortization (&#147;EBITDA&#148;) is the appropriate measure of financial performance to use when determining similar economic characteristics of its operating segments. </P>
<P STYLE="margin-top:18pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman"><I>Qualitative Considerations </I></P> <P STYLE="margin-top:6pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">The
Company&#146;s two operating segments face similar economic characteristics. As previously discussed, the compensation received for physician services provided by its affiliated physician practices is based upon rates for specific services,
primarily from third-party payors as well as from hospitals and other healthcare providers. Government programs are usually fee-for-service payment systems. Other options include managed care, preferred provider organizations, and private
fee-for-service and specialty plans. </P> <P STYLE="margin-top:18pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman"><I>Quantitative Considerations&#151;Expectation of Similar Long-Term Financial Performance </I></P>
<P STYLE="margin-top:6pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">Based on the Company&#146;s analysis, the Company expects that the long-term EBITDA margins of its operating segments will be similar. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">As of December&nbsp;31, 2016, the EBITDA margins for the Company&#146;s physician services (excluding radiology) and radiology operating
segments were [***]% and [***]%, respectively. As required in the accounting guidance, the Company based its quantitative assessment related to EBITDA margins on a long-term view. For purposes of the analysis, the period used was five years. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">The Company&#146;s EBITDA margins for physician services (excluding radiology) have historically remained relatively stable; therefore, this
was used as the starting point. As of December&nbsp;31, 2016, based on the Company&#146;s assumptions, the radiology operating segment over a five year time period was expected to have an operating margin of [*]%. The revenue growth assumption
estimates ranged from approximately [***]% in 2017 to [***]% in 2020. It should be noted that operational, financial or managerial synergies that may result as the overall integration plan for this service line is developed could slightly increase
its EBITDA margins over time. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">Although the accounting guidance does not define &#147;similar,&#148; it has been observed through various
interpretative materials, that the SEC Staff has not objected to a difference in margins in aggregated operating segments of approximately 10%, but has objected to a difference in margins of over 20%. With the Company&#146;s physician services
(excluding radiology) operating segment being the most established with an overall EBITDA margin of [***]%, the disparity in margins would be acceptable based on this in a range of approximately [***]% (at 10%) to [***]% (using a more conservative
15%). A difference in excess of approximately [***]% (at 20%) would be considered too disparate. The difference between the Company&#146;s two operating segments&#146; expected long-term EBITDA margins of [***]% ([***]% EBITDA margin for physician
services (excluding radiology) as compared to the expected long-term EBITDA margin of approximately [***]% for radiology services) is well under the acceptable range. </P>

<p Style='page-break-before:always'>
<HR  SIZE="3" style="COLOR:#999999" WIDTH="100%" ALIGN="CENTER">


 <P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center"><B>CONFIDENTIAL TREATMENT REQUESTED </B></P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">CONFIDENTIAL INFORMATION OMITTED HEREIN HAS BEEN SUBMITTED SEPARATELY TO THE SECURITIES </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">AND EXCHANGE COMMISSION PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT. SUCH </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; font-size:10pt; font-family:Times New Roman" ALIGN="center">OMISSIONS ARE DENOTED BY BRACKETED ASTERISKS &#147;[***]&#148; </P> <p STYLE="margin-top:0pt;margin-bottom:0pt ; font-size:8pt">&nbsp;</P>
 <P STYLE="margin-top:0pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">With respect to the areas that the Staff noted as dissimilarities across the Company&#146;s
physician practices, many of these items vary by individual practice in general. For example, in all of our practice areas, payor mix can vary from time to time due to geographic characteristics, shifts in population ages and other factors. Any
payor mix variance can affect an individual practice&#146;s profitability, including internal profitability thresholds established to set a baseline before bonuses can be earned, and the practice&#146;s EBITDA. A majority of physician services
provided by the Company through its affiliated practices are delivered in similar settings, primarily hospital or office-based settings while others such as radiology, due to the fact that the physician service is to read an image such as an x-ray,
are provided to hospital and other healthcare providers through technology (i.e. &#147;vRad&#148;). Almost all of the Company&#146;s physician services provided through its affiliated physician practices have a fixed cost component such that
challenges with respect to volume, payor mix and other reimbursement related factors that affect revenue, as well as any challenges that increase expenses, affect the underlying practices&#146; profitability, including the practices&#146; EBITDA.
Despite these practice level dissimilarities, we believe that when these areas are viewed at the operating segment level, the areas are not materially dissimilar. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">For example, certain operating challenges discussed on the Company&#146;s earnings calls that affected the Company&#146;s radiology physician
service line in late 2016 with respect to volume and compensation expense increases and affected the Company&#146;s physician services (excluding radiology) thus far in 2017, such as payor mix shifts and compensation expense increases, have impacted
the Company&#146;s current year results and are expected to impact its growth and profitability throughout 2017. However, it is expected that the longer term growth rates and profitability will improve in 2018 and beyond such that they are
materially in line with the assumptions used at December&nbsp;31, 2016 to estimate long-term EBITDA margins. </P> <P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">Based on the above analysis,
including the long-term view on economic performance as required in the accounting guidance, the Company concludes that its operating segments qualify for aggregation into a single reportable segment. </P>
<P STYLE="margin-top:12pt; margin-bottom:0pt; text-indent:4%; font-size:10pt; font-family:Times New Roman">If you or any other member of the Staff should have any further comments or questions regarding this response, please feel free to contact the
undersigned by phone at 954-384-0175, extension 5083, or alternatively, at the address provided elsewhere in this letter, with a copy to Dominic J. Andreano, the Company&#146;s general counsel, at the same address. </P>
<P STYLE="font-size:12pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P><DIV ALIGN="right">
<TABLE CELLSPACING="0" CELLPADDING="0" WIDTH="40%" BORDER="0" STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt">


<TR>
<TD WIDTH="100%"></TD></TR>


<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top">Very truly yours,</TD></TR>
<TR STYLE="font-size:1pt">
<TD HEIGHT="16"></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top"> <P STYLE="margin-top:0pt; margin-bottom:1pt; border-bottom:1px solid #000000; font-size:10pt; font-family:Times New Roman">/s/ Vivian Lopez-Blanco</P></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top"> <P STYLE=" margin-top:0pt ; margin-bottom:0pt; margin-left:1.00em; text-indent:-1.00em; font-size:10pt; font-family:Times New Roman">Vivian Lopez-Blanco</P></TD></TR>
<TR STYLE="page-break-inside:avoid ; font-family:Times New Roman; font-size:10pt">
<TD VALIGN="top"> <P STYLE=" margin-top:0pt ; margin-bottom:0pt; margin-left:1.00em; text-indent:-1.00em; font-size:10pt; font-family:Times New Roman">Chief Financial Officer</P></TD></TR>
</TABLE></DIV> <P STYLE="font-size:12pt;margin-top:0pt;margin-bottom:0pt">&nbsp;</P>
<TABLE STYLE="BORDER-COLLAPSE:COLLAPSE; font-family:Times New Roman; font-size:10pt" BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%">
<TR style = "page-break-inside:avoid">
<TD WIDTH="4%" VALIGN="top" ALIGN="left">cc:</TD>
<TD ALIGN="left" VALIGN="top">Kathryn Jacobson (SEC) </TD></TR></TABLE> <P STYLE="margin-top:0pt; margin-bottom:0pt; margin-left:4%; font-size:10pt; font-family:Times New Roman">Robert S. Littlepage (SEC) </P>
<P STYLE="margin-top:0pt; margin-bottom:0pt; margin-left:4%; font-size:10pt; font-family:Times New Roman">Dominic J. Andreano </P>
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end
</TEXT>
</DOCUMENT>
</SEC-DOCUMENT>
