USE CASE · M&A & NETWORK DILIGENCE
Map who controls a provider network before the deal closes.
Resolve ownership and chain affiliation, then price the enforcement exposure — SNF ownership chains, PBJ staffing, and CMS deficiency history joined from federal primary sources, with linked-source metadata retained where available. Built for diligence counsel and payer SIUs who need a defensible record, and the analysts who build the model.
SNF ownership rows deficiency citationsLinked-field provenanceNamed CMS observations
✓ No PHI✓ Federal primary source✓ Ownership chain✓ Hash-bearing export metadata
The diligence exposure
Inherited enforcement risk you did not price.
A provider network carries ownership relationships and a regulatory history that the deal model has to price. Miss an operating-organization tie or a chain affiliation and the acquirer inherits enforcement exposure — civil monetary penalties, false-claims liability — it never underwrote. A target's realized-harm history is the floor: of all federal nursing-home citations reach scope/severity G or above, and the rate varies sharply by state — Illinois averages 4.57 G+ citations per facility against New Hampshire's 0.31, a difference aggregate ratings smooth over.
Fonteum surfaces each ownership tie and citation from the CMS record itself, so the exposure is on the table before the deal closes — not discovered after.
The analyst pain
Three CMS files, joined by hand, lineage lost.
Ownership, staffing, and deficiency history live in three different CMS files on three cadences. Stitching them into a portfolio view means a brittle ETL job — and once joined, the lineage of which file produced which field is gone, so counsel cannot trace a figure back to its source.
One GETresolves a facility's ownership and returns source, observation-date, and limitation metadata when linked — including the of top-10-chain rows that carry a missing ownership_percentage in the federal file, flagged rather than imputed.
How it works
The federal sources joined, and what each one prices.
Ownership chain
CMS SNF All Owners across 14,425 facilities — managing org, operating org, and individual owners with percentage interest and role, PECOS-derived under ACA §6101.
Staffing signal
PBJ daily nurse-staffing records per quarter across 14,537 facilities — RN, LPN, and CNA payroll hours, the leading operating signal after the staffing-floor rescission.
Regulatory history
CMS Care Compare deficiency citations across 14,635 facilities — deficiency tag, harm scope, and survey event ID, the audit trail for enforcement risk.
Nullable
Provenance
Source-linked values retain a source name, observation date, and documented limitation; values without a linked provenance row are not presented as source-linked.
Integration & workflow
One record. Two ways in.
Analysts resolve ownership by facility over REST. Diligence teams scope a portfolio and export the joined record. Both surfaces expose the same available source and observation metadata.
GET /api/v1/ask?question=ownership&scheme=ccn&value={ccn}
curl "https://fonteum.com/api/v1/ask?question=ownership&scheme=ccn&value=015009" \
-H "Accept: application/json"Response
{
"question": "ownership",
"subject": { "scheme": "ccn", "value": "015009" },
"answer_text": "Facility 015009 is operated by 1 organization with 3 owner records on file.",
"facts": [
{
"role": "operating_organization",
"owner_type": "organization",
"ownership_percentage": null,
"provenance": {
"_source": "CMS SNF All Owners",
"_source_url": "https://data.cms.gov/provider-data/",
"_snapshot": "2026-05-01",
"_last_checked": "2026-06-17",
"_methodology": "ownership/v1",
"_confidence": 1.0,
"_limitation": "ownership_percentage absent in source row"
}
}
],
"citations": [
{ "source": "CMS SNF All Owners", "source_url": "https://data.cms.gov/provider-data/" }
]
}The ask endpoint is deterministic — no language model. '0 records on file' is an answer, never a silent empty; a source read failure returns 502, never a masked empty. For a full target portfolio, the FHIR R4 bulk $export returns NDJSON keyed to the facilities you scope.
- 01Scope the target portfolio to the facilities under evaluation, keyed by CCN.
- 02Resolve each facility's ownership chain — managing organization, operating organization, individual owners — from the CMS SNF All Owners record.
- 03Overlay the operating signal: PBJ staffing trend and the G+ deficiency history, joined to the same facilities.
- 04Export the joined dataset with the CMS-file and observation metadata available for source-linked values.
- 05Hand counsel a record they can re-derive: the federal source, not a commercial interpretation, underwrites the enforcement exposure.
