Item
1. Business.
Our
Company
DocGo
is redefining on-demand access to healthcare. We deliver high-quality, cost-effective healthcare mobility solutions and are
unlocking further promise and potential of telehealth treatment through our “last-mile” care capabilities. We do so
by leveraging our proprietary technology platform powered by artificial intelligence (“AI”), and our network of healthcare
professionals spanning more than 26 states and the United Kingdom. We often provide our services in collaboration with leading
healthcare organizations, via long-term relationships that drive meaningful revenue, ensure efficient and effective capital
allocation, and create low-risk opportunities for significant growth.
Our
mission is to transform medical transportation and mobile healthcare, outside the traditional “brick-and-mortar” facilities,
with more accessible, affordable, and efficient patient-centered care. Since our founding in 2015, through more than 6.2 million
patient interactions, we have created an unmatched medical transportation network that can provide better care outside of the physical
walls of the healthcare system. We began by developing a state-of-the-art, intuitive platform to drive greater efficiency and improved
access to patient care. Our innovative technology can change the way healthcare facilities manage patient transportation, and eliminate
many of the common obstacles faced when scheduling service, ultimately freeing medical professionals to focus more time and their valuable
resources on what they do best — providing patient care. Additionally, in certain markets, our Mobile Health in-person care
model facilitates medical treatment directly to patients in the comfort of their homes, workplaces, and other non-traditional locations.
Working under the guidance of prescribing physicians, our network (which includes both company employees and agency staff) of more than
4,000 medical clinicians including Emergency Medical Technicians (“EMTs”), paramedics, licensed practical nurses (“LPNs”),
registered nurses (“RNs”)and support staff, provides a wide range of tests, procedures and interventions that, until now,
required a visit to a traditional healthcare setting.
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Our
Segments
Transportation
Services
DocGo’s
on-demand medical mobility solutions are offered under the Ambulnz brand. We enable reliable, efficient access to local clinical
services, including primary and specialty care, dialysis treatments for chronic care management, and transfers between clinical
settings. Every vehicle in our fleet is equipped with our proprietary technology platform, which is integrated with some of the
nation’s largest electronic medical record (“EMR”) systems.
This
integration enables seamless transfer of electronic patient information and discharge data to our healthcare provider customers, which
improves order speed and accuracy, and helps eliminate a myriad of manual processes. Consequently, our healthcare facility customers are
better able to order, track and manage transportation requests and patient movement, thereby improving utilization of resources and cost.
Our Ambulnz ShareLink technology provides our healthcare partners and patients with real-time vehicle locations and accurate ETAs,
delivering valuable peace of mind. As of December 31, 2021, we had 294 ambulances in service throughout the United States,
and 32 in the United Kingdom. For the fiscal year ended December 31, 2021, we generated approximately 26.4% of our revenues
from our mobility solutions delivered by this segment.
Mobile
Health Solutions
The
traditional healthcare model requires patients to interact with many levels of healthcare providers — including
receptionists, nurses, lab technicians and physicians — for even the most routine tests, procedures and interventions.
We recognized that a number of these services could easily be performed by EMTs or paramedics under the guidance of physicians,
but in the comfort of a patient’s home or workplace. Our patient-centered approach helps limit the need for individuals
to seek routine treatment in more expensive and environmentally exposed, less comfortable settings such as emergency departments
and urgent care clinics. In addition to providing greater convenience to patients, our Mobile Health solutions help
reduce unnecessary burdens on healthcare systems, by freeing up their finite, in-person resources to address more urgent
and critical patient needs. DocGo’s Mobile Health on-demand telehealth clinical services, which we expanded into the
home and workplace in 2020, facilitate medical care via a turnkey suite of integrated, “last-mile” solutions. We offer
a range of services, including on-site evaluation, diagnostics, triage, and treatment as detailed in the following table:
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As
adoption of telehealth continues to climb, we believe our virtual care-enabling solutions are poised for significant growth, by delivering
in-person patient care previously inaccessible outside of the more traditional healthcare settings. We partner with leading national
health systems, insurance carriers, private organizations and employers, state and local governments and managed care organizations, to
provide our Mobile Health solutions, including NYC Health + Hospitals, Mount Sinai Health System and Carnival Corporation. For the fiscal
year ended December 31, 2021, we generated approximately 73.6% of our revenues from the solutions provided by our Mobile Health
segment.
Merger
with Motion Acquisition Corp.
On
November 5, 2021 (the “Closing Date”), DocGo Inc., a Delaware corporation (formerly known as Motion Acquisition
Corp. “Motion”) (prior to the Closing Date, “Motion” and after the Closing Date, “DocGo”,
) consummated the previously announced business combination (the “Closing”) pursuant to that certain Agreement
and Plan of Merger dated March 8, 2021 (the “Merger Agreement”), by and among Motion Acquisition Corp., a
Delaware corporation (“Motion”), Motion Merger Sub Corp., a Delaware corporation and a direct wholly owned
subsidiary of Motion (“Merger Sub”), and Ambulnz, Inc., a Delaware corporation (“Ambulnz”). In
connection with the Closing, the registrant changed its name from Motion Acquisition Corp. to DocGo Inc. As contemplated by
the Merger Agreement and as described in Motion’s definitive proxy statement/consent solicitation/prospectus filed with
the U.S. Securities and Exchange Commission (the “SEC”) on October 14, 2021 (the “Prospectus”),
Merger Sub was merged with and into Ambulnz, with Ambulnz continuing as the surviving corporation (the “Merger”
and, together with the other transactions contemplated by the Merger Agreement, the “Business Combination”). As a
result of the Merger, Ambulnz is a wholly-owned subsidiary of DocGo and each share of Series A preferred stock of Ambulnz, no
par value (“Ambulnz Preferred Stock”), Class A common stock of Ambulnz, no par value (“Ambulnz Class A
Common Stock”), and Class B common stock of Ambulnz, no par value (“Ambulnz Class B Common Stock”, together
with Ambulnz Class A Common Stock, “Ambulnz Common Stock”) was cancelled and converted into the right to receive
a portion of merger consideration issuable as common stock of DocGo, par value $0.0001 (“Common Stock”), pursuant
to the terms and conditions set forth in the Merger Agreement.
In
connection with the Business Combination, the Company raised $158.0 million, net of transaction costs of $20.0 million. This amount was
comprised of $43.4 million of cash held in Motion’s trust account from its initial public offering, net of DocGo’s transaction
costs and underwriters’ fees of $9.6 million, and $114.6 million of cash in connection with the PIPE Financing, net of $10.4 million
in transaction costs. These transaction costs consisted of banking, legal, and other professional fees which were recorded as a reduction
to additional paid-in capital.
Human
Capital Resources
We
strive to hire the best talent across our industry, with a focus on inspiring performance. As of December 31, 2021, we had over 2,900
employees, including revenue-generating healthcare professionals, field management personnel and corporate support staff, as represented
in the table below. Healthcare professionals consist of EMTs, paramedics, LPNs, RNs, clinicians and related support staff; field management
personnel includes supervisors and managers; and corporate support staff includes software development, billing, finance, sales, marketing,
and executives.
| |
Full-time | | |
Part-time | | |
Total | |
Healthcare Professionals | |
| 1295 | | |
| 1205 | | |
| 2500 | |
Field Management | |
| 169 | | |
| 9 | | |
| 178 | |
Corporate Support | |
| 242 | | |
| 4 | | |
| 246 | |
Total | |
| 1706 | | |
| 1218 | | |
| 2924 | |
None
of our employees is represented by a labor union or subject to any collective bargaining agreement. In addition to the employees
above, as of December 31, 2021, the Company engaged the services of approximately 2,100 people, primarily in the healthcare professional
area, through a variety of subcontracted labor agencies.
Recruiting
We
consider our employees to be our most valuable assets. Our employee experience begins with identifying and attracting people who
embody our core values and share our vision to provide high-quality patient care. We are committed to building a company that
our employees are proud to be a part of, and fostering an environment in which our employees can grow, evolve and discover their
existing and untapped potential. We believe our focused approach to recruiting and developing talent allows us to attract strong
candidates to continue growing and scaling our business.
Compensation
and Benefits
Ongoing
evolution in the healthcare system and an aging population mean EMTs, paramedics and nurses are more critical to medical care
than ever before, yet EMTs and paramedics remain the lowest paid professionals in the chain of care. Most companies in the industry
pay an hourly wage only, and offer no benefits, often resulting in low employee morale, high turnover, and ultimately a less efficient
business. We take pride in our high-quality medical professionals, and have created an attractive compensation model that demonstrates
their vital importance to our business, and motivates them to deliver exceptional care.
We
offer a pay package which we believe is innovative within our industry and elevates our employee compensation levels above national
averages and those of our peers. In addition to base hourly wages, DocGo also offers employees bonuses based on certain performance
metrics, medical insurance, paid time off, and an equity incentive plan for our frontline clinicians — an industry
leading program that provides the opportunity to acquire an ownership stake in our company. We believe that this approach makes
us a more attractive employer and supports a strong pipeline of top-tier talent across all levels of our company.
Training
We
have also created a number of programs to foster the professional development of our employees and to continue to attract top-tier
talent. To help our staff continue to build clinical skills, we created a Medical Mentorship Program whereby EMTs and paramedics
can learn advanced medical techniques including phlebotomy, mobile ultrasound, EKG training, Point of Care testing, vaccine administration,
and wound care. Once certified, our employees can put these newly acquired skills to use while providing our Mobile Health services.
Our
staff of ten training coordinators runs a robust, in-person onboarding program to ensure that employees are trained and up to
date in relevant procedures and protocols. We are an official American Heart Association Training Site, and offer all of our employees
in-house basic life support (BLS), advanced cardiovascular life support (ACLS), and pediatric advanced life support (PALS)
training and certification.
We
have also implemented a virtual training program for company policy and procedures training, mandated OSHA training courses, hazardous
materials awareness, FEMA Incident Command Systems training (100, 200, 700, 800), clinical skills, customer service, diversity,
HIPAA regulations, safety and compliance, on-site traffic control, and annual documentation training.
Our
drivers are additionally trained in emergency vehicle operator course (EVOC) and Coaching the Emergency Vehicle Operator (CEVO)
4 driver training, vehicle maintenance incident reporting, transport risk assessment, critical care transport orientation, and
fatigue abatement. Our system is utilized for credential tracking and Continuous Quality Improvement, so that our staff maintains
all required credentials relevant to their positions with our company.
With
constant reporting, employees and their supervisors are automatically notified at designated times of recertification deadlines.
Course completion, assignments, and other compliance requirements are tracked in this system as well. Verification monitoring
ensures that all employees meet current state requirements. This tool verifies Office of Inspector General (“OIG”)
of the U.S. Department of Health and Human Services (“HHS”) exclusions at the state and federal levels, and performs
sanction screening for licensed personnel and 24/7 monitoring of state board licenses.
Our
comprehensive training programs utilize a full range of resources, including print materials, training modules, webinars, seminars,
and videos provided by the CDC, and federal, state, and local entities, medical institutions, and public health agencies.
In
December 2021, we announced the launch of DocGo Academy and DocGo EMS Academy, two full-service programs dedicated to recruiting
and training clinicians, EMS workers and other healthcare professionals. Combining classroom education with practical hands-on
learning, the programs are designed to help existing healthcare professionals advance their careers and provide aspiring entry-level
workers with the opportunity to enter the healthcare industry. DocGo Academy focuses on uptraining clinicians, while DocGo EMS
Academy is tailored to EMS workers, from EMTs to paramedics. The comprehensive training programs are available in select states,
with plans for national expansion in the coming months. Tuition is free for students who continue their employment with DocGo,
which we anticipate will assist us in our recruiting efforts.
Competition
The
U.S. healthcare industry is highly competitive, and we compete with a broad and diverse set of companies spanning both of
our businesses. The competitive landscape is highly fragmented for both medical mobility services and “last-mile”
healthcare solutions, ranging in each case from small, locally owned and operated providers to large national organizations. While
we do not believe that any single competitor offers our full suite of mobility solutions and “last-mile” healthcare
services, numerous companies offer components of medical mobility transportation and/or telehealth services that compete with
our solutions.
Competition
in the medical transportation industry is based primarily on the ability to improve customer service, such as on-time performance
and efficient call intake; to provide comprehensive clinical care; and to recruit, train and motivate employees, particularly
ambulance crews who have direct contact with patients and healthcare personnel. Pricing, billing and reimbursement expertise are
also critical. Competitors within the industry vary considerably in type and identify by market, with our primary competitors
being small, locally owned operators as well as local fire departments and other local government providers. Larger private provider
competitors include Rural/Metro Corporation, Falck, American Medical Response (AMR), Southwest Ambulance, Paramedics Plus and
Acadian Ambulance.
Competition
in the telehealth industry is primarily based on scale; ease of use, convenience and accessibility; brand recognition; breadth,
depth, and efficacy of telehealth services; technology; clinical quality; customer support; cost; reputation; and customer satisfaction
and value. The major competitors include much larger, national or regional telehealth providers such as Teladoc, Livongo, Amwell,
and One Medical that generally provide telehealth on behalf of self-insured employers and insurance plans. These competitors,
however, generally do not provide direct patient care or “last-mile” care on behalf of the provider organization.
We also believe there are several smaller, private organizations providing in-home or on-site care utilizing different,
higher cost healthcare providers. Non-traditional providers and others such as payors may enter the space and/or develop
innovative technologies or business activities that could disrupt the industry. Competition could also increase from large technology
companies, such as Apple, Amazon, Facebook, Verizon, or Microsoft, who may develop their own telehealth solutions, as well as
from large retailers like Walmart, CVS and others. Despite the significant growth of telehealth services in recent years,
we believe the market is still in its infancy and new competitors with similar and novel models will enter the market as it matures.
Intellectual
Property
Our
intellectual property includes the content of our website, our proprietary platform, our mobile application, registered domain
names, software code, firmware, hardware and hardware designs, registered and unregistered common law trademarks, trademark applications,
copyrights, trade secrets, inventions (whether or not patentable), patents, and patent applications. We also license the use of
certain technology and other intellectual property rights owned and controlled by others. We believe that our intellectual property
is a valuable asset to our business that affords us a competitive advantage in the markets in which we operate.
We
protect our intellectual property primarily through a combination of copyrights, trademarks, patents, and trade secrets, intellectual
property licenses and other contractual rights and provisions (including confidentiality, non-disclosure, proprietary rights and
assignment-of-invention agreements with our employees, independent contractors, consultants and companies with which we conduct
business). We have registered the Ambulnz trademark and our corporate logo in the United States and the United Kingdom.
We have registered DocGo trademark and design in the UK, and are in the process of registering both for DocGo in the US. Generally,
registered trademarks have perpetual life, provided that they are renewed on a timely basis and continue to be used properly as
trademarks. Upon discovery of potential infringement of our intellectual property, we assess and, when necessary, take action
to protect our rights as appropriate.
Regulation
Our
operations are subject to comprehensive United States federal, state and local and comparable multiple levels of
international regulation in the jurisdictions in which we do business. The laws and rules governing our business and
interpretations of those laws and rules continue to expand, are subject to frequent change and may become more restrictive.
Our ability to operate profitably will depend in part upon our ability, and that of our healthcare provider partners, to
maintain all necessary licenses and to operate in compliance with applicable laws and rules. We therefore devote significant
resources to monitoring developments in healthcare regulation. As the applicable laws and rules change, we may be required to
make conforming modifications in our business processes from time to time. In many jurisdictions where we operate, neither
our current nor our anticipated business model, in particular with respect to our Mobile Health related services, has been
the subject of judicial or administrative interpretation. We cannot be assured that a review of our business by courts or
regulatory authorities will not result in determinations that could limit or otherwise adversely affect our operations or
that the healthcare regulatory environment will not change in a way that restricts our operations.
False
Claims Act
The
federal False Claims Act is a means of policing false bills or false requests for payment in the healthcare delivery system. Among
other things, the federal False Claims Act authorizes the imposition of up to three times the government’s damages and significant
per claim civil penalties on any “person” (including an individual, organization or company) who, among other acts:
| ● | knowingly
presents or causes to be presented to the federal government a false or fraudulent claim for payment or approval; |
| ● | knowingly
makes, uses or causes to be made or used a false record or statement material to a false or fraudulent claim; |
| ● | knowingly
makes, uses or causes to be made or used a false record or statement material to an obligation to pay the government, or knowingly conceals; |
| ● | knowingly
and improperly avoids or decreases an obligation to pay or transmit money or property to the federal government; or |
| ● | conspires
to commit the above acts. |
In
addition, amendments to the federal False Claims Act and Social Security Act impose severe penalties for the knowing and improper
retention of overpayments collected from government payors. Under these provisions, within 60 days of identifying and quantifying
an overpayment, a provider is required to notify the Centers for Medicare and Medicaid Services (“CMS”), or the Medicare
Administrative Contractor (“MAC”) of the overpayment and the reason for it and return the overpayment. An overpayment
impermissibly retained could subject a party to liability under the federal False Claims Act, exclusion from government healthcare
programs, including Medicare and Medicaid, and penalties under the federal Civil Monetary Penalties Law discussed below.
The
penalties for a violation of the federal False Claims Act range from $5,500 to $11,000 (adjusted for inflation) for each false
claim, plus up to three times the amount of damages caused by each false claim, which can be as much as the amounts received directly
or indirectly from the government for each such false claim. On June 19, 2020, the U.S. Department of Justice (“DOJ”)
issued a final rule announcing adjustments to federal False Claims Act penalties, under which the per claim range increases to
a range from $11,803 to $23,607 per claim, so long as the underlying conduct occurred after November 2, 2015.
The
federal government has used the statute to prosecute a wide variety of alleged false claims and fraud allegedly perpetrated against
Medicare and state healthcare programs, including but not limited to coding errors, billing for services not rendered, the submission
of false cost or other reports, billing for services at a higher payment rate than appropriate, billing under a comprehensive
code as well as under one or more component codes included in the comprehensive code, billing for care that is not considered
medically necessary and false reporting of risk-adjusted diagnostic codes to Medicare Advantage (or Part C) Plans. The Affordable
Care Act, as currently structured, provides that claims tainted by a violation of the federal Anti-Kickback Statute are false
for purposes of the federal False Claims Act. Some courts have held that filing claims or failing to refund amounts collected
in violation of the Stark Law can form the basis for liability under the federal False Claims Act. In addition to the provisions
of the federal False Claims Act, which provide for civil enforcement through “qui tam” whistleblower lawsuits, the
federal government can also use several criminal statutes to prosecute persons who are alleged to have submitted false or fraudulent
claims for payment to the federal government.
Federal
Fraud and Abuse Laws
The
federal Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology
for Economic and Clinical Health Act (“HITECH”), and their implementing regulations and related rules (collectively,
“HIPAA”), established several separate criminal penalties for making false or fraudulent claims to insurance companies
and other non-governmental payors of healthcare services. Under HIPAA, these two additional federal crimes are: “Healthcare
Fraud” and “False Statements Relating to Healthcare Matters.” The Healthcare Fraud statute prohibits knowingly
and recklessly executing a scheme or artifice to defraud any healthcare benefit program, including private payors. A violation
of this statute is a felony and may result in fines, imprisonment or exclusion from government sponsored programs. The False Statements
Relating to Healthcare Matters statute prohibits knowingly and willfully falsifying, concealing or covering up a material fact
by any trick, scheme or device or making any materially false, fictitious or fraudulent statement in connection with the delivery
of or payment for healthcare benefits, items or services. A violation of this statute is a felony and may result in fines or imprisonment.
This statute could be used by the government to assert criminal liability if a healthcare provider knowingly fails to refund an
overpayment. These provisions are intended to punish some of the same conduct in the submission of claims to private payors as
the federal False Claims Act covers in connection with governmental health programs.
In
addition, the Civil Monetary Penalties Law imposes civil administrative sanctions for, among other violations, inappropriate billing
of services to federally funded healthcare programs and employing or contracting with individuals or entities who are excluded
from participation in federally funded healthcare programs. Moreover, a person who offers or transfers to a Medicare or Medicaid
beneficiary any remuneration, including waivers of co-payments and deductible amounts (or any part thereof), that the person knows
or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner or supplier of
Medicare or Medicaid payable items or services may be liable for civil monetary penalties of up to $20,000 for each wrongful act.
Moreover, in certain cases, providers who routinely waive co-payments and deductibles for Medicare and Medicaid beneficiaries
can also be held liable under the federal Anti-Kickback Statute and federal False Claims Act, either of which can impose
additional penalties associated with the wrongful act. One of the statutory exceptions to the prohibition is non-routine, unadvertised
waivers of co-payments or deductible amounts based on individualized determinations of financial need or exhaustion of reasonable
collection efforts. The OIG emphasizes, however, that this exception should only be used occasionally to address special financial
needs of a particular patient. Although this prohibition applies only to federal healthcare program beneficiaries, the routine
waivers of co-payments and deductibles offered to patients covered by commercial payors may implicate applicable state laws
related to, among other things, unlawful schemes to defraud, excessive fees for services, tortious interference with patient contracts
and statutory or common law fraud.
State
Fraud and Abuse Laws
Various
states in which we operate have also adopted similar fraud and abuse laws as the federal laws and statutes described above. The
scope of these laws and the interpretations thereof vary from state to state and are enforced by state courts and regulatory authorities,
each with broad discretion. Some state fraud and abuse laws apply to items or services reimbursed by any payor, including patients
and commercial insurers, not just those reimbursed by a federally funded healthcare program. A determination of liability under
such state fraud and abuse laws could result in fines and penalties and restrictions on our ability to operate in these jurisdictions.
Health
Information Privacy and Security Laws
There
are numerous U.S. federal and state laws and regulations related to the privacy and security of personally identifiable information
(“PII”), including health information. In particular, HIPAA establishes privacy and security standards that limit
the use and disclosure of protected health information (“PHI”), and require the implementation of administrative,
physical, and technical safeguards to ensure the confidentiality, integrity and availability of individually identifiable health
information in electronic form. HIPAA’s requirements to “covered entities” and to their independent contractors,
agents and other “business associates” that create, receive, maintain or transmit PHI in connection with providing
services to covered entities. Although we are a covered entity under HIPAA, we are also a business associate of other covered
entities when we are working on behalf of our healthcare provider partners.
Violations
of HIPAA may result in civil and criminal penalties. The civil penalties range from $119 to $59,522 per violation, with a cap
of $1.8 million per year for violations of the same standard during the same calendar year. However, a single breach incident
can result in violations of multiple standards. We must also comply with HIPAA’s breach notification rule. Under the breach
notification rule, covered entities must notify affected individuals without unreasonable delay in the case of a breach of unsecured
PHI, which may compromise the privacy, security or integrity of the PHI. In addition, notification must be provided to HHS
and the local media in cases where a breach affects more than 500 individuals. Breaches affecting fewer than 500 individuals must
be reported to HHS on an annual basis. The regulations also require business associates of covered entities to notify the covered
entity of breaches by the business associate.
State
attorneys general also have the right to prosecute HIPAA violations committed against residents of their states. While HIPAA does
not create a private right of action that would allow individuals to sue in civil court for a HIPAA violation, its standards have
been used as the basis for the duty of care in state civil suits, such as those for negligence or recklessness in misusing personal
information. In addition, HIPAA mandates that HHS conduct periodic compliance audits of HIPAA-covered entities and their business
associates for compliance. It also tasks HHS with establishing a methodology whereby harmed individuals who were the victims of
breaches of unsecured PHI may receive a percentage of the fine paid by the violator under the Civil Monetary Penalties Law paid
by the violator. In light of recent enforcement activity, and statements from HHS, we expect increased federal and state HIPAA
privacy and security enforcement efforts.
HIPAA
also required HHS to adopt national standards establishing electronic transaction standards that all healthcare providers must
use when submitting or receiving certain healthcare transactions electronically.
Many
states in which we operate and in which our customers reside also have laws that protect the privacy and security of sensitive
and personal information, including health information. These laws may be similar to or even more protective than HIPAA and other
federal privacy laws. For example, the laws of the State of California, in which we operate, are more restrictive than HIPAA. Where
state laws are more protective than HIPAA, we must comply with the state laws we are subject to, in addition to HIPAA. In
certain cases, it may be necessary to modify our systems or planned operations to comply with these more stringent state laws.
Not only may some of these state laws impose fines and penalties upon violators, but also some, unlike HIPAA, may afford private
rights of action to individuals who believe their personal information has been misused. In addition, state laws are changing
rapidly, and there is discussion of a new federal privacy law or federal breach notification law, to which we may be subject.
In
recent years, there have been a number of well-publicized data breaches involving the improper use and disclosure of PII
and PHI. Many states have responded to these incidents by enacting laws requiring holders of personal information to maintain
safeguards and to take certain actions in response to a data breach, such as providing prompt notification of the breach to affected
individuals and state officials. In addition, under HIPAA and pursuant to the related contracts that we enter into with our healthcare
provider partners and other third parties, we must report breaches of unsecured PHI to our contractual partners following discovery
of the breach. Notification must also be made in certain circumstances to affected individuals, federal authorities and others.
In
addition to HIPAA, state health information privacy and state health information privacy laws, we may be subject to other state
and federal privacy laws, including laws that prohibit unfair privacy and security practices and deceptive statements about privacy
and security and laws that place specific requirements on certain types of activities, such as data security and texting.
Anti-Kickback
Statute
The
federal Anti-Kickback Statute is a broadly worded prohibition on the knowing and willful offer, payment, solicitation or receipt
of any form of remuneration in return for, or to induce, (i) the referral of a person covered by Medicare, Medicaid or other
governmental programs, (ii) the furnishing or arranging for the furnishing of items or services reimbursable under Medicare,
Medicaid or other governmental programs or (iii) the purchasing, leasing or ordering or arranging or recommending purchasing,
leasing or ordering of any item or service reimbursable under Medicare, Medicaid or other governmental programs. Certain federal
courts have held that the Anti-Kickback Statute can be violated if “one purpose” of a payment is to induce referrals.
In addition, a person or entity does not need to have actual knowledge of this statute or specific intent to violate it to have
committed a violation, making it easier for the government to prove that a defendant had the requisite state of mind or “scienter”
required for a violation. Moreover, the government may assert that a claim including items or services resulting from a violation
of the Anti-Kickback Statute constitutes a false or fraudulent claim for purposes of the federal False Claims Act. Violations
of the Anti-Kickback Statute can result in exclusion from Medicare, Medicaid or other governmental programs as well as civil and
criminal penalties, including fines of $104,330 per violation, plus up to three times the amount of the unlawful remuneration,
and imprisonment of up to ten years. Civil penalties for such conduct can further be assessed under the federal False Claims
Act. In addition to a few statutory exceptions, the OIG has published safe harbor regulations that outline categories of activities
that are deemed protected from prosecution under the Anti-Kickback Statute provided all applicable criteria are met. The
failure of a financial relationship to meet all of the applicable safe harbor criteria does not necessarily mean that the particular
arrangement violates the Anti-Kickback Statute. However, conduct and business arrangements that do not fully satisfy each
applicable safe harbor may result in increased scrutiny by government enforcement authorities, such as the OIG.
Federal
Stark Law
Section 1877
of the Social Security Act, also known as the physician self-referral law and commonly referred to as the Stark Law, prohibits
a physician who has a financial relationship, or who has an immediate family member who has a financial relationship, with entities
providing certain designated health services from referring Medicare patients to such entities for the furnishing of designated
health services, unless an exception applies. Although uncertainty exists, federal agencies and at least one court have taken
the position that the Stark Law also applies to Medicaid. Designated health services are defined to include, among others, clinical
laboratory services, physical therapy services, occupational therapy services, radiology services including ultrasound services,
durable medical equipment and supplies, parenteral and enteral nutrients, equipment, and supplies, home health services, outpatient
prescription drugs, inpatient and outpatient hospital services and outpatient speech-language pathology services. The types
of financial arrangements between a physician and an entity providing designated health services that trigger the self-referral prohibitions
of the Stark Law are broad and include direct and indirect ownership and investment interests and compensation arrangements. The
Stark Law prohibits any entity providing designated health services that has received a prohibited referral from presenting, or
causing to be presented, a claim or billing for the services arising out of the prohibited referral. Similarly, the Stark Law
prohibits an entity from “furnishing” a designated health service to another entity in which it has a financial relationship
when that entity bills for the service. The Stark Law also prohibits self-referrals within an organization by its own physicians,
although broad exceptions exist. The prohibition applies regardless of the reasons for the financial relationship and the referral.
Unlike the federal Anti-Kickback Statute discussed above, the Stark Law is a strict liability statute, which means proof
of specific intent to violate the law is not required.
If
the Stark Law is implicated, the financial relationship must fully satisfy a Stark Law exception. If an exception is not satisfied,
then the parties to the arrangement could be subject to sanctions, including denial of payment for claims for services provided
in violation of the statute, mandatory refunds of amounts collected for such services, civil penalties of up to $25,820 for each
violation and twice the dollar value of each such service as well as possible exclusion from future participation in the federally
funded healthcare programs, including Medicare and Medicaid. A person who engages in a scheme to circumvent the Stark Law’s
prohibitions may be fined up to $172,137 for each applicable arrangement or scheme. Amounts collected on claims related to prohibited
referrals must be reported and refunded generally within 60 days after the date on which the overpayment was identified.
In addition, the government and some courts have taken the position that claims presented in violation of the various statutes,
including the Stark Law, and failure to return overpayments in a timely manner can form the basis for liability under the federal
False Claims Act discussed below based on the contention that a provider impliedly certifies compliance with all applicable laws,
regulations and other rules when submitting claims for reimbursement.
U.S. Corporate
Practice of Medicine; Fee Splitting
The
laws and regulations relating to our operations vary from state to state and many states prohibit general business corporations, such
as us, from practicing medicine, controlling physicians’ medical decisions or engaging in some practices such as splitting professional
fees with physicians. We contract with healthcare providers, physicians or physician-owned professional associations and professional
corporations as part of our business. An important aspect of our strategy is to form contractual relationships with different third-party providers
pursuant to which we provide them or their patients with medical transportation and/or telehealth services and they pay us for those services
out of the fees they collect from patients and third-party payors. In certain instances, we also share a portion of our revenues
with our partners. These contractual relationships are subject to various state laws that prohibit fee splitting or the practice of medicine
by lay entities or persons and are intended to prevent unlicensed persons from interfering with or influencing the physician’s professional
judgment. In addition, various state laws also generally prohibit the sharing of professional services income with nonprofessional or
business interests. Activities other than those directly related to the delivery of healthcare may be considered an element of the practice
of medicine in many states. Under the corporate practice of medicine restrictions of certain states, decisions and activities such as
scheduling, contracting, setting rates and the hiring and management of non-clinical personnel may implicate the restrictions on the corporate
practice of medicine.
State
corporate practice of medicine and fee-splitting laws vary from state to state and are not always consistent. In addition, these
requirements are subject to broad powers of interpretation and enforcement by state regulators. Regulatory authorities or other
parties may assert that, despite these arrangements, we are engaged in the corporate practice of medicine or that our contractual
arrangements with affiliated third parties constitute unlawful fee splitting. In this event, failure to comply could lead to adverse
judicial or administrative action against us and/or our healthcare provider partners, civil or criminal penalties, receipt of
cease-and-desist orders from state regulators, loss of licenses, and the need to make changes to the terms of engagement with
our provider partners that interfere with our business.
International
Regulation
We
expect to continue to expand our operations internationally through both organic growth and acquisitions. Our international operations
are subject to different, and sometimes more stringent, legal and regulatory requirements, which vary widely by jurisdiction,
including anti-corruption laws such as the Foreign Corrupt Practices Act (“FCPA”), and corresponding foreign laws,
including the UK Bribery Act 2010; regulation by the U.S. Treasury’s Office of Foreign Assets Control (“OFAC”)
and economic sanctions laws; various privacy, insurance, tax, tariff and trade laws and regulations; corporate governance, privacy,
data protection, data mining, data transfer, labor and employment, intellectual property, consumer protection and investment laws
and regulations; discriminatory licensing procedures; required localization of records and funds; and limitations on dividends
and repatriation of capital.
Other
Regulations
Our
operations are subject to various state hazardous waste and non-hazardous medical waste disposal laws. These laws do not classify
as hazardous most of the waste produced from healthcare services. Occupational Safety and Health Administration regulations require
employers to provide workers who are occupationally subject to blood or other potentially infectious materials with prescribed
protections. These regulatory requirements apply to all healthcare facilities, including primary care centers, and require employers
to make a determination as to which employees may be exposed to blood or other potentially infectious materials and to have in
effect a written exposure control plan. In addition, employers are required to provide or employ hepatitis B vaccinations, personal
protective equipment and other safety devices, infection control training, post-exposure evaluation and follow-up, waste
disposal techniques and procedures and work practice controls. Employers are also required to comply with various record-keeping requirements.
Some
of our operations may be subject to compliance with certain provisions of the federal Fair Debt Collection Practices Act and comparable
statutes in many states. Under the Fair Debt Collection Practices Act, a third-party collection company is restricted in the methods
it uses to contact consumer debtors and elicit payments with respect to placed accounts. Requirements under state collection agency
statutes vary, with most requiring compliance similar to that required under the Fair Debt Collection Practices Act. Many of the
states in which we operate have comparable state statutes as well.
See
the section of this Annual Report on Form 10-K statement titled “Risk Factors — Risks Related to Healthcare
Regulation.”
Available
Information
We
file electronically with the SEC our Annual Report on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K and
amendments to those reports filed or furnished pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended,
or the Exchange Act. We make available on our website at www.DocGo.com, under “Investors,” free of charge, copies
of these reports as soon as reasonably practicable after filing or furnishing these reports with the SEC.
Item
1A. Risk Factors.
Risks
Related to DocGo’s Business Strategy
DocGo’s
failure to implement its business strategy could adversely affect its business.
DocGo’s
future financial performance and success is dependent in large part upon its ability to implement its business strategy successfully.
DocGo’s business strategy includes several initiatives, including developing contractual relationships with new healthcare
provider partners and expanding its business with existing partners; capitalizing on organic growth opportunities such as growing
complementary and integrated service offerings, particularly with respect to its mobile health solutions; pursuing selective acquisitions
to expand its geographic presence, among other things; and enhancing operational efficiencies and productivity. DocGo may not
be able to implement its business strategy successfully or achieve the anticipated benefits of its business plan. If DocGo is
unable to do so, its long-term growth, profitability and ability to service its debt will be adversely affected. Even if
DocGo is able to implement some or all of the initiatives of its business plan, one or more may not be successful in achieving
the desired goals and DocGo’s operating results may not improve to the extent it anticipates, or at all, or could be adversely
affected.
Implementation
of DocGo’s business strategy could also be affected by a number of factors beyond its control, including increased competition,
government regulation, general economic conditions or increased operating costs or expenses. In particular, DocGo’s future
success is contingent on DocGo’s ability to penetrate new markets and, to a lesser extent, further penetrate existing markets,
which is subject to a number of uncertainties, many of which are beyond DocGo’s control. Expanding service offerings such
as DocGo’s mobile health solutions also carries unique risks, including lack of market acceptance and not realizing any
return on the capital invested. Government regulations in both DocGo’s domestic and international markets can also delay
or prevent expansion or the introduction of new service offerings, or require changes to some of the services DocGo already offers,
which could negatively impact the success of DocGo’s strategies. In addition, to the extent DocGo has misjudged the nature
and extent of industry trends or its competition, it may have difficulty in identifying new provider partners, achieving any geographic
expansion, introducing new service offerings or achieving DocGo’s other strategic objectives. As such, due to these and
other known and unknown risks, DocGo cannot assure you that its business strategy will be successful, and any failure to effectively
implement its business strategy and otherwise grow the business could have a material adverse effect on DocGo’s business,
financial condition and results of operations.
DocGo’s
reliance on its contractual relationships with its healthcare provider partners and other strategic alliances could adversely
affect its business.
DocGo
relies significantly on its contractual relationships with its healthcare provider partners and other strategic partners and alliances
to generate revenues, expand into new markets and further penetrate existing markets. In recent years, DocGo has entered
into strategic business relationships with, among others, healthcare providers and hospital systems, to take advantage of commercial
opportunities across its operations, but particularly in its medical transportation services segment. DocGo’s contract with
Fresenius, under which DocGo generated approximately 7.1% of its revenues in the year ended December 31, 2021, is of particular
importance to DocGo’s results. The structure of DocGo’s relationships with its healthcare provider partners is a novel
model in DocGo’s industry and because there is little precedent for this approach, there can be no assurances that it will
be operationally or financially successful in the long term.
DocGo’s
contractual relationships with its healthcare provider partners and its reliance on revenues generated pursuant to these arrangements
carry commercial and other risks and uncertainties that are different from those underlying DocGo’s other revenue streams,
including the opportunity cost of not pursuing the specific venture independently or with other partners. For example, strategic
partners may have business or economic interests that are inconsistent with those of DocGo and may take actions contrary to DocGo’s
interests. While DocGo typically manages the day-to-day operations, DocGo’s partners have certain consent rights
and they may not agree with decisions that DocGo believes are appropriate or are otherwise in the venture’s or its best
interests. This structure can also lead to disputes with partners, which could require DocGo’s management to commit additional
time and resources to resolve any disagreements or, in some instances, may lead to arbitration or litigation. Contractual relationships
like these typically carry termination rights and one or more of DocGo’s partners may choose to exit the relationship prematurely
and, in certain arrangements, the partner may have the option to put its interest in the venture to DocGo or acquire DocGo’s
stake at a predetermined price, even if the relationship is proving beneficial to DocGo and it would choose to continue the arrangement.
If one of DocGo’s ventures or any of its strategic partners is subject to a regulatory investigation or legal dispute or
is otherwise the subject of any negative publicity, DocGo may be associated with the matter and similarly harmed, regardless of
whether the specific partnership or DocGo itself had any connection to the underlying matters. In addition, DocGo may, in certain
circumstances, be liable for the actions of its partners. Contractual relationships such as these can also raise fraud and abuse
issues. For example, the Office of Inspector General (the “OIG”) of the U.S. Department of Health and Human Services
(“HHS”) has taken the position that certain contractual relationships between a party which makes referrals and a
party which receives referrals for a specific type of service may violate the federal Anti-Kickback Statute if not appropriately
structured. Any of the foregoing risks or others related to DocGo’s reliance on strategic partners and other relationships
could have a material adverse effect on DocGo’s business, financial condition and results of operations.
DocGo
incurs significant up-front costs in its client relationships and any inability to maintain and grow these client relationships
over time or to recover these costs could adversely affect its business.
DocGo’s
business strategy depends heavily on achieving economies of scale because its initial up-front investment is costly and the
associated revenue is recognized on a ratable basis. DocGo devotes significant resources to establish relationships with its clients
and implement its solutions. This is particularly so in the case of large enterprises like those DocGo implements with its healthcare
provider partners. Accordingly, DocGo’s results of operations will depend in substantial part on its ability to maintain
and grow its relationships with customers over time. Additionally, as DocGo’s business is growing significantly, its client
acquisition costs could outpace its build-up of recurring revenue, and DocGo may be unable to manage its total operating
costs enough to achieve profitability, or if achieved, to maintain it. If DocGo fails to achieve appropriate economies of scale
or if it fails to manage or anticipate demand, its business, financial condition and results of operations could be materially
adversely affected.
The
growth of DocGo’s business depends, in part, on its ability to execute on its acquisition strategy.
A
significant portion of DocGo’s historical growth has occurred through acquisitions, and it anticipates continued growth
through acquisitions in the future. DocGo’s growth strategy is primarily focused on geographic expansion, often as part
of growing its relationship with an existing healthcare provider partner, and DocGo expects acquisitions to be the primary means
of acquiring the infrastructure, licenses or other resources necessary to enter new markets in the future. DocGo is presently
evaluating, and expects to continue evaluating on an ongoing basis, a variety of possible acquisition transactions.
DocGo
cannot predict the timing of any contemplated transactions, and there can be no assurances that DocGo will identify suitable acquisition
opportunities in the geographies into which it expects to grow or, if it does, that any transaction can be consummated on terms
acceptable to it. DocGo also competes for acquisitions with other potential acquirers, some of which may have greater financial
or operational resources than DocGo. A significant change in DocGo’s business or the economy, an unexpected decrease in
cash flows or any restrictions imposed by DocGo’s debt may limit its ability to obtain the necessary capital for acquisitions
or otherwise impede its ability to complete an acquisition. Certain proposed acquisitions or dispositions may also trigger regulatory
review by governmental agencies, including the U.S. Department of Justice (the “DOJ”), the U.S. Federal
Trade Commission(the “FTC”), under their respective regulatory authority. Any delay, prohibition or modification required
by regulatory authorities for competitive purposes or otherwise could adversely affect the terms of a proposed acquisition or
could require DocGo to modify or abandon an otherwise attractive acquisition opportunity. The failure to identify suitable transaction
partners and to consummate transactions on acceptable terms or at all could adversely affect DocGo’s business, financial
condition and results of operations.
DocGo’s
acquisition strategy exposes it to significant risks and additional costs.
Acquisitions
involve risks that the businesses acquired will not perform as expected or provide sufficient infrastructure and other resources
necessary to operate in a given geography and DocGo’s judgments regarding the value, strengths and weaknesses and profitability
of acquired businesses may prove wrong. DocGo may become liable for certain unforeseen pre-acquisition liabilities of an
acquired business, including, among others, tax liabilities, environmental liabilities, liabilities for regulatory violations
and liabilities for employment practices, and these liabilities could be significant. In addition, an acquisition could result
in the impairment of client relationships and other acquired assets such as goodwill. DocGo may also incur costs and experience
inefficiencies to the extent an acquisition expands the services, markets or geographies in which it operates. Acquisitions may
require that DocGo incur additional debt to finance the transaction, which could be substantial and limit its operating flexibility
or, alternatively, acquisitions may require that DocGo issue stock as consideration, which could dilute share ownership. Acquisitions
can also involve post-transaction disputes regarding a number of matters, including a purchase price or working capital adjustment,
earn-out or other contingent payments, environmental liabilities or other obligations. DocGo’s recent growth and its
acquisition strategy have placed, and will continue to place, significant demands on management’s time, which may divert
their attention from DocGo’s day-to-day business operations, and may lead to significant due diligence and other
expenses regardless of whether DocGo pursues or consummates any acquisition. DocGo may also not be able to manage its growth resulting
from acquisitions due to the number, diversity and geographic disparity of the businesses it may acquire or for other reasons.
These and other risks related to acquisitions could adversely affect DocGo’s business, financial condition and results of
operations.
Any
inability to successfully integrate acquisitions or realize their anticipated benefits could adversely affect DocGo’s business.
Acquisitions
require that DocGo integrate separate companies that historically operated independently or as part of another, larger organization,
and had different systems, processes and cultures. DocGo may not be able to successfully integrate any business it has acquired
or may acquire, or may not be able to do so in a timely, efficient or cost-effective manner. Risks related to the successful
integration of an acquired business include:
| ● | diverting
the attention of DocGo’s management and that of the acquired business; |
| ● | merging
or linking different accounting and financial reporting systems and systems of internal controls and, in some instances, implementing
new controls and procedures; |
| ● | merging
computer, technology and other information networks and systems, including enterprise resource planning systems and billing systems; |
| ● | assimilating
personnel, human resources, billing and collections, and other administrative departments and potentially contrasting corporate cultures; |
| ● | disrupting
relationships with or losses of key clients and suppliers of DocGo’s business or the acquired business; |
| ● | interfering
with, or loss of momentum in, DocGo’s ongoing business or that of the acquired company; |
| ● | failure
to retain DocGo’s key personnel or that of the acquired company; and |
| ● | delays
or cost-overruns in the integration process. |
DocGo’s
inability to manage its growth through acquisitions, including the integration process, and to realize the anticipated benefits
of an acquisition could have a material adverse effect on its business, financial condition and results of operations.
Risks
Related to DocGo’s Business and Industry
The
COVID-19 pandemic has materially impacted DocGo’s business.
In
December 2019, a novel strain of coronavirus (COVID-19) surfaced in Wuhan, China. Since then, the virus has spread globally,
including to the United States, and the World Health Organization has declared the outbreak a pandemic and the Secretary
of HHS has declared a public health emergency. Public health organizations and international, federal, state and local governments
have implemented measures to combat the spread of COVID-19, including restrictions on movement such as quarantines, “stay-at-home”
orders and social distancing ordinances and restricting or prohibiting outright some or all forms of commercial and business activity.
These measures, or others that may be implemented in the future, although temporary in nature, may become more restrictive or
continue indefinitely.
The
COVID-19 pandemic and its national and global impact have adversely affected DocGo, particularly in its healthcare transportation
segment, and this segment and other aspects of DocGo’s business may be adversely affected by the pandemic and its impact in the
future. DocGo’s and its customers’ businesses have generally been classified as “essential” in most jurisdictions,
permitting DocGo and its customers to continue operations in most markets. However, there can be no assurance that DocGo’s business
or those of its customers’ and suppliers’ will continue to be classified as “essential” in the future, or that
DocGo or they will not voluntarily limit or cease operations in one or more markets if it or they believe it is in the company’s
or their best interests. For example, healthcare providers have limited the availability of elective procedures, at times entirely stopping
these procedures, which has had an adverse impact on DocGo’s revenues related to non-emergency transportation services. DocGo
has also determined to increase its reserves for bad debt since the pandemic began because of uncertainty regarding payments from some
uninsured consumers. Further, DocGo’s business can put its healthcare professionals in direct contact with patients infected with
COVID-19, which significantly increases the risk that DocGo employees will contract the virus. Should there be an outbreak of COVID-19 among
DocGo’s employees in one or more of its markets, in response, DocGo may need to significantly reduce or cease operations there.
The demands of the pandemic have also placed significant financial burdens on healthcare providers, including DocGo’s healthcare
provider partners and other customers, and if one or more of DocGo’s partners or other customers declare bankruptcy or otherwise
restrict or cease its operations, DocGo’s business may be harmed. The pandemic may also adversely affect DocGo’s ability to
collect accounts receivable. DocGo also utilized several government programs in 2020 related to the pandemic, receiving approximately
$1.0 million in payments through the Public Health and Social Services Emergency Fund authorized under the Coronavirus Aid, Relief
and Economic Security Act and related legislation as well as various state and local programs, net of amounts that will be repaid to HHS. DocGo
also received accelerated Medicare payments of approximately $2.4 million that were required to be repaid beginning in April 2021.
See Note 19 to the notes to the audited consolidated financial statements of DocGo included elsewhere in this Annual Report on Form
10-K.
DocGo’s
cost structure has also been adversely impacted by the pandemic. A number of DocGo’s suppliers have also been negatively impacted
by the COVID-19 pandemic and there have been significant disruptions in its supply chains, particularly with respect to the personal
protective equipment, or PPE, that DocGo’s healthcare professionals require to do their jobs. At times, sufficient levels of PPE
have not been available and these shortages have limited DocGo’s ability to meet demand and provide its services to customers in
a timely manner. Further, the demand for PPE in the healthcare industry and the public at large caused by the pandemic has significantly
increased the cost of PPE and DocGo may not be able to recover these increased costs in the rates it charges for its services, which could
adversely affect DocGo’s profitability. Limitations on the availability or increases in the price of PPE have and could in the future
continue to adversely affect DocGo’s business and results of operations. DocGo’s suppliers’ businesses have similarly
generally been classified as “essential business” permitting operations to continue, but DocGo cannot be certain that its
suppliers will continue to be classified as “essential” or that they will not voluntarily limit or cease operations or that
a sufficient quantity of PPE will be available and at prices that fit within DocGo’s cost structure.
DocGo’s
management is focused on mitigating the impact of COVID-19 on its business and the risk to its employees. This focus has
diverted management’s attention away from normal business operations. Additionally, DocGo has taken a number of precautionary
measures intended to mitigate the impact of COVID-19 on its business and the risk to its employees, including implementing
detailed cleaning and disinfecting processes at its facilities and across its fleet, adhering to social distancing protocols and
encouraging employees to work from home when possible, any of which could adversely affect DocGo’s business. While these
measures and others DocGo may take are temporary, they may continue until the pandemic is contained and restrictions on movement
or commercial and business activity and related orders or ordinances are sufficiently modified or lifted, and could amplify existing
risks or introduce new risks that could adversely affect DocGo’s business, including, but not limited to, risks related
to internal controls and cybersecurity and others identified in these risk factors. For example, DocGo’s platform and the
other systems or networks used in its business may experience an increase in attempted cyberattacks seeking to take advantage
of shifts to employees working remotely using their household or personal Internet networks and to leverage fears promulgated
by the COVID-19 pandemic.
Conversely,
the pandemic has significantly increased the demand for DocGo’s remote and mobile testing and vaccination services and many of these
contracts are on a short-term basis, often spanning only a number of weeks or months. Much of DocGo’s revenue, employee
and operations growth has occurred during recent years, which has been partially driven by significant COVID-related impacts. For example,
the Company estimates that COVID testing relating revenue for 2021 was approximately $110 million. Our ability to forecast our future
operating results is limited and subject to a number of uncertainties, including our ability to predict revenue and expense levels, and
plan for and model future growth. Moreover, it is unlikely this new demand will be sustained in the long term, at least with respect to
COVID-19-related testing and vaccination, particularly if the pandemic subsides, and there can be no assurances that DocGo will be
able to find alternative revenue streams to compensate for the loss. These uncertainties are exacerbated by the effects of the Covid-19
pandemic.
The
pandemic has adversely affected many industries as well as the economies and financial markets of many countries, including the
United States, causing a significant deceleration of economic activity. This slowdown has reduced production, decreased demand
for a broad variety of goods and services, diminished trade levels, and led to widespread corporate downsizing, causing a sharp
increase in unemployment. There has also been disruption to and extreme volatility in the global capital markets, which could
increase the cost of, or entirely restrict access to, capital. The impact of this pandemic on the U.S. and world economies
is uncertain and, until the pandemic is contained, these adverse impacts could worsen, impacting all segments of the global economy,
and result in a significant recession or worse.
While
the detrimental business impacts of COVID-19 moderated somewhat in 2021 as compared to 2020, considerable uncertainty still surrounds
the COVID-19 virus and its potential effects, including potential future variants of the virus and the extent of and effectiveness
of any responses taken on local, state, national and global levels. While DocGo expects the pandemic and related events will continue
to impact its business, the unpredictable and unprecedented nature of the pandemic, including new variants and the extent to which
vaccines will be made available globally, makes it impractical to identify all potential risks or estimate the full extent and
scope of the impact on DocGo’s business and industry, as well as national, regional and global markets and economies. Accordingly,
DocGo’s ability to conduct its business in the manner previously or currently expected could be materially and adversely
affected, and any of the foregoing risks and uncertainties as well as those that have not yet manifested themselves or been identified
could materially and adversely affect DocGo’s business, financial condition and results of operations. The pandemic may
also have the effect of heightening many of the other risks described herein.
The
high level of competition in DocGo’s industry could adversely affect its business.
The
medical transportation industry is highly competitive. In providing these services to DocGo’s healthcare provider partners,
individual customers and municipalities, DocGo competes with governmental entities, including cities and fire districts, hospitals,
local and volunteer private providers, as well as other regional and local private companies. The industry also includes several
large national and regional providers such as Rural/Metro Corporation, Falck, American Medical Response (AMR), Southwest Ambulance,
Paramedics Plus and Acadian Ambulance. The most important competitive factors in the medical transportation services industry
include the ability to improve customer service, such as on-time performance and efficient call intake; to provide comprehensive
clinical care; and to recruit, train and motivate employees, particularly ambulance crews who have direct contact with patients
and healthcare personnel. Pricing, billing and reimbursement expertise are also very important.
While
the telehealth market is in an early stage of development, it is competitive and DocGo expects it to attract increased competition,
which could make it difficult for DocGo to succeed. The major competitors in the industry include much larger, national or regional
telehealth providers such as Teladoc, Livongo, Amwell, and One Medical that generally provide telehealth on behalf of self-insured employers
and insurance plans. These competitors, however, generally do not provide direct patient care or last-mile care on behalf
of the provider organization. DocGo also believes there are several smaller, private organizations providing in-home or in-site care
utilizing different, higher cost healthcare providers. Non-traditional providers and others such as large health systems
or payors, some of which may be DocGo customers or partners, may enter the space using consumer-grade video conferencing
platforms such as Zoom and Twilio or develop innovative technologies or business activities that could be disruptive to the industry.
Competition could also increase from large technology companies such as Apple, Amazon, Facebook, Verizon, or Microsoft, who may
develop their own telehealth solutions, as well as from large retailers like Walmart, which see an opportunity in the surge in
interest in telehealth in connection with the COVID-19 pandemic. Competition in the telehealth industry is primarily based
on scale; ease of use, convenience and accessibility; brand recognition; breadth, depth, and efficacy of telehealth services;
technology; clinical quality; customer support; cost; reputation; and customer satisfaction and value.
DocGo
may not be successful in maintaining or growing its competitive position in one or more of its existing markets or in those into
which it may expand. Some of DocGo’s competitors may have access to greater financial or other resources than it does, which
may afford them greater power, efficiency, financial flexibility, geographical reach or capital resources for growth. In addition,
some of DocGo’s competitors are vertically integrated and can leverage this structure to their advantage. DocGo may fail
to identify optimal service or geographic markets, focus its attention on suboptimal service or geographic markets or fail to
execute an appropriate business model in certain service or geographic markets. DocGo’s competitors may develop new services
or technologies that are superior to DocGo’s, develop more efficient or effective methods of providing services or adapt
more quickly, efficiently or effectively than DocGo does to new technologies and opportunities. DocGo’s competitors may
be positioned to provide better service or influence customer requirements, or more quickly respond to changing customer requirements,
and thereby establish stronger customer relationships. DocGo’s competitors may offer their services at lower prices because,
among other things, they possess the ability to provide similar services more efficiently, as part of a bundle with other services
or generally at a lower cost. These pricing pressures could require DocGo to lower its prices to at or below its costs, requiring
DocGo to sacrifice margins or incur losses. Alternatively, DocGo may choose to forgo entering certain markets or exit others,
which would limit its growth and competitive reach. Any failure by DocGo to compete or to generally maintain and improve its competitive
position could adversely affect its business, financial condition and results of operations.
DocGo’s
revenue would be adversely affected if it loses some or all of its business under existing contracts.
A
significant portion of DocGo’s revenue growth has historically resulted from increases in the business and related fees
it collects under existing contracts and the addition of new contracts. DocGo’s contracts with healthcare providers and
other customers generally have terms of one to three years and most of its contracts are terminable by either of the parties
upon notice of as little as 30 days. Many of the pandemic-specific testing and vaccination contracts have much shorter
terms, as little as a number of weeks or months, and there is no certainty these revenue streams can be sustained at
existing levels, regardless of whether the pandemic is brought under control. Even if DocGo has an existing contract with a healthcare
provider it does not create any exclusive relationship and even if DocGo is given preferred status, the customer often still does
business with one or more of DocGo’s competitors. For example, execution under DocGo’s medical transportation services
contracts requires that an ambulance or other necessary fleet vehicle be available and within a certain proximity and the time
of need and, if one is not, the customer will seek alternative options. Furthermore, certain of DocGo’s contracts will expire
during each fiscal period, and DocGo may be required to seek renewal of these contracts through a formal bidding process that
often requires written responses to a request for proposal. Even if DocGo is successful in renewing the contract, it may contain
terms that are not as favorable to DocGo as its current contracts. There can be no assurances that DocGo will successfully retain
its existing contracts and any loss of contracts or reduction in services provided thereunder or under any renewal would have
a material adverse effect on DocGo’s business, financial condition and results of operations.
DocGo’s
reliance on government contracts could adversely affect its business.
While
DocGo’s government contract work historically represented a small portion of its revenue, this work has recently increased substantially,
representing approximately 7.3% and 65.1% of DocGo’s revenue for the years ended December 31, 2020 and 2021, respectively,
and maintaining and continuing to grow this revenue stream is an important part of DocGo’s growth strategy. However, government
contract work is subject to significant risks and uncertainties. Only eligible parties can bid on and service most government contracts,
which requires DocGo to comply with various statutes, rules, regulations and other governmental policies, including those related to wages,
benefits, overtime, working conditions, equal employment opportunity, affirmative action and drug testing. If DocGo fails to comply with
any of these requirements it may be suspended or debarred from government work or subject to various administrative sanctions and civil
and criminal penalties and fines. Government contract work subjects DocGo to government audits, investigations, and proceedings, which
can cause similar results if it is determined that a statute, rule, regulation, policy or contractual provision has been violated. Audits
can also lead to adjustments to the amount of contract costs DocGo believes are reimbursable or the ultimate amount DocGo may be paid
under the agreement.
Additionally,
governments are typically under no obligation to maintain funding at any specific level, and funds for government programs can
be eliminated with little or no notice. As a result, contracts with government agencies may only be partially funded or may be
terminated, and DocGo may not realize all of the potential revenue from those contracts. Government contracts typically can be
paused or canceled entirely at any time, in whole or in part, for the government’s convenience or for default with little
or no prior notice. Under these circumstances, the contractor typically receives payment only for the lesser of the work completed
or the amount authorized under the contract, but not the anticipated revenue and profit that would have been earned had the contract
been completed. A temporary stoppage or delay or the complete cancellation of a project can create inefficiencies, such as leaving
portions of DocGo’s fleet idle for a significant period of time, cause DocGo to lose some or all of its investment in the
project or result in financial and other damages that DocGo may not be able to recover from the government. The timing of project
awards, including expansions of existing projects, is also unpredictable and can involve complex and lengthy negotiations and
competitive bidding processes. Other risks associated with government contracting include more extended collection cycles and
heightened or unlimited indemnification obligations. Any failure to maintain and grow DocGo’s government contract revenues
for one or more of these or any other reasons could adversely affect DocGo’s business, financial condition and results of
operations.
A
significant portion of our recent revenue growth is derived from a small number of large customers.
A significant
portion of our revenues and income growth in 2021 was derived from a from a limited number of customers. For the year ended December 31,
2021, one customer accounted for approximately 26% of total sales, while another customer accounted for approximately 24% of sales. One
of these customers is a public benefit corporation and the other is a municipality with separate contracts with several of its agencies
and departments. Services are provided under different contracts with the various independent agencies of the municipality and are not
guaranteed and are terminable at will by the particular agency. However, termination of any one of those particular contracts does not
necessarily indicate a greater likelihood of termination of any of the municipality’s other contracts, as these contracts are awarded
on a project basis, with each project running independently of the others. We cannot assure you that this customer or other large customers
will continue to do business with us on terms or at rates currently in effect, or will not elect to do business with our competitors or
perform their own services themselves. The loss of one of our top customers, if not offset by revenues from new or other existing customers,
would have a material adverse effect on our business, financial condition and results of operations.
DocGo’s
labor costs are significant and any inability to control those costs could adversely affect its business.
Labor
costs are DocGo’s largest fixed cost, representing approximately 25.1% and 59.9% of its 2021 and 2020 revenues, respectively. DocGo
competes with other healthcare providers in attracting these professionals, including EMTs, paramedics and nurses, to support its operations.
In some markets, the lack of availability of clinical personnel has become a significant operating issue facing all healthcare providers.
This shortage may require DocGo to continue to enhance wages and benefits to recruit and retain qualified personnel or to identify and
contract with more expensive temporary personnel. DocGo also depends on the available labor pool of technology-skilled workers in
certain of the markets in which it operates.
If
DocGo’s labor costs increase, it may not be able to raise rates to offset these increased costs. Because a significant percentage
of DocGo’s revenue consists of fixed, prospective payments, its ability to pass along increased labor costs is limited.
In particular, if labor costs rise at an annual rate greater than its revenues, DocGo’s results of operations and cash flows
will likely be adversely affected.
Any
union activity that may occur within DocGo’s workforce in the future could contribute to increased labor costs. Certain
proposed changes in federal labor laws and the National Labor Relations Board’s modification of its election procedures
could increase the likelihood of employee unionization attempts. Although none of DocGo’s employees are currently represented
by a collective bargaining agreement, to the extent a significant portion of its employee base unionizes, it is possible DocGo’s
labor costs could increase materially. DocGo’s failure to recruit and retain qualified healthcare professionals, or to control
labor costs, could have a material adverse effect on DocGo’s business, financial condition and results of operations.
DocGo’s
inability to collect on its customer receivables or unfavorable shifts in payor mix could adversely affect its business.
The
general practice in DocGo’s industry is to provide medical services in advance of payment and, in many cases, prior to any
assessment of the patient’s ability to pay. DocGo ultimately bills a number of different payors, including private insurance,
Medicare and Medicaid, the healthcare provider or facility and self-pay patients. These different payors typically have different
billing, coding, documentation and other compliance requirements that DocGo must satisfy and any procedural deficiencies or incorrect
or incomplete information could result in delays or partial or complete non-payment for the services DocGo rendered. Changes
in payor mix, particularly those that increase the percentage of patients covered by lower paying government programs as compared
to private insurance or that increase the percentage of self-pay patients, can reduce the amount DocGo receives for its services
and adversely affect DocGo’s ability to collect on its receivables. The ability to bill and collect on certain accounts
may also be limited by statutory, regulatory and investigatory initiatives such as restrictions on charges for out-of-network services
or by private lawsuits, including those directed at healthcare charges and collection practices for uninsured and underinsured
patients. Other factors that can adversely affect DocGo’s billing and collection efforts include general economic conditions,
disputes between payors as to which party is responsible for payment, variation in coverage for similar services among various
payors and the ability of individual patients to pay. In addition, DocGo recently internalized its billing and collection functions,
services that were historically provided by third parties. Any transition of this nature carries significant risks and uncertainties
and the failure of these departments to operate efficiently and effectively could cause periodic or prolonged disruptions to DocGo’s
billing and collection efforts or create other unanticipated inefficiencies. These and other risks and uncertainties that impact
DocGo’s ability to timely bill and collect on its receivables or the amount DocGo can charge for its services could adversely
affect DocGo’s business, financial condition or results of operations.
DocGo
may not accurately assess the costs it will incur under new revenue opportunities.
DocGo
must accurately assess the costs it will incur in providing services in order to realize adequate profit margins and otherwise
meet its financial and strategic objectives, particularly with respect to the expansion of its telehealth business. Increasing
pressures from healthcare payors to restrict or reduce reimbursement rates at a time when the costs of providing medical services
continue to increase make assessing the costs associated with the pricing of new contracts, as well as maintenance of existing
contracts, and pricing new services that DocGo has not previously offered, more difficult. Starting new contracts and service
offerings may also negatively impact cash flow as DocGo absorbs various expenses before it is able to bill and collect revenue
associated with the new contracts or services. In addition, integrating new contracts, particularly those in new geographic locations,
could prove more costly, and could require more management time, than DocGo anticipates. Any failure to accurately predict costs
or to negotiate an adequate profit margin could have a material adverse effect on DocGo’s business, financial condition
and results of operations.
DocGo
may enter into a large-scale deployment of resources in response to a national emergency as a subcontractor to FEMA, which may
adversely affect DocGo’s business.
DocGo
does not believe that a FEMA deployment would adversely affect its ability to service its customers. DocGo is not contractually
obligated to respond to FEMA requests. However, if management elects to participate, any significant FEMA deployment requires
significant management attention and could reduce DocGo’s ability to pursue other opportunities and to pursue geographic
expansion and its growth strategies, which could have an adverse effect on DocGo’s business, financial condition and results
of operations.
DocGo
may face litigation and other risks as a result of Motion’s restatement of its historical financial statements and related
matters.
Motion
previously accounted for its outstanding Public Warrants and Private Warrants as components of equity instead of as derivative
liabilities. The Warrant Agreement governing the warrants includes a provision that provides for potential changes to the settlement
amounts dependent upon the characteristics of the holder of the warrant. Upon review of the “Staff Statement on Accounting
and Reporting Considerations for Warrants Issued by Special Purpose Acquisition Companies (SPACs)” promulgated by the SEC
on April 12, 2021 (the “SEC Staff Statement”), Motion’s management further evaluated the Public Warrants
and Private Warrants under Accounting Standards Codification (“ASC”) Subtopic 815-40, Contracts in Entity’s
Own Equity. ASC Section 815-40-15 addresses equity versus liability treatment and classification of equity-linked financial
instruments, including warrants, and states that a warrant may be classified as a component of equity only if, among other things,
the warrant is indexed to the issuer’s common stock. Based on management’s evaluation, Motion’s audit committee,
in consultation with management, concluded that the Public Warrants and Private Warrants are not indexed to Motion’s common
stock. As a result, Motion reclassified the Public Warrants and Private Warrants as derivative liabilities. Under this accounting
treatment, Motion was required to measure the fair value of the Public Warrants and Private Warrants at the end of each reporting
period and recognize changes in the fair value from the prior period in Motion’s operating results for the current period.
As
a result of the foregoing matters, DocGo may become subject to additional risks and uncertainties, including, among others, unanticipated
costs for accounting and legal fees, the increased possibility of legal proceedings, shareholder lawsuits, governmental agency
investigations, and inquiries by Nasdaq or other regulatory bodies, which could cause investors to lose confidence in our reported
financial information and could subject DocGo to civil or criminal penalties, shareholder class actions or derivative actions.
DocGo could face monetary judgments, penalties or other sanctions that could have a material adverse effect on its business, financial
condition and results of operations and could cause our stock price to decline. If any such actions occur, they will, regardless
of the outcome, consume a significant amount of management’s time and attention and may result in additional legal, accounting,
insurance and other costs. If DocGo does not prevail in any such proceedings, DocGo could be required to pay damages or settlement
costs.
DocGo
is an “emerging growth company” and it cannot be certain if the reduced disclosure requirements applicable to emerging
growth companies will make the Common Stock less attractive to investors.
DocGo
is an “emerging growth company” as defined in the JOBS Act. As an emerging growth company, DocGo is only required
to provide two years of audited financial statements and only two years of related selected financial data and management
discussion and analysis of financial condition and results of operations disclosure. In addition, DocGo is not required to obtain
auditor attestation of its reporting on internal control over financial reporting, has reduced disclosure obligations regarding
executive compensation and is not required to hold non-binding advisory votes on executive compensation. In addition, the
JOBS Act provides that an emerging growth company can take advantage of an extended transition period for complying with new or
revised accounting standards. This allows an emerging growth company to delay the adoption of these accounting standards until
they would otherwise apply to private companies. DocGo has elected to take advantage of such extended transition period. DocGo
cannot predict whether investors will find Common Stock to be less attractive as a result of its reliance on these exemptions.
If some investors find the Common Stock to be less attractive as a result, there may be a less active trading market for Common
Stock and the price of the Common Stock may be more volatile than the historical trading market and price of Motion’s Class A
Common Stock.
DocGo
will remain an emerging growth company until the earliest of: (i) the end of the fiscal year in which DocGo has total annual
gross revenue of $1.07 billion; (ii) the last day of DocGo’s fiscal year following the fifth anniversary
of the Initial Public Offering (or December 31, 2025); (iii) the date on which DocGo issues more than $1.0 billion
in non-convertible debt during the preceding three-year period; or (iv) the end of the fiscal year in which the market
value of the Common Stock held by non-affiliates exceeds $700 million as of the last business day of its most recently
completed second fiscal quarter.
Further,
there is no guarantee that the exemptions available under the JOBS Act will result in significant savings. To the extent that
DocGo chooses not to use exemptions from various reporting requirements under the JOBS Act, it will incur additional compliance
costs, which may impact DocGo’s financial condition.
Risks
Related to DocGo’s Limited Operating History
DocGo’s
limited operating history may make it difficult to evaluate its business, which may be unsuccessful.
DocGo
has a limited operating history since its inception in 2015. As such, there is limited information on which to base an evaluation
of its business and prospects. DocGo’s operations are subject to all of the risks inherent in the establishment of a recently
formed business and its success may be limited by expenses, difficulties, inefficiencies, complications and delays, including
the need for additional financing, challenges with the successful commercialization of its services and its geographic expansion,
market and customer acceptance of its services and technologies, unexpected issues with federal or state regulatory authorities,
competition from larger operations, uncertain intellectual property protection, fluctuations in expenses and dependence on corporate
partners and collaborators. Any failure to successfully address these and other risks and uncertainties commonly associated with
early stage companies could seriously harm DocGo’s business and prospects, and it may not succeed given the challenges it
faces in the markets in which it operates or may choose to expand in the future. Additionally, the idea of providing healthcare
transportation services with significant reliance on a mobile platform is novel, the telehealth industry is nascent and still
evolving and there are no well-established companies offering the “last-mile” telehealth solutions that DocGo
offers, all of which carry its own unique risks, including market and consumer acceptance and adoption. Any evaluation of DocGo’s
business and its prospects must be considered in light of these factors and the other risks and uncertainties frequently encountered
by companies in this early stage of development. No assurance can be given that DocGo will successfully navigate these issues
or implement any of its growth strategies in a timely or effective manner, which would negatively impact DocGo’s business,
financial condition and results of operations.
Much
of DocGo’s revenue, employee and operations growth has occurred during recent years, which has been partially driven by significant
COVID-related impacts. For example, the Company estimates that COVID testing relating revenue for 2021 was approximately $110 million
Our ability to forecast our future operating results is limited and subject to a number of uncertainties, including our ability to predict
revenue and expense levels, and plan for and model future growth. These uncertainties are exacerbated by the effects of the Covid-19 pandemic.
DocGo
has a history of losses, expects its operating expenses to increase significantly in the foreseeable future and may not achieve
or sustain profitability.
Prior
to 2021, when DocGo recorded $19.2 million in net income, DocGo had experienced a net loss in each year since inception, including a net
loss of $14.8 million for the fiscal year ended December 31, 2020. As of December 31, 2021, DocGo had an accumulated
deficit of $63.6 million. While DocGo has been able to generate revenues and believes its business strategy provides for predictable
revenue streams in future periods, the business may not be able to increase revenues in future periods and may resume incurring net losses
for some time as it continues to grow. It is difficult for DocGo to predict its future results of operations, and it expects its operating
expenses to increase significantly over the next several years as it continues to expand its operations and infrastructure, acquire
additional vehicles, hire additional personnel, make and integrate future acquisitions and invest in technology and research and development.
In addition to the costs to grow its business, DocGo also expects to incur significant additional legal, accounting and other expenses
as a newly public company. If DocGo fails to increase its revenue to offset the increases in its operating expenses, DocGo may not achieve
or sustain profitability in the future.
If
DocGo is unable to effectively manage its growth, its financial performance and future prospects will be adversely affected.
Since
DocGo’s inception in 2015, it has experienced rapid growth in the United States and more recently, internationally in the United Kingdom,
and it expects to continue to grow in the future. For example, DocGo’s revenues have grown from $30.9 million in the year ended
December 31, 2017 to $318.7 million in the year ended December 31, 2021, and DocGo’s employee base has grown to more
than 2,900 in just over four years. This growth has placed, and may continue to place, significant strain on DocGo’s management,
its operational and financial infrastructure and its controls and procedures, which may not be adequate to support this growth or sustain
further expansion in the future.
DocGo’s
ability to effectively manage its growth has required and will continue to require it to expand and improve its operational and
financial infrastructure, including its controls and procedures, and to retain, attract, train, motivate and manage employees,
including qualified medical professionals, operations personnel and financial and accounting staff. Additionally, DocGo has needed
to and will continue to need to integrate new technologies and acquisitions into its existing business and establish consistent
policies across regions and functions. Achieving these goals has required DocGo to commit substantial financial, operational and
technical resources, and DocGo expects these demands to persist, and very likely may increase, as it continues to grow in the
future.
This
expansion and increasing complexity of DocGo’s business has placed significant strain on its operations, personnel and systems
and further growth in the future could restrict DocGo’s ability to develop and improve its operational, financial and management
controls and enhance its reporting systems and procedures. If DocGo is not able to expand its operations and attract, train and
retain additional qualified personnel in an efficient manner, DocGo’s operations and services will be adversely affected
and its customers may choose one or more of its competitors. Additionally, DocGo’s failure to maintain or upgrade its technology
infrastructure effectively to support its growth or otherwise maintain its technological competitive advantage could result in
unanticipated system disruptions, slow response times, or an unsatisfactory customer experience. An inability to maintain effective
management, financial and reporting systems, controls and procedures could adversely affect DocGo’s ability to provide timely
and accurate financial information or result in a misstatement of account balances or disclosures. If DocGo is unable to effectively
manage its recent or future growth, its operations may suffer, which would adversely affect DocGo’s business, financial
condition and results of operations.
Risks
Related to Technology
DocGo’s
business depends on numerous complex information systems and any failure to successfully maintain these systems could adversely
affect its business.
DocGo
depends on complex, integrated information systems and standardized procedures for operational and financial information and its
billing operations. DocGo may not have the necessary resources to enhance existing information systems or implement new systems
where necessary to handle its volume and changing needs. For example, DocGo recently implemented new information systems and processes
in connection with internalizing its billing and collection functions, services that were historically provided by third parties,
and any failure of these systems could adversely affect DocGo’s ability to submit and collect claims in a timely manner
or at all. DocGo also uses the development and implementation of sophisticated and specialized technology such as its platform
to differentiate its services from its competitors and improve DocGo’s profitability.
DocGo
may experience unanticipated delays, complications and expenses in implementing, integrating and operating its systems. Any system
disruption can adversely affect DocGo’s ability to properly allocate resources and process billing information in a timely
manner, which could result in customer dissatisfaction and delayed cash flow. While DocGo has disaster recovery systems and business
continuity plans in place, any disruptions in its disaster recovery systems or the failure of these systems to operate as expected
could, depending on the magnitude of the problem, limit DocGo’s capacity to effectively monitor and control its operations.
The failure to successfully implement and maintain operational, financial and billing information systems could have an adverse
effect on DocGo’s business, financial condition and results of operations.
DocGo’s
dependence on the performance of its innovative platform and reliability of the Internet and similar infrastructures could adversely
affect its business.
DocGo’s
technology platform is one of its primary competitive advantages and its business depends in significant part on the performance
and reliability of the Internet and other mobile infrastructures and communication systems to ensure access to and the functionality
of its platform. Disruptions in Internet infrastructure or GPS signals or the failure of telecommunications network operators
to provide DocGo with the bandwidth it needs to operate its platform and provide its services, whether as a result of power outage,
telecommunications delay or failure, security breach or otherwise, could result in delays or interruptions and interfere with
the speed and availability of DocGo’s platform. DocGo may also operate in jurisdictions that provide limited Internet connectivity,
particularly as it expands into more rural areas and internationally. Internet access and access to a mobile device are frequently
provided by companies with significant market power that could take actions that degrade, disrupt or increase the cost to access
DocGo’s platform. In addition, DocGo has no control over the costs of the services provided by national telecommunications
operators and if mobile Internet access fees or other charges to Internet users increase, consumer traffic may decrease. Any such
failure in or disruptions to Internet or mobile device accessibility, even for a short period of time, could adversely affect
DocGo’s business, financial condition and results of operations.
DocGo’s
platform is highly technical and its failure to operate effectively could adversely affect DocGo’s business.
DocGo’s
business and its competitive advantage are dependent upon its ability to maintain operation and functionality of its platform, which is
a complex system composed of many interoperating components and incorporates both proprietary and open-source software. The software and
other components used in the platform may now or in the future contain undetected errors, bugs, vulnerabilities or limitations, some of
which may only be discovered after the code has been released. These types of errors, misconfigurations of its systems, and unintended
interactions between systems or other limitations could result in platform downtime impacting the availability of DocGo’s services.
In addition, updates or expansions to DocGo’s platform of the software it relies upon may inadvertently cause interruptions in the
availability or functionality of the technology. DocGo also relies on co-located data centers for the operation of its platform and,
if one or more of these data centers fail, DocGo’s platform may not operate effectively or at all. If sustained for more than a
brief period of time or repeated, these outages or other failures could, among other things, reduce the utility or attractiveness of DocGo’s
platform to users, expose DocGo to liability if a patient’s health is adversely affected, result in negative publicity or damage
DocGo’s reputation, cause DocGo to fail to comply with certain federal, state or foreign reporting obligations, and have a material
adverse effect on DocGo’s business, financial condition and results of operations.
DocGo
relies on third-party mobile operating systems and application marketplaces to make its platform available and any failure to
effectively operate across these operating systems and within these marketplaces could adversely affect DocGo’s business.
One
of the most important features of DocGo’s platform is its broad interoperability with and availability on a range of devices,
operating systems and third-party applications, including iOS and Android and their respective application marketplaces.
DocGo does not have any control over these third-party operating systems and technologies or their respective marketplaces
and there can be no assurances that these third parties will maintain their current structures. DocGo may also not be successful
in developing or maintaining relationships with key participants in the mobile industry and there is no certainty that one or
more will not change the fees to list DocGo’s platform for download. Further, as new mobile devices and mobile platforms
are released, there is no guarantee that all mobile devices will continue to support DocGo’s platform or effectively roll
out any updates. Any changes in these technologies, operating systems or marketplaces or the emergence of new alternatives that
degrade the functionality of DocGo’s platform, increase the cost of using DocGo’s platform or make DocGo’s platform
more difficult to access or otherwise unavailable could have a material adverse effect on DocGo’s business, financial condition
and results of operations.
DocGo’s
reliance on third-party service providers could adversely affect its business.
DocGo’s
success depends in part on its integrations and relationships with third-party service providers, particularly third-party providers
of technology related services. DocGo also uses a combination of third-party cloud computing services and co-located data
centers in the United States and in the United Kingdom, including those of Amazon Web Services and Microsoft Azure,
over which DocGo has no control. These third-party operations, services and co-located data centers may experience disruptions,
including break-ins, computer viruses, denial-of-service attacks and other misconduct and may be vulnerable to damage or
interruption from power loss, telecommunications failures, fires, floods, earthquakes and similar events. DocGo’s systems
do not provide complete redundancy of data storage or processing, and as a result, the occurrence of these or other similar events,
a decision by the third-party service providers to cease providing a service or close a co-located data center without
adequate notice, or other unanticipated problems may result in DocGo’s inability to service data reliably or require it
to find an alternative or migrate its data to a new on-premises data center or cloud computing service. Additionally, the
contracts pursuant to which the service is provided, including the co-located data center facility agreements, can be of
limited durations, and the third party generally has no obligation to renew their agreements with DocGo, whether on commercially
reasonable terms or at all. These agreements can often be terminated on short notice. DocGo may not be able to easily switch to
another service or cloud or data center provider in the event of any disruptions or interference to the services it uses, and
even if it does, other providers are subject to the same risks and may not be available on commercially reasonable terms or at
all. Any need to change a service provider or find a new cloud or data center could be time consuming and costly and may result
in the loss of data and significantly interrupt the functionality of DocGo’s platform and its ability to provide its services.
Further, any negative publicity related to any of DocGo’s third-party partners, including any publicity related to
quality standards or safety concerns, could similarly affect DocGo’s reputation and brand, and could potentially lead to
increased regulatory or litigation exposure. Any of the foregoing risks related to DocGo’s reliance on third-party services
providers could have a material adverse effect on its business, financial condition and results of operations.
DocGo’s
reliance on third-party software, including open-source software, could adversely affect its business.
DocGo’s
success depends in part on its integrations and relationships with third-party software providers and expects that DocGo
will continue to do so in the future in connection with the development and expansion of DocGo’s offerings and technologies.
For example, DocGo’s use of Google Waze for the mapping and traffic function is critical to the functionality of its ShareLink
technology. DocGo does not believe that an alternative mapping solution exists that can provide the scale and functionality that
DocGo requires to offer these features in all of the markets in which it operates or may expand. DocGo also relies on third-party encryption
and authentication technologies licensed from third parties that are designed to securely transmit electronic medical records
and other personal patient information. DocGo uses third-party software internally as well, including for communication purposes.
If these third parties cease to provide access to the software that DocGo uses, if it is not available on terms that DocGo believes
to be reasonable, or it is not available in the most current version, DocGo may be required to seek comparable software from other
sources, which may be more expensive or inferior, or may not be available at all. Some of DocGo’s technology partners may
also take actions which disrupt the utility of the software to DocGo or the interoperability of DocGo’s platform with their
own products or services, or exert strong business influence on DocGo’s ability to and the terms on which it operates and
distributes its platform. Additionally, third-party services and products are constantly evolving, and DocGo may not be able
to modify its operations or platform to assure its compatibility with that of other third parties following development changes.
DocGo’s third-party licenses are typically non-exclusive and its competitors may obtain the right to use any of
the technology covered by these licenses to compete directly with it. If any of DocGo’s technology partners limits access
or modifies their products, standards or terms of use in a manner that degrades the functionality or performance of DocGo’s
platform, that is otherwise unsatisfactory or adverse to DocGo, or that gives preferential treatment to competitive products or
services, DocGo’s business, financial condition and results of operations could be adversely affected.
DocGo
also uses third-party open-source software in connection with its business and the development and operation of its platform, which
carries its own unique risks. From time to time, companies that use third-party open-source software have faced claims of ownership
or challenging the use of such open-source software and their compliance with the terms of the applicable open source license. Some open
source licenses require end users who distribute or make available across a network software and services that include open source software
to make available all or part of such software, which in some circumstances could include valuable proprietary code, meaning DocGo’s
ability to protect its intellectual property rights in such software source code may be limited or lost entirely and DocGo would not
be able to prevent competitors or others from using the code and developing competing technologies. While DocGo employs practices designed
to monitor its compliance with third-party open-source software licenses and to protect its valuable proprietary source code, DocGo
has not run a complete open-source license review and may inadvertently use third-party open source software in a manner that exposes
it to claims of non-compliance with the applicable license terms, including claims for infringement of intellectual property rights
or for breach of contract. Furthermore, there is an increasing number of different types of open-source software licenses, most
of which have not been tested in a court of law, resulting in a significant absence of guidance regarding the proper legal interpretation
of these licenses. If DocGo was to receive a claim of non-compliance with the terms of any of its open-source licenses, it may be
required to publicly release some or all of its proprietary source code or expend substantial time and resources to re-engineer some
or all of its software. Use of open-source software may also present additional security risks because the public availability of such
software may make it easier for hackers and other third parties to determine how to compromise DocGo’s platform. Any of the foregoing
or other risks related to the use of open-source software could have an adverse effect on DocGo’s business, financial condition
and results of operations.
Security
breaches, loss of data and other disruptions could compromise sensitive business, customer or patient information or prevent DocGo
from accessing critical information and expose it to liability, which could adversely affect DocGo’s business.
DocGo
is highly dependent on information technology networks and systems, including on-site systems, managed data center systems
and cloud-based computing center system, to securely process, transmit and store sensitive data and information, such as
protected health information (“PHI”) and other types of personal data or personally identifiable information (“PII”)
relating to its employees, customers, patients and other confidential or proprietary business information. Computer malware, viruses,
spamming, and phishing attacks have become more prevalent, have occurred on DocGo’s systems in the past, and may occur on
DocGo’s systems in the future. Various other factors may also cause system failures, including power outages, catastrophic
events, inadequate or ineffective redundancy, issues with upgrading or creating new systems or platforms, flaws in third-party software
or services, errors or intentional acts by DocGo’s employees or third-party service providers, or breaches in the security
of these systems or platforms. These and other issues can create system disruptions, shutdowns or unauthorized access to or disclosure
or modifications of such sensitive data or information, including PHI or PII. DocGo also utilizes third-party service
providers for important aspects of the collection, storage, processing and transmission of this sensitive information and therefore
is dependent on these third parties to similarly manage cybersecurity risks.
Because
of the sensitivity of the PHI, other PII and other sensitive information DocGo and its service providers collect, store, transmit,
and otherwise process, the security of DocGo’s technology platform and other aspects of its services, including those provided
or facilitated by DocGo’s third-party service providers, are important to DocGo’s operations and business strategy.
DocGo takes certain administrative, physical and technological safeguards to address these risks, such as by requiring contractors
and other third-party service providers who handle this PHI, other PII and other sensitive information to enter into agreements
that contractually obligate them to use reasonable efforts to safeguard such PHI, other PII, and other sensitive information.
DocGo is also in the process of upgrading its systems to be ISO 27001 and Service Organization Controls (SOC) 2 compliant. Measures
taken to protect DocGo’s systems, those of its contractors or third-party service providers, or the PHI, other PII,
or other sensitive information DocGo or contractors or third-party service providers process or maintain, may not adequately
protect DocGo from the risks associated with the collection, storage, processing and transmission of such sensitive data and information.
Additionally, updates or upgrades to systems, including those currently underway with respect to ISO 27001 and SOC 2 compliance,
are time-consuming and effective, may not operate as designed and could create new inefficiencies or vulnerabilities. DocGo
may also be required to expend significant capital and other resources to address problems caused by security breaches. Despite
DocGo’s implementation of security measures, cyberattacks are becoming more sophisticated and frequent. As a result, DocGo
or its third-party service providers may be unable to anticipate these techniques or to implement adequate protective measures.
If DocGo is unable to earn and maintain necessary certifications, including ISO 27001 and SOC 2 compliance, it could result in
reputational harm, customer churn and adversely affect DocGo’s ability to provide its services.
A
security breach or privacy violation that leads to disclosure or unauthorized use or modification of, or that prevents access
to or otherwise impacts the confidentiality, security, or integrity of, patient information, including PHI or other PII, or other
sensitive information DocGo or its contractors or third-party service providers maintain or otherwise process, could harm
DocGo’s reputation, compel it to comply with breach notification laws, cause it to incur significant costs for remediation,
fines, penalties, notification to individuals and for measures intended to repair or replace systems or technology and to prevent
future occurrences, potential increases in insurance premiums, and require DocGo to verify the accuracy of database contents,
resulting in increased costs or loss of revenue. If DocGo is unable to prevent or mitigate such security breaches or privacy violations
or implement satisfactory remedial measures, or if it is perceived that DocGo has been unable to do so, its operations or the
functionality of its innovative technology could be disrupted, it may be unable to provide access to its systems, and it could
suffer a loss of customers, and it may as a result suffer loss of reputation, adverse impacts on customer, consumer and investor
confidence, financial loss, governmental investigations or other actions, regulatory or contractual penalties, and other claims
and liability. In addition, security breaches and other inappropriate access to, or acquisition or processing of, information
can be difficult to detect, and any delay in identifying such incidents or in providing any notification of such incidents may
lead to increased harm.
Any
such breach or interruption of DocGo’s systems or those of any of its third-party service providers could compromise
DocGo’s networks or data security processes and sensitive information could be made inaccessible or could be accessed by
unauthorized parties, publicly disclosed, lost or stolen. Any such interruption in access, improper access, disclosure or other
loss of information could result in legal claims or proceedings, liability under laws and regulations that protect the privacy
of member information or other personal information, such as the Health Insurance Portability and Accountability Act of 1996,
as amended by the Health Information Technology for Economic and Clinical Health Act of 2009 (“HITECH”),
and their implementing regulations and related rules (collectively, “HIPAA”), and regulatory penalties. See the section
of this Annual Report on Form 10-K statement/consent solicitation statement/prospectus titled “Description of DocGo’s
Business — Regulatory Matters.” Unauthorized access, loss or dissemination could also disrupt DocGo’s
operations, including its ability to perform its services, access customer and patient health information, collect, process, and
prepare company financial information, and provide information about DocGo’s current and future services. Any such breach
could also result in the compromise of DocGo’s trade secrets and other proprietary information, which could adversely affect
DocGo’s business and competitive position. While DocGo maintains insurance covering certain security and privacy damages
and claim expenses, it may not carry insurance or maintain coverage sufficient to compensate for all liability and in any event,
insurance coverage would not address the reputational damage that could result from a security incident.
As
of the date of this filing, DocGo has not been impacted by any security breaches to its technology platform, including its on-site systems,
managed data center systems and cloud-based computing center system.
Other
Risks Related to DocGo’s Business
DocGo
depends on its key management personnel.
DocGo’s
success depends to a significant degree upon the contributions of certain key management personnel including, but not limited to, its
founder Stan Vashovsky and the other officers listed in this Annual Report on Form 10-K. If any of DocGo’s key management personnel
were to cease employment with it, DocGo’s operating results could suffer. DocGo’s ability to retain its key management personnel
or to attract suitable replacements should any member(s) of its management team leave is dependent on the culture the leadership
team fosters and on the competitive nature of the employment market, particularly in a heavily regulated industry like that of DocGo.
DocGo does not have key management life insurance that would provide it with proceeds in the event of death or disability of any of its
key management personnel. The loss of services from key management personnel or any inability to find a suitable replacement should there
be turnover at those positions could materially and adversely affect DocGo’s business, financial condition and results of operations.
DocGo’s
inability to successfully recruit, train and retain qualified healthcare professionals could adversely affect its business.
The
pool of qualified healthcare professionals, including EMTs, paramedics, LPNs and nurses, available to staff DocGo’s broad
spectrum of contracts and customer needs is limited and DocGo invests significant resources to attract, train and retain these
professionals. There is a relatively high rate of turnover in healthcare professional positions and, with DocGo’s expansion,
its requirements in these positions have increased significantly. A significant number of employees have joined DocGo in recent years
as it has grown and DocGo’s success is dependent on its ability to maintain and instill its culture, align its talent with
its business needs, engage its employees and inspire them to be open to change, to innovate and to maintain a customer-driven focus
when delivering its services. As such, DocGo’s ability to recruit, train and retain a sufficient number of qualified healthcare
professionals has a direct impact on its operations.
DocGo
has, from time to time, experienced, and it expects to continue to experience, difficulty in hiring and retaining healthcare professionals
with appropriate qualifications, a difficulty that is amplified by the scope of the geographic and demographic diversity of the
markets in which DocGo operates or may expand into in the future. Moreover, DocGo’s customers, including the healthcare
providers with which it partners, have increasingly demanded a greater degree of specialized skills, training and experience in
the healthcare professionals providing services under their contracts, which also decreases the number of healthcare professionals
who may be qualified to staff certain of DocGo’s contracts. DocGo competes with other companies to recruit and retain these
qualified healthcare professionals, including DocGo’s direct competitors, government and private emergency and first responders
as well as healthcare providers, including DocGo’s partners and customers. Competition to fill these positions can be even
greater in certain geographic regions, including more rural or economically depressed areas. In addition, the COVID-19 pandemic
has significantly increased the demand for healthcare professionals in all regards, which makes it more difficult for DocGo to
attract and retain the necessary qualified professionals. If DocGo is unable to attract, train and retain highly qualified healthcare
professions, or if turnover rates are higher than it anticipates, it could have an adverse effect on DocGo’s business, financial
condition and results of operations.
DocGo’s
failure to protect or enforce its intellectual property rights could adversely affect its business.
DocGo’s
success is dependent in part upon protecting its intellectual property rights and technology, including code, information, data,
processes and other forms of information, know-how and technology. DocGo relies on a combination of patents, copyrights,
trademarks, service marks, trade secret laws and contractual restrictions to establish and protect its intellectual property.
DocGo also enters into confidentiality and invention assignment agreements with its employees and consultants and enters into
confidentiality agreements with certain of its third-party providers and strategic partners. However, these and other steps
DocGo takes to protect its intellectual property may not be sufficient or effective.
Many
intellectual property protections do not prevent competitors or others from independently developing technologies that are substantially
equivalent or superior to DocGo’s offerings. Further, it may still be possible for competitors and other unauthorized third
parties to copy DocGo’s technology and use its proprietary information to create or enhance competing platforms, solutions
and services. DocGo also enters into strategic relationships, joint development and other similar agreements with third parties
where intellectual property arising from such relationships may be jointly owned or may be transferred or licensed to the counterparty.
These arrangements may limit DocGo’s ability to protect, maintain, enforce or commercialize such intellectual property rights,
including requiring agreement with or payment to the joint development partners before protecting, maintaining, licensing or initiating
enforcement of such intellectual property rights, and may allow such joint development partners to register, maintain, enforce
or license such intellectual property rights in a manner that may affect the value of the jointly owned intellectual property
or DocGo’s ability to compete in the market. As DocGo expands its international activities, its exposure to unauthorized
use, copying, transfer and disclosure of proprietary information will likely increase as the laws of some countries do not provide
the same level of intellectual property protection as do the laws of the United States and effective intellectual property
protections may not be available or may be limited and harder to enforce in some jurisdictions.
DocGo
may be required to spend significant resources in order to monitor and protect its intellectual property rights, and some violations
may be difficult or impossible to detect. And, even if DocGo does detect violations of its intellectual property rights, it may
need to engage in litigation or other actions to enforce its rights. Any enforcement efforts, and litigation in particular, could
be costly, time-consuming and distracting to management and could result in the impairment or loss of portions of DocGo’s
intellectual property. DocGo’s efforts to enforce its intellectual property rights may also be met with defenses, counterclaims
and countersuits attacking the validity and enforceability of its intellectual property rights. DocGo’s inability to protect
its proprietary technology against unauthorized copying or use, as well as any costly litigation or extensive enforcement activities,
could impair the functionality of DocGo’s platform, delay introductions of enhancements to the platform, result in DocGo’s
substituting inferior or more costly technologies into its platform, harm DocGo’s reputation or brand and otherwise have
a material adverse effect on its business, financial condition and results of operations.
Claims
by others that DocGo infringed their proprietary technology or other intellectual property rights could adversely affect DocGo’s
business.
From
time to time third parties may assert claims of infringement of intellectual property rights against DocGo. In addition, third
parties have sent DocGo correspondence regarding various allegations of intellectual property infringement. DocGo incorporates
technology from third parties into its platform and, as such, cannot be certain that these licensors are not infringing the intellectual
property rights of others or that the suppliers and licensors have sufficient rights to the technology in all jurisdictions in
which DocGo may operate. As DocGo gains an increasingly higher public profile, DocGo expects the possibility of these and other
types of intellectual property rights claims against it will grow. Although DocGo believes that it has meritorious defenses, there
can be no assurance that DocGo will be successful in defending against these and future allegations or in reaching a business
resolution that is acceptable to DocGo.
Many
potential litigants, including some of DocGo’s competitors and patent-holding companies, have the ability to dedicate
substantial resources to assert their intellectual property rights. Any claim of infringement by a third party, even those without
merit, could be costly, time-consuming and a significant distraction to management. Furthermore, because of the substantial
amount of discovery required in connection with intellectual property litigation, DocGo could risk compromising its confidential
information during this type of litigation. With respect to any intellectual property rights claim, DocGo may have to negotiate
a license to continue operations found to be in violation of such rights, and these licenses may not be available on favorable
or commercially reasonable terms or at all. DocGo may be required to pay substantial damages, royalties or other fees in connection
with a claimant securing a judgment against it, DocGo may be subject to an injunction or other restrictions that prevent it from
using the relevant intellectual property, or DocGo may determine it is prudent to agree to a settlement that restricts DocGo’s
operations or its use of certain intellectual property, any of which could adversely affect DocGo’s business, financial
condition and results of operations.
If
DocGo is unable to successfully develop new offerings and technologies or adapt to rapidly changing technology and industry standards
or changes to regulatory requirements, DocGo’s business could be adversely affected.
Technology,
including the mobile technologies DocGo utilizes on its innovative platform, is characterized by rapid change, evolving industry
standards and changing regulatory requirements. This constant evolution may reduce the utility or effectiveness of DocGo’s
technology or render its business model or platform noncompetitive or obsolete. DocGo’s continued success and growth depend
in part upon its ability to anticipate these challenges and to innovate by enhancing its platform and other technologies and developing
and successfully implementing updates and new features to keep pace with these ever-changing and increasingly sophisticated
demands.
New
technology introductions and platform updates can be complex and expensive as they require significant planning, design, development
and testing. DocGo may find it difficult or costly to update its platform and its service offerings and to develop new services
quickly enough to work effectively with new or changed technologies, to keep the pace with evolving industry standards or to meet
customers’ needs. In addition, DocGo’s industry may be slow to accept DocGo’s use of technology because of,
among other things, general unfamiliarity of healthcare providers with new technologies and the wide disparity of technology used
in the industry, including with respect to electronic medical records. As a result, any new technologies or platform updates that
DocGo may develop may not be successful for a number of years, if at all. If DocGo is unable to successfully develop new
services or enhance or update its platform and existing services to meet these challenges, its business, financial condition and
results of operations may be adversely affected.
DocGo’s
marketing efforts to help grow its business, including its recent rebrand, may not be effective.
Promoting
awareness of DocGo’s brand, innovative technology and services is important to its ability to grow its business and to attract
and retain customers, and these efforts can be costly. DocGo believes that much of the growth in its business is in part attributable
to its marketing initiatives. DocGo’s marketing initiatives may become increasingly expensive and generating a meaningful
return on those initiatives may be difficult. Even if DocGo successfully increases revenue as a result of its paid marketing efforts,
it may not offset the additional marketing expenses it incurs. Any factor that diminishes DocGo’s reputation or that of
its brands, including adverse publicity or failing to meet the expectations of customers, could make it substantially more difficult
for DocGo to attract new customers. If these marketing efforts are not successful, DocGo’s business, financial condition
and results of operations could be adversely affected.
Additionally,
in January 2021, the company rolled-out a new corporate name — DocGo — while continuing to use
the Ambulnz brand for its healthcare transportation services. This process carries additional risk and requires time and expense. DocGo
may lose customers if they do not respond favorably to the new brand or fail to recognize the new brand as a continuation of the same
business and platform. DocGo may also lose potential new customers who may have been familiar with the company, but are not yet aware
of DocGo. The change may also impede the company’s ability to attract new qualified personnel if candidates do not recognize the
new name. The rebranding will also increase costs. Any unforeseen costs, lack of success or loss of current or potential new customers
related to the corporate name change could adversely affect DocGo’s business, financial condition and results of operations.
DocGo
could be subject to lawsuits for which it does not have sufficient reserves.
Healthcare
providers and other participants in the healthcare industry have become subject to an increasing number of lawsuits alleging medical
malpractice and related legal theories such as negligent hiring, supervision and credentialing. Similarly, healthcare transportation
services can result in lawsuits related to vehicle collisions and personal injuries, patient care incidents or mistreatment and
employee job-related injuries. Moreover, in the normal course of DocGo’s business, it is involved in lawsuits, claims,
audits and investigations, including those arising out of its billing practices, employment disputes, contractual claims and other
business disputes for which DocGo may have no insurance coverage, and which are not subject to actuarial estimates. Some of these
lawsuits may involve large claim amounts and substantial defense costs.
Adverse
outcomes with respect to litigation or any of these legal proceedings may result in significant settlement costs or judgments,
penalties and fines, which may or may not be covered by DocGo’s existing insurance, or require DocGo to modify its services
or require it to stop serving certain customers or geographies, all of which could negatively impact its existing business and
its ability to grow. DocGo may also become subject to periodic audits, which would likely increase its regulatory compliance costs
and may require it to change its business practices or the scope of its operations. Managing legal proceedings, litigation and
audits, even if DocGo achieves favorable outcomes, is time-consuming and diverts management’s attention from DocGo’s day-to-day business.
The outcome of these matters or future claims and disputes are difficult to predict and determining reserves for pending litigation
and other legal, regulatory and audit matters requires significant judgment. There can be no assurance that DocGo’s expectations
will prove correct, and even if these matters are resolved in its favor or without significant cash settlements, these matters,
and the time and resources necessary to litigate or resolve them, could have a material effect on DocGo’s results of operations
in the period when it identifies the matter, and could have a material adverse effect on DocGo’s business, financial condition
and results of operations.
DocGo is subject
to a variety of federal, state and local laws and regulatory regimes, including a variety of labor laws and regulations, and changes to
or the failure to comply with these laws and regulations could adversely affect DocGo’s business.
DocGo
is subject to various federal, state, and local laws and regulations including the Employee Retirement Income Security Act of 1974
(“ERISA”) and regulations promulgated by the Internal Revenue Service (“IRS”), the U.S. Department
of Labor and the Occupational Safety and Health Administration. DocGo is also subject to a variety of federal and state employment
and labor laws and regulations, including the Americans with Disabilities Act, the federal Fair Labor Standards Act, the Worker
Adjustment and Retraining Notification Act, and other regulations related to working conditions, wage-hour pay, overtime
pay, family leave, employee benefits, antidiscrimination, termination of employment, safety standards and other workplace regulations.
Compliance with these and other applicable laws and regulations can be time-consuming and costly. Failure to properly adhere
to these and other applicable laws and regulations could result in investigations, the imposition of penalties or adverse legal
judgments by public or private plaintiffs. Changes to these laws and regulations can also increase costs and require DocGo to
commit additional resources to compliance. For example, raising the federal minimum wage or the minimum wage within a state where
DocGo has significant operations, which has been and continues to be a subject of ongoing discussions in Washington, D.C. and
other U.S. state capitals, could significantly increase DocGo’s selling, general and administrative expenses. Changes
to or any failure to comply with applicable laws and regulations could have a material adverse effect on DocGo’s business,
financial condition and results of operations. See also “— Risks Related to Healthcare Regulation.”
DocGo’s
insurance coverage, including the reserves DocGo establishes with respect to its insurable losses, could adversely affect its
business.
In
connection with DocGo’s insurance programs, management establishes reserves for losses and related expenses within its self-insured retention
limits, which represent estimates involving actuarial and statistical projections, at a given point in time, of DocGo’s
expectations of the ultimate resolution and administration costs of losses it has incurred in respect of its liability risks.
Insurance reserves inherently are subject to uncertainty. DocGo’s reserves are based on historical claims, demographic factors,
industry trends, severity and exposure factors and other actuarial assumptions. The actuarial projections include studies of projected
ultimate losses on an annual basis and provide quarterly updates to those projections. DocGo uses these actuarial estimates to
determine appropriate reserves. DocGo’s reserves could be significantly affected if current and future occurrences differ
from historical claim trends and expectations. While DocGo monitors claims closely when it estimates reserves, the complexity
of the claims and the wide range of potential outcomes may hamper timely adjustments to the assumptions DocGo uses in these estimates.
Actual losses and related expenses may deviate, individually and in the aggregate, from the reserve estimates reflected in DocGo’s
consolidated financial statements. If DocGo determines that its estimated reserves are inadequate, it will be required to increase
reserves at the time of the determination, which would reduce DocGo’s earnings in the period in which the deficiency is
determined and could have a material adverse effect on DocGo’s business, financial condition and results of operations.
Some
of DocGo’s insurance coverage is through various third-party insurers. To the extent DocGo holds policies to cover
certain groups of claims or relies on insurance coverage obtained by third parties to cover such claims, DocGo may still be responsible
for losses. This could occur for a variety of reasons, including if DocGo or such third parties did not obtain sufficient insurance
limits, did not buy an extended reporting period policy, where applicable, or the issuing insurance company is unable or unwilling
to pay such claims. Furthermore, for DocGo’s losses that are insured or reinsured through commercial insurance companies,
it is subject to the “credit risk” of those insurance companies. In addition, professional liability insurance is
expensive and insurance premiums may increase significantly in the future, particularly as DocGo expands the geographies in which
it does business. As a result, adequate professional liability insurance may not be available to it in the future at acceptable
costs or at all. While DocGo believes its commercial insurance company providers are creditworthy, there can be no assurance that
such insurance companies will remain so in the future, and any failure of DocGo’s insurance coverage to adequately cover
any losses could have a material adverse effect on DocGo’s business, financial condition and results of operations.
DocGo
is required to make capital expenditures in order to remain compliant and competitive.
DocGo’s
capital expenditure requirements primarily relate to maintaining, growing and upgrading its vehicle fleet and medical equipment
to serve its customers and remain competitive. The aging of DocGo’s vehicle fleet requires it to make regular capital expenditures,
including to lease newer replacement vehicles, to maintain its current level of service. DocGo’s net capital expenditures
totaled $4.7 million and $4.1 million in the years ended December 31, 2021 and 2020, respectively, representing
acquisitions of property and equipment, less the proceeds from disposals of property and equipment. In addition, changing competitive
conditions or the emergence of any significant advances in medical technology could require DocGo to invest significant capital
in additional equipment or capacity in order to remain competitive. DocGo is also required to commit sufficient capital to acquiring
the necessary infrastructure when it expands into new geographies. If DocGo is unable to fund any such investment or otherwise
fail to invest in new vehicles, medical equipment or other infrastructure, its business, financial condition or results of operations
could be materially and adversely affected.
DocGo’s
international operations subject it to additional risks that could adversely affect its business.
DocGo
currently provides healthcare transportation services in the United Kingdom and intends to further expand its operations
and services internationally, which subjects DocGo to regulatory, economic, political and other events and uncertainties in these
foreign jurisdictions. In addition to the risks discussed elsewhere herein that are common to DocGo’s operations more generally,
DocGo faces additional risks specific to its international operations, including but not limited to:
| ● | political,
social, economic and financial instability, including wars, civil unrest, acts of terrorism and other conflicts; |
| ● | difficulties
and increased costs in developing, staffing and simultaneously managing a large number of varying foreign operations as a result of distance,
language and cultural differences; |
| ● | restrictions
and limitations on the transfer or repatriation of funds and fluctuations in currency exchange rates; |
| ● | complying
with varying legal and regulatory environments in multiple foreign jurisdictions, including privacy laws such as the E.U. General
Data Protection Regulation; |
| ● | laws
and business practices that favor local competitors or prohibit foreign ownership of certain businesses; |
| ● | potential
for privatization and other confiscatory actions; and |
| ● | other
dynamics in international jurisdictions, any of which could result in substantial additional legal or compliance costs, liabilities or
obligations for DocGo or could require it to significantly modify its current business practices or even exit a given market. |
Foreign
operations bring increased complexity and the costs of managing or overseeing foreign operations, including adapting and localizing
services or systems to specific regions and countries, can be material. Further, international operations carry inherent uncertainties
regarding the effect of local or domestic actions, such as the unpredictable impact of the United Kingdom’s exit from
the European Union (Brexit) and the uncertainty regarding how the agreements reached will operate, any of which could be material.
International operations also carry financial risks such as those related to fluctuations in foreign currency exchange rates and
disparate tax laws. These and other risks related to DocGo’s existing or future foreign operations, or the associated costs
or liabilities, could have a material adverse effect on DocGo’s business, financial condition and results of operations.
DocGo’s
business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism,
cybersecurity incidents, and/or other acts by third parties.
DocGo
and its customers depend on the ability of its business to run smoothly, including the ability of its fleet of ambulances, which
are often needed in times of emergency, to transport patients. Any material disruption caused by natural disasters, including,
fires, floods, hurricanes, volcanoes, and earthquakes; power loss or shortages; environmental disasters; telecommunications or
business information systems failures; acts of war or terrorism; viral outbreaks and other similar epidemics; cybersecurity incidents;
and other actions by third parties and other similar disruptions could cause DocGo to lose critical data and services and otherwise
adversely affect DocGo’s ability to conduct business. Even with disaster recovery arrangements, DocGo’s services could
be interrupted and DocGo’s insurance coverage may not compensate it for losses that may occur in the wake of such events.
If any disruption results in the destruction of some or all of DocGo’s fleet, significant disruption to DocGo’s business,
contributes to a general decrease in local, regional or global economic activity or otherwise impairs DocGo’s ability to
meet customer demands, or if DocGo is not able to develop or execute on an adequate recovery plan in such circumstances, DocGo’s
business, financial condition and results of operations could be materially adversely affected.
DocGo’s
ability to utilize its net operating loss carryforwards and certain other tax attributes may be limited.
As
of December 31, 2021 and 2020, DocGo had aggregate federal net operating loss carryforwards of approximately $56.6 million and $76.8 million,
respectively. As of December 31, 2021 and 2020, the Company had state net operating loss carryforwards of approximately $67.2 million
and $99.4 million, respectively. As of December 31, 2021 and 2020, DocGo had approximately $202,965 and $41,515, respectively, of
foreign net operating loss carryforwards. The federal net operating loss carryforwards generated after December 31, 2017, of approximately
$62.2 million carry forward indefinitely, while the remaining federal net carryforwards of approximately $11.7 million begin to expire
in 2037. State and foreign net operating loss carryforwards generated in the tax years from 2017 to 2020 will begin to expire, if
not utilized, by 2039. DocGo’s unused losses generally carry forward to offset future taxable income, if any, until such unused
losses expire. DocGo may be unable to use these losses to offset income before such unused losses expire. However, U.S. federal net
operating losses generated in 2019 and forward are not subject to expiration and, if not utilized by fiscal 2021, are only available to
offset 80% of taxable income each year due to changes in tax law attributable to the passage of Tax Cuts and Jobs Act. In addition, if
a corporation undergoes an “ownership change” — generally defined as a greater than 50% cumulative change
in the equity ownership of certain shareholders over a rolling three-year period — under Section 382 of the
Internal Revenue Code, DocGo’s ability to use its pre-change net operating loss carryforwards and other pre-change tax
attributes to offset future taxable income or taxes may be limited. Although the Merger did not constitute such an ownership change, DocGo
may experience ownership changes in the future as a result of changes in its stock ownership, some of which may not be within DocGo’s
control, which could materially reduce or eliminate DocGo’s ability to use these losses or tax attributes to offset future taxable
income or tax and have an adverse effect on its business, financial condition and results of operations.
Changes
in tax laws or unanticipated tax liabilities could adversely affect DocGo’s effective income tax rate and profitability.
DocGo
is subject to income taxes in the United States (federal and state) and various foreign jurisdictions. DocGo’s effective
income tax rate could be adversely affected in the future by a number of factors, including changes in the valuation of deferred
tax assets and liabilities, changes in tax laws and regulations or their interpretations and application, and the outcome of income
tax audits in various jurisdictions around the world. In particular, the Biden administration has proposed increases to the U.S. corporate
income tax rate from 21% to 28% and made other proposals. If any of these (or similar) proposals are ultimately enacted into law,
in whole or in part, they could have a negative impact on our effective tax rate. We cannot predict the likelihood, timing or
substance of U.S. tax proposals and will continue to monitor the progress of such proposals, as well as other global tax
reform initiatives.
Changes
in accounting rules, assumptions or judgments could materially and adversely affect DocGo.
Accounting
rules and interpretations for certain aspects of DocGo’s financial reporting are highly complex and involve significant assumptions
and judgment. These complexities could lead to a delay in the preparation and dissemination of DocGo’s financial statements. Furthermore,
changes in accounting rules and interpretations or in DocGo’s accounting assumptions or judgments, such as asset impairments and
contingencies, are likely to significantly impact its financial statements. In some cases, DocGo could be required to apply a new or revised
standard retroactively, resulting in restating financial statements from prior period(s). Any of these circumstances could have a material
adverse effect on DocGo’s business, financial condition and results of operations. For additional information, see the financial
statements of DocGo and related footnotes included elsewhere in this Annual Report on Form 10-K.
DocGo’s
internal control over financial reporting may not be effective and its independent registered public accounting firm may not be
able to certify as to their effectiveness, which could adversely affect DocGo’s business.
As
a public company, DocGo is required to comply with the SEC’s rules implementing Sections 302 and 404 of the Sarbanes-Oxley Act,
which require management to certify financial and other information in its quarterly and annual reports and provide an annual
management report on the effectiveness of internal control over financial reporting. DocGo is an emerging growth company and,
as such, its independent registered public accounting firm will not be required to formally attest to the effectiveness of its
internal control over financial reporting pursuant to Section 404 until the date DocGo is no longer an emerging growth company.
At such time, DocGo’s independent registered public accounting firm may issue a report that is adverse in the event that
it is not satisfied with the level at which DocGo’s controls are documented, designed or operating.
To
comply with the requirements of being a public company, DocGo may need to undertake various actions, such as implementing additional
internal controls and procedures and hiring additional accounting or internal audit staff. Testing and maintaining internal controls
can divert management’s attention from other matters that are important to the operation of DocGo’s business. If DocGo
identifies material weaknesses in its internal control over financial reporting or is unable to comply with the requirements of
Section 404 or assert that its internal control over financial reporting is effective, or if DocGo’s independent registered
public accounting firm is unable to express an opinion as to the effectiveness of its internal control over financial reporting
when such disclosure is required, investors may lose confidence in the accuracy and completeness of DocGo’s financial reports
and the market price of its common stock could be negatively affected, and DocGo could become subject to investigations by the
SEC or other regulatory authorities, any of which could have an adverse effect on DocGo’s business, financial condition
and results of operations.
We
identified material weaknesses in Motion’s internal control over financial reporting with respect to Motion’s previously
issued financial statements. These material weaknesses could continue to adversely affect our ability to report our results of
operations and financial condition accurately and in a timely manner.
Management
is responsible for establishing and maintaining adequate internal control over financial reporting designed to provide reasonable
assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in
accordance with GAAP. Management also evaluates the effectiveness of the Company’s internal controls and we will disclose
any changes and material weaknesses identified through such evaluation in those internal controls. A material weakness is a deficiency,
or a combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that
a material misstatement of our annual or interim financial statements will not be prevented or detected on a timely basis.
Prior
to the Closing, Motion identified a material weakness in Motion’s internal control over financial reporting related to the
classification of the Warrants as equity instead of liabilities. On May 10, 2021, the audit committee of Motion and management
concluded that Motion’s internal control over financial reporting was not effective as of December 31, 2020, and, accordingly,
the audit committee of Motion authorized management to restate Motion’s audited financial statements for the year ended
December 31, 2020, where Motion concluded that the control deficiency that resulted in the incorrect classification of Warrants
constituted a material weakness as of December 31, 2020, resulting in the filing of Amendment No. 1 to Motion’s Annual
Report on Form 10-K/A, filed with the SEC on May 28, 2021. This material weakness resulted in a material misstatement of
Warrant liabilities, change in fair value of Warrant liabilities, additional paid-in capital, accumulated deficit and related
financial disclosures as of and for the period from August 11 (inception) through December 31, 2020, as of September 30,
2020, for the three months ended September 30, 2020, and the period from August 11, 2020 (inception) through September 30,
2020.
Subsequent
to filing of Amendment No. 1 to Motion’s Annual Report on Form 10-K/A, based on SEC guidance, we identified a material weakness
in Motion’s internal control over financial reporting related to the Motion’s application of ASC 480-10-S99-3A to
its accounting classification of the Motion Class A Common Stock. On November 22, 2021, our audit committee and management
concluded that Motion’s internal control over financial reporting was not effective as of December 31, 2020, and, accordingly,
our audit committee authorized management to restate Motion’s audited financial statements for the year ended December 31,
2020, where we concluded that the control deficiency that resulted in the incorrect classification of Motion Class A Common Stock
constituted a material weakness as of December 31, 2020, resulting in the filing of Amendment No. 2 to Motion’s Annual
Report on Form 10-K/A, filed with the SEC on November 23, 2021. Historically, a portion of the Public Shares was classified
as permanent equity to maintain stockholders’ equity greater than $5 million on the basis that Motion would not redeem
its Motion Class A Common Stock in an amount that would cause its net tangible assets to be less than $5,000,001, as described
in the amended and restated certificate of incorporation of Motion. Pursuant to the Company’s re-evaluation of Motion’s
application of ASC 480-10-S99-3A to its accounting classification of the Motion Class A Common Stock, the Company’s
management has determined that the Motion Class A Common Stock include certain provisions that require classification of all of
the Motion Class A Common Stock as temporary equity regardless of the net tangible assets redemption limitation contained in the
amended and restated certificate of incorporation of Motion. For a discussion of management’s consideration of the material
weakness identified related to the Company’s application of ASC 480-10-S99-3A to its accounting classification of the
Public Share, see “Note 2” to Motion’s financial statements included in this prospectus.
We
have implemented a remediation plan to remediate these material weakness surrounding Motion’s historical presentation of
our Warrants and Motion Class A Common Stock but can give no assurance that the measures we have taken will prevent any future
material weaknesses or deficiencies in internal control over financial reporting. Even though we have strengthened controls and
procedures, in the future those controls and procedures may not be adequate to prevent or identify irregularities or errors or
to facilitate the fair presentation of our financial statements.
We
may face litigation and other risks as a result of the material weakness in Motion’s internal control over financial reporting.
As
a result of such material weakness, the restatements, the change in accounting for the Warrants, the change in the classification
of all of the Motion Class A Common Stock as temporary equity, and other matters raised or that may in the future be raised by
the SEC, we face potential for litigation or other disputes which may include, among others, claims invoking the federal and state
securities laws, contractual claims or other claims arising from the restatement and material weaknesses in our internal control
over financial reporting and the preparation of our financial statements. As of the date of this prospectus, we have no knowledge
of any such litigation or dispute. However, we can provide no assurance that such litigation or dispute will not arise in the
future. Any such litigation or dispute, whether successful or not, could have a material adverse effect on the Company’s
business, results of operations and financial condition.
Risks
Related to Healthcare Regulation
DocGo
conducts business in a heavily regulated industry and any failure to comply with these laws and government regulations could require
DocGo to make significant changes to its operations and could have a material adverse effect on its business, financial condition,
and results of operations.
The
U.S. healthcare industry is heavily regulated and closely scrutinized by federal and state governments. Comprehensive statutes
and regulations govern the manner in which DocGo provides and bills for its services and collects reimbursement from governmental
programs and private payors, its relationship with its providers, vendors and clients, its marketing activities and other aspects
of its operations. Of particular importance are:
| ● | the
federal False Claims Act that imposes civil and criminal liability on individuals or entities that knowingly submit false or fraudulent
claims for payment to the government or knowingly making, or causing to be made, a false statement in order to have a false claim paid,
including qui tam or whistleblower suits; |
| ● | the
federal Civil Monetary Penalties Law prohibits, among other things, the offering or transfer of remuneration to a Medicare or state healthcare
program beneficiary if the person knows or should know it is likely to influence the beneficiary’s selection of a particular provider,
practitioner or supplier of services reimbursable by Medicare or a state healthcare program, unless an exception applies; |
| ● | reassignment
of payment rules that prohibit certain types of billing and collection practices in connection with claims payable by the Medicare or
Medicaid programs; |
| ● | a
provision of the Social Security Act that imposes criminal penalties on healthcare providers who fail to disclose or refund known overpayments; |
| ● | federal
and state laws that prohibit providers from billing and receiving payment from Medicare and Medicaid 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; |
| ● | the
criminal healthcare fraud provisions of HIPAA that prohibit knowingly and willfully executing a scheme or artifice to defraud any healthcare
benefit program or falsifying, concealing or covering up a material fact or making any materially false, fictitious or fraudulent statement
in connection with the delivery of or payment for healthcare benefits, items or services. HIPAA also imposes certain regulatory and contractual
requirements regarding the privacy, security and transmission of PHI. Similar to the federal Anti-Kickback Statute, a person
or entity does not need to have actual knowledge of the statute or specific intent to violate it to have committed a violation; |
| ● | federal
and state laws and policies that require healthcare providers to maintain licensure, certification or accreditation to provide professional
healthcare services, to enroll and participate in the Medicare and Medicaid programs, to report certain changes in their operations to
the agencies that administer these programs, as well as state insurance laws; |
| ● | the
federal Anti-Kickback Statute that prohibits the knowing and willful offer, payment, solicitation or receipt of any bribe, kickback,
rebate or other remuneration for referring an individual, in return for ordering, leasing, purchasing or recommending or arranging for
or to induce the referral of an individual or the ordering, purchasing or leasing of items or services covered, in whole or in part,
by any federal healthcare program, such as Medicare and Medicaid. Remuneration has been interpreted broadly to be anything of value,
and could include compensation, discounts or free marketing services. A person or entity does not need to have actual knowledge of the
statute or specific intent to violate it to have committed a violation. In addition, the government may assert that a claim including
items or services resulting from a violation of the federal Anti-Kickback Statute constitutes a false or fraudulent claim for purposes
of the False Claims Act; |
| ● | similar
state law provisions pertaining to false claims, self-referral and anti-kickback issues, some of which may apply to items or
services reimbursed by any third-party payor, including commercial insurers or services paid out-of-pocket by patients; |
| ● | the
federal physician self-referral law under Section 1877 of the Social Security Act, commonly referred to as the Stark Law, that,
unless one of the statutory or regulatory exceptions applies, prohibits physicians from referring Medicare or Medicaid patients to an
entity for the provision of certain “designated health services” if the physician or a member of such physician’s immediate
family has a direct or indirect financial relationship (including an ownership interest or a compensation arrangement) with the entity,
and prohibits the entity from billing Medicare or Medicaid for such designated health services. Failure to refund amounts received as
a result of a prohibited referral on a timely basis may constitute a false or fraudulent claim and may result in civil penalties and
additional penalties under the federal False Claims Act noted below; |
| ● | state
laws that prohibit general business corporations, such as DocGo, from practicing medicine, controlling physicians’ medical decisions
or engaging in some practices such as splitting fees with physicians; |
| ● | the
Federal Trade Commission Act and federal and state consumer protection, advertisement and unfair competition laws, which broadly regulate
marketplace activities and activities that could potentially harm consumers; and |
| ● | laws
that regulate debt collection practices. |
DocGo’s
ability to provide its services internationally is subject to the similar laws and regulations in those jurisdictions and the
interpretation of these laws is evolving and varies significantly from country to county. As in the United States, many of
these laws and regulations are enforced by governmental, judicial and regulatory authorities with broad discretion. Although similar
to their U.S. counterparts in the subject matters addressed, these foreign laws may be very different in what is required
of the business and how they regulate the underlying activities. DocGo cannot be certain that its interpretation of such laws
and regulations are correct in how its structures its operations, its arrangements with its healthcare provider partners, services
agreements and customer arrangements.
Many
of these laws and regulations are complex, broad in scope and have few or narrowly structured exceptions and safe harbors. Often
DocGo is required to fit certain activities within one of the statutory exceptions and safe harbors available and it is possible
that some of DocGo’s current or future business activities could be subject to challenge under one or more of such laws.
Achieving and sustaining compliance with these laws can be time-consuming, requires the commitment of significant resources and
may prove costly. The risk of DocGo being found in violation of these laws and regulations is increased by the fact that many
of these laws and regulations have not been fully interpreted by the regulatory authorities or the courts, and their provisions
are sometimes open to a variety of interpretations. DocGo’s failure to accurately anticipate the application of these laws
and regulations to its current or future business or any other failure or alleged failure to comply with legal or regulatory requirements
could create liability for DocGo and negatively affect its business. Any action against DocGo for violation of these laws or regulations,
even if DocGo successfully defends against it, could cause DocGo to incur significant legal expenses, divert management’s
attention from the operation of the business and result in adverse publicity.
Enforcement
officials have a number of mechanisms to combat regulatory compliance, fraud and abuse, and if DocGo fails to comply with applicable
laws and regulations, it could suffer civil or criminal penalties, including fines, damages, recoupment of overpayments, loss
of licenses needed to operate, loss of enrollment status and approvals necessary to participate in Medicare, Medicaid and other
government and private third-party healthcare and payor programs, and exclusion from participation in Medicare, Medicaid
and other government healthcare programs. Investors, officers and managing employees associated with entities found to have committed
healthcare fraud may also be excluded from participation in government healthcare programs. In addition, because of the potential
for large monetary exposure, criminal liability and negative publicity, healthcare providers often resolve allegations without
admissions of liability for significant and material amounts to avoid the uncertainty of damages that may be awarded in litigation
proceedings. Such settlements often contain additional compliance and reporting requirements as part of a consent decree, settlement
agreement or corporate integrity agreement.
DocGo
believes that its business operations materially comply with applicable healthcare laws and regulations. However, some of the
healthcare laws and regulations applicable to DocGo are subject to limited or evolving interpretations, and a review of DocGo’s
business or operations by a court, law enforcement or a regulatory authority might result in a determination of non-compliance.
Any failure to comply with applicable legal and regulatory requirements and the consequences of such non-compliance, including
those discussed above, could have a material adverse effect on DocGo’s business, financial condition and results of operations.
DocGo
is required to comply with laws governing the transmission, security and privacy of health information.
Numerous
state and federal laws and regulations govern the collection, dissemination, use, privacy, confidentiality, security, availability,
integrity and other processing of PHI and PII, including HIPAA. HIPAA establishes a set of national privacy and security
standards for the protection of PHI by health plans, healthcare clearinghouses and certain healthcare providers, referred to as
“covered entities,” and the business associates with whom such covered entities contract for services. HIPAA requires
covered entities such as DocGo and their business associates to develop and maintain policies and procedures with respect to PHI
that is used or disclosed, including the adoption of administrative, physical and technical safeguards to protect this information.
HIPAA also implemented the use of standard transaction code sets and standard identifiers that covered entities must use when
submitting or receiving certain electronic healthcare transactions, including activities associated with the billing and collection
of healthcare claims.
HIPAA
also authorizes state attorneys general to file suit on behalf of their residents. Courts may award damages, costs and attorneys’
fees related to violations of HIPAA in these cases. While HIPAA does not create a private right of action allowing individuals
to sue DocGo in civil court for violations of HIPAA, its standards have been used as the basis for duty of care in state civil
suits such as those for negligence or recklessness in the misuse or breach of PHI. In addition, HIPAA mandates that the Secretary
of HHS conduct periodic compliance audits of covered entities and business associates for compliance with the HIPAA privacy and
security requirements. HIPAA also tasks HHS with establishing a methodology whereby harmed individuals who were the victims of
breaches of unsecured PHI may receive a percentage of the fine paid by the violator under the Civil Monetary Penalties Law.
HIPAA
further requires that patients be notified of any unauthorized acquisition, access, use or disclosure of their unsecured PHI that
compromises the privacy or security of such information, with certain exceptions related to unintentional or inadvertent use or
disclosure by employees or authorized individuals. HIPAA specifies that such notifications must be made “without unreasonable
delay and in no case later than 60 calendar days after discovery of the breach.” If a breach affects 500 patients or
more, it must be reported to HHS without unreasonable delay, and HHS will post the name of the breaching entity on its public
web site. Breaches affecting 500 patients or more in the same state or jurisdiction must also be reported to the local media.
If a breach involves fewer than 500 people, the covered entity must record it in a log and notify HHS at least annually.
In
addition to HIPAA, numerous other federal and state laws and regulations protect the confidentiality, privacy, availability, integrity
and security of PHI and other types of PII. State statutes and regulations vary from state to state, and these laws and regulations
in many cases are more restrictive than, and may not be preempted by, HIPAA and its implementing rules. These laws and regulations
are often uncertain, contradictory and subject to changed or differing interpretations, and DocGo expects new laws, rules and
regulations regarding privacy, data protection and information security to be proposed and enacted in the future. In the event
that new data security laws are implemented, DocGo may not be able to timely comply with such requirements, or such requirements
may not be compatible with its current processes. Changing DocGo’s processes could be time-consuming and expensive,
and failure to timely implement required changes could subject DocGo to liability for non-compliance. Some states may afford private
rights of action to individuals who believe their PII has been misused. This complex, dynamic legal landscape regarding privacy,
data protection and information security creates significant compliance issues for DocGo and potentially restricts its ability
to collect, use and disclose data and can expose it to additional expense, adverse publicity and liability.
There
is ongoing concern from privacy advocates, regulators and others regarding data protection and privacy issues, and the number
of jurisdictions with data protection and privacy laws has been increasing. In addition, the scope of protection afforded to data
subjects by many of these data protection and privacy laws has been increasing. There are also ongoing public policy discussions
regarding whether the standards for deidentified, anonymous or pseudonymized health information are sufficient, and the risk of
re-identification sufficiently small, to adequately protect patient privacy. These trends may lead to further restrictions
on the use of this and similar categories of information. These initiatives or future initiatives could compromise DocGo’s
ability to access and use data or to develop or market current or future services.
While
DocGo has implemented data privacy and security measures in an effort to comply with applicable laws and regulations relating
to privacy and data protection, some PHI and other PII or confidential information is transmitted to DocGo by third parties, who
may not implement adequate security and privacy measures, and it is possible that laws, rules and regulations relating to privacy,
data protection or information security may be interpreted and applied in a manner that is inconsistent with DocGo’s practices
or those of third parties who transmit PHI and other PII or confidential information to it. Additionally, as a business associate
under HIPAA, DocGo may also be liable for privacy and security breaches of PHI and certain similar failures of DocGo’s subcontractors.
Even though DocGo contractually requires its subcontractors to safeguard protected health information as required by law, DocGo
still has limited control over their actions and practices. If DocGo or these third parties are found to have violated such laws,
rules or regulations, it could result in government-imposed fines, orders requiring that DocGo or these third parties change
its or their practices, or criminal charges, which could adversely affect DocGo’s business. Complying with these various
laws and regulations could cause DocGo to incur substantial costs or require it to change its business practices, systems and
compliance procedures in a manner adverse to its business.
DocGo
publishes statements to its patients and partners that describe how it handles and protects PHI. If federal or state regulatory
authorities or private litigants consider any portion of these statements to be untrue, DocGo may be subject to claims of deceptive
practices, which could lead to significant liabilities and consequences, including, without limitation, costs of responding to
investigations, defending against litigation, settling claims and complying with regulatory or court orders.
DocGo
also sends short message service, or SMS, text messages to potential end users who are eligible to use its service through certain
customers and partners. While DocGo obtains consent from or on behalf of these individuals to send text messages, federal or state
regulatory authorities or private litigants may claim that the notices and disclosures DocGo provides, form of consents it obtains
or its SMS texting practices, are not adequate. These SMS texting campaigns are potential sources of risk for class action
lawsuits and liability for DocGo. Numerous class action suits under federal and state laws have been filed in the past year against
companies who conduct SMS texting programs, with many resulting in multimillion-dollar settlements to the plaintiffs. Any
future such litigation against DocGo could be costly and time-consuming to defend.
Any
failure to comply with HIPAA or similar laws and regulations and the consequences of such non-compliance could have a material
adverse impact on DocGo’s business, financial condition and results of operations.
If
DocGo does not effectively adapt to changes in the healthcare industry, including changes to laws and regulations regarding telehealth,
DocGo’s business may be harmed.
The
unpredictability of the healthcare regulatory landscape means that sudden changes in laws, rules, regulations and policy are possible.
Federal, state and local legislative bodies frequently pass legislation and promulgate regulations that affect the healthcare
industry. As has been the trend in the past decade with healthcare reform, it is reasonable to assume that there will continue
to be increased government oversight and regulation of the healthcare industry in the future, particularly in times of changing
political, regulatory and other influences. DocGo cannot provide any assurances regarding the ultimate content, timing or effect
of any new healthcare legislation or regulations, nor is it possible at this time to estimate the impact of potential new legislation
or regulations on its business. It is possible that future legislation enacted by Congress or state legislatures, or regulations
promulgated by regulatory authorities at the federal or state level, could adversely affect DocGo’s current or future business.
The extent to which a jurisdiction considers particular actions or relationships to comply with the applicable legal requirements
is also subject to evolving interpretations by medical boards and state attorneys general, among others, each with broad discretion.
It is possible that the changes to the Medicare, Medicaid or other governmental healthcare program reimbursements may serve as
precedent to possible changes in other payors’ reimbursement policies in a manner adverse to DocGo. Similarly, changes in
private payor reimbursements could lead to adverse changes in Medicare, Medicaid and other governmental healthcare programs.
As
one example, the telehealth industry is still relatively young and DocGo’s ability to provide its telehealth solutions is
directly dependent upon the development and interpretation of the laws governing remote healthcare, the practice of medicine and
healthcare delivery in the applicable jurisdictions and more broadly. A few states have imposed different, and, in some cases,
additional, standards regarding the provision of services via telehealth. State medical boards have also established new rules
or interpreted existing rules in their respective states in a manner that has limited the way telehealth services can be provided.
Although the COVID-19 pandemic has led to the relaxation of certain Medicare, Medicaid and state licensure restrictions on
the delivery of telehealth services, it is uncertain how long the relaxed policies will remain in effect, and there can be no
guarantee that once the COVID-19 pandemic subsides or ends that such restrictions will not be reinstated or changed in a
way that adversely affects DocGo’s current or future telehealth offerings.
Accordingly,
DocGo must monitor its compliance with law in every jurisdiction in which it operates, on an ongoing basis. While DocGo believes
that it has structured its contracts and operations in material compliance with applicable healthcare laws and regulations, the
healthcare laws and regulations applicable to DocGo may be amended or interpreted in new or different ways that are adverse to
DocGo and new laws and regulations adverse to DocGo’s current or future business may be adopted in the future. There can
be no assurance that DocGo will be able to successfully address changes in the current regulatory environment or new laws and
regulations that may be implemented in the future, or that practices which are compliant now will continue to be so in the future.
Any failure to comply with any changes to or new developments in the healthcare regulatory environment could have a material adverse
effect on DocGo’s business, financial condition and results of operations.
DocGo
must be properly enrolled in governmental healthcare programs before it can receive reimbursement for services, and there may
be delays in the enrollment process.
Each
time DocGo expands into a new market, whether organically or by way of acquisition, DocGo must enroll the new operations under
DocGo’s applicable group identification number for Medicare and Medicaid programs and for certain managed care and private
insurance programs before DocGo can receive reimbursement for services rendered to beneficiaries of those programs. The estimated
time to receive approval for the enrollment is sometimes difficult to predict.
With
respect to Medicare, providers can retrospectively bill Medicare for services provided 30 days prior to the effective date
of the enrollment. In addition, the enrollment rules provide that the effective date of the enrollment will be the later of the
date on which the enrollment application was filed and approved by the Medicare contractor, or the date on which the provider
began providing services. If DocGo is unable to complete the enrollment process within the 30 days after the commencement
of services, DocGo will be precluded from billing Medicare for any services which were provided to a Medicare beneficiary more
than 30 days prior to the effective date of the enrollment. With respect to Medicaid, new enrollment rules and whether a
state will allow providers to retrospectively bill Medicaid for services provided prior to submitting an enrollment application
varies by state. Failure to timely enroll could reduce DocGo’s total revenues and have a material adverse effect on the
business, financial condition or results of operations.
The
Affordable Care Act, as currently structured, added additional enrollment requirements for Medicare and Medicaid, which have been
further enhanced through implementing regulations and increased enforcement scrutiny. Every enrolled provider must revalidate
its enrollment at regular intervals and must update the Medicare contractors and many state Medicaid programs with significant
changes on a timely basis. If DocGo fails to provide sufficient documentation as required to maintain its enrollment, Medicare
and Medicaid could deny continued future enrollment or revoke DocGo’s enrollment and billing privileges.
The
requirements for enrollment, licensure, certification and accreditation may include notification or approval in the event of a
transfer or change of ownership or certain other changes. Other agencies or payors with which DocGo has contracts may have similar
requirements, and some of these processes may be complex. Failure to provide required notifications or obtain necessary approvals
may result in the delay or inability to complete an acquisition or transfer, loss of licensure, lapses in reimbursement or other
penalties. While DocGo makes reasonable efforts to substantially comply with these requirements, it cannot assure you that the
agencies that administer these programs or have awarded DocGo contracts will not find that DocGo has failed to comply in some
material respects. A finding of non-compliance and any resulting payment delays, refund demands or other sanctions could
have a material adverse effect on DocGo’s business, financial condition or results of operations.
Reductions
in Medicare reimbursement rates or changes in the rules governing the Medicare program could have a material adverse effect on
DocGo.
DocGo
generates a significant amount of revenues from Medicare, either directly or through Medicare Advantage (“MA”) plans,
particularly in its healthcare transportation segment. Medicare revenues represent approximately 22.4% and 6.4% of DocGo’s
revenues for the years ended December 31, 2020 and 2021, respectively. In addition, many private payors base their reimbursement
rates on the published Medicare rates or are themselves reimbursed by Medicare for the services DocGo provides. As a result, DocGo’s
results of operations are, in part, dependent on government funding levels for Medicare programs and any changes that limit or
reduce MA or general Medicare reimbursement levels, such as reductions in or limitations of reimbursement amounts or rates under
programs, reductions in funding of programs, expansion of benefits without adequate funding or elimination of coverage for certain
benefits or for certain individuals, could have a material adverse effect on DocGo’s business, financial condition and results
of operations.
The
Medicare program and its reimbursement rates and rules are subject to frequent change. These include statutory and regulatory
changes, rate adjustments (including retroactive adjustments), administrative or executive orders and government funding restrictions,
all of which may materially adversely affect the rates at which Medicare reimburses DocGo for its services. Budget pressures often
cause the federal government to reduce or place limits on reimbursement rates under Medicare. Implementation of these and other
types of measures could result in substantial reductions in DocGo’s revenues and operating margins. For example, due to
the federal sequestration, an automatic 2% reduction in Medicare spending took effect beginning in April 2013. The CARES
Act, which was signed into law on March 27, 2020, designed to provide financial support and resources to individuals and
businesses affected by the COVID-19 pandemic, temporarily suspended these reductions from May 1, 2020 through March 31,
2021, and extended the sequester by one year, through 2030.
Each
year, the Centers for Medicare and Medicaid Services (“CMS”) issues a final rule to establish the MA benchmark payment
rates for the following calendar year. Reductions to MA rates impacting DocGo may be greater than the industry average rate and
the final impact of the MA rates can vary from any estimate DocGo may have. In addition, CMS may change the rules governing the
Medicare program, including those governing reimbursement. Reductions in reimbursement rates or the scope of services being reimbursed
could have a material adverse effect on DocGo’s business, financial condition and results of operations.
State
and federal efforts to reduce Medicaid spending could adversely affect DocGo.
Certain
of DocGo’s customers who are individuals are dual-eligible, meaning their coverage comes from both Medicare and Medicaid.
As a result, a small portion of DocGo’s revenue comes from Medicaid, accounting for approximately 4.8% and 1.4% of revenue
for the years ended December 31, 2020 and 2021, respectively. Medicaid is a joint federal-state program purchasing
healthcare services for the low income and indigent as well as certain higher income individuals with significant health needs.
Under broad federal criteria, states establish rules for eligibility, services and payment. Medicaid is a state-administered program
financed by both state funds and matching federal funds. Medicaid spending has increased rapidly in recent years, becoming
a significant component of state budgets. This, combined with slower state revenue growth, has led both the federal government
and many states to institute measures aimed at controlling the growth of Medicaid spending, and in some instances reducing aggregate
Medicaid spending.
For
example, a number of states have adopted or are considering legislation designed to reduce their Medicaid expenditures, such as
financial arrangements commonly referred to as provider taxes. Under provider tax arrangements, states collect taxes from healthcare
providers and then use the revenue to pay the providers as a Medicaid expenditure, which allows the states to then claim additional
federal matching funds on the additional reimbursements. Current federal law provides for a cap on the maximum allowable provider
tax as a percentage of the provider’s total revenue. There can be no assurance that federal law will continue to provide
matching federal funds on state Medicaid expenditures funded through provider taxes, or that the current caps on provider taxes
will not be reduced. Any discontinuance or reduction in federal matching of provider tax-related Medicaid expenditures could
have a significant and adverse effect on states’ Medicaid expenditures, and as a result could have an adverse effect on
DocGo’s business, financial condition and results of operations.
Also,
as part of the movement to repeal, replace or modify the Health Care Reform Law and as a means to reduce the federal budget deficit,
there are renewed congressional efforts to move Medicaid from an open-ended program with coverage and benefits set by the
federal government to one in which states receive a fixed amount of federal funds, either through block grants or per capita caps,
and have more flexibility to determine benefits, eligibility or provider payments. If those changes are implemented, DocGo cannot
predict whether the amount of fixed federal funding to the states will be based on current payment amounts, or if it will be based
on lower payment amounts, which would negatively impact those states that expanded their Medicaid programs in response to the
Health Care Reform Law.
DocGo
expects these state and federal efforts to continue for the foreseeable future. The Medicaid program and its reimbursement rates
and rules are subject to frequent change at both the federal and state level. These include statutory and regulatory changes,
rate adjustments (including retroactive adjustments), administrative or executive orders and government funding restrictions,
all of which may materially adversely affect the rates at which DocGo’s services are reimbursed by state Medicaid plans.
DocGo
has been and could become the subject of federal and state investigations and compliance reviews.
Companies
in the broader healthcare industry are subject to a high level of scrutiny by various governmental agencies and their agents.
Both federal and state government agencies have heightened and coordinated civil and criminal enforcement efforts as part of numerous
ongoing investigations of healthcare companies, as well as their executives and managers. These investigations relate to a wide
variety of topics, including referral and billing practices. For example, to enforce compliance with the federal laws, DOJ and
the OIG have established national enforcement initiatives that focus on specific billing practices or other suspected areas of
abuse. Given the significant size of actual and potential settlements, it is expected that the government will continue to devote
substantial resources to investigating healthcare providers’ compliance, including compliance with the healthcare reimbursement
rules and fraud and abuse laws. DocGo is also required to conduct periodic internal audits in connection with its third-party relationships
and receives repayment demands from third-party payors based on allegations that its services were not medically necessary,
were billed at an improper level or otherwise violated applicable billing requirements that require investigation. Further, DocGo
periodically conducts internal reviews of its regulatory compliance. Although to date none historically have, an investigation
or audit of DocGo, its executives or its managers, whether by the government and its agents, a third-party or DocGo itself,
could result in significant expense to the company, adverse publicity and divert management’s attention from DocGo’s
business, regardless of the outcome, and could result in significant fines, penalties and other sanctions, any of which could
have a material adverse effect on DocGo’s business, financial condition and results of operations.
DocGo’s
business practices may be found to constitute illegal fee-splitting or corporate practice of medicine, which may lead to penalties
and could adversely affect DocGo’s business.
Many
states have laws that prohibit business corporations such as DocGo from practicing medicine, employing physicians, exercising
control over medical judgments or decisions of physicians or other health care professionals (such as EMTs and nurses), or engaging
in certain business arrangements such as fee-splitting, with each of the foregoing activities collectively referred to as the
“corporate practice of medicine.” In some states these prohibitions are expressly stated in a statute or regulation,
while in other states the prohibition is a matter of judicial or regulatory interpretation. Many of the states in which DocGo
currently operates generally prohibit the corporate practice of medicine, and other states may as well, including those into which
DocGo may expand in the future.
The
state laws and regulations and administrative and judicial decisions that enumerate the specific corporate practice of medicine
rules vary considerably from state to state and have been subject to limited judicial or regulatory interpretations. These laws
and regulations are enforced by both the courts and government agencies, each with broad discretion. Courts, government agencies
or other parties, including physicians, may assert that DocGo is engaged in the unlawful corporate practice of medicine. While
penalties for violations of the corporate practice of medicine vary from state to state, as