Sample audit-evidence artifact
M&A DILIGENCE — FACILITY OWNERSHIP RECORD
Facility (CCN) ...... 015009
Operating org ....... [present] [SNF All Owners · 2026-05-01]
Owner records ....... 3 [SNF All Owners · 2026-05-01]
Ownership % ......... null (absent in source) — flagged, not imputed
PBJ staffing trend .. declining RN hrs [PBJ · 2026-05-01]
G+ deficiencies ..... 2 in 36 months [Care Compare NH · 2026-05-01]
Methodology ......... ownership/v1
Re-derivable ........ GET /api/v1/ask?question=ownership&scheme=ccn&value=015009The exported record preserves linked federal provenance metadata so counsel can re-derive source-linked values from the named CMS input.
Proof — not logos
The displayed study figures cite public CMS inputs.
Ownership rows
The dated CMS SNF All Owners study snapshot across 14,425 facilities — managing organizations, operating organizations, and individual owners, PECOS-derived.
Deficiency citations
The CMS Care Compare citation record across 14,635 facilities — each with deficiency tag, harm scope, and survey event ID, openly downloadable.
ownership/v1
Methodology version
The version documents the query method. Re-deriving a past record also requires the retained source snapshot; methodology alone does not preserve history.
Scoped
Attestation
An export can include separate snapshot-attestation metadata where present. It does not create a deterministic signature link for every diligence fact.
“Counsel underwrites the federal record, not a vendor's interpretation of it. The source, the snapshot, and the documented gap are the product.”
M&A & NETWORK DILIGENCE
Resolve a target portfolio's ownership and enforcement history.
Questions
Before the security questionnaire.
What federal data backs an M&A or network-diligence review?
Three CMS layers, joined by facility. CMS SNF All Owners — PECOS-derived ownership rows across 14,425 facilities, capturing managing organization, operating organization, and individual owner percentage interests. CMS PBJ Daily Nurse Staffing — daily payroll-hour records per quarter across 14,537 facilities. CMS Care Compare NH Deficiencies — citation records across 14,635 facilities, including deficiency tags, harm scope, and survey event IDs when present. Displayed citations identify the originating CMS file and observation date.
Can I resolve the ownership chain for a target portfolio?
Yes. The CMS SNF All Owners record resolves managing organization, operating organization, and individual owners with percentage interest and role type, keyed by facility. A material caveat surfaces directly in the federal file: a Health Affairs 2024 analysis, reproducible from the public CMS data, found of top-10-chain rows carry a missing ownership_percentage. Fonteum surfaces that gap as a documented limitation rather than imputing a value — because to an acquirer, an absent percentage is itself material.
How is this different from a commercial healthcare-intelligence dataset?
The data property, not the vendor. A derived dataset typically surfaces CMS data as a rolled-up score with no path back to the underlying record. Fonteum publishes the CMS citation itself — deficiency tag, harm scope, survey event ID — alongside the source citation and methodology version, so counsel underwrites against the federal record rather than an interpretation of it. The full set of citations across 14,635 facilities is openly downloadable.
Why does the PBJ staffing layer matter more after the 2025 rule rescission?
CMS Payroll-Based Journal data reports actual RN, LPN, and CNA payroll hours — daily records per quarter across 14,537 facilities. The federal 3.48-hour minimum staffing standard was rescinded December 3, 2025 (effective February 2, 2026), so there is no national floor to underwrite against — which makes per-facility staffing transparency the remaining accountability signal. A facility drifting toward contract-heavy or sustained-low RN hours shows in the payroll record before a star-rating change or a survey deficiency.
What is the G+ harm flag and why is it the regulatory-risk floor?
CMS assigns each survey deficiency a scope-and-severity letter from A to L. Citations at G or above denote actual harm to a resident and carry the heaviest enforcement consequences, including civil monetary penalties and denial of payment for new admissions. In the federal record of citations across 14,635 facilities, fall at G or above. Because a G+ citation marks realized harm with documented enforcement exposure, a target's G+ history is the minimum any diligence model must price in.
Is any patient data involved?
No. Every layer is public federal record keyed by CCN, NPI, and PECOS-ID. There is no PHI in the pipeline and none is required to resolve ownership, read a staffing trend, or pull a deficiency history.
Go deeper
The data and research behind the diligence record.
Solutions
All solutions — by use case & buyer →
Platform
The capability layer — entity graph & bulk export →
Data catalog
CMS SNF All Owners →
Data catalog
CMS PBJ daily nurse staffing →
Brand hub
Ownership & chain analysis →
Research
Nursing-home ownership concentration →
Research
Hospital ownership changes (CHOW) →
Research
Nursing-home deficiency correction time →
Developers
API, FHIR, and bulk export — the dev hub →
FONTEUM · M&A DILIGENCE
Run network diligence on public federal data only. No PHI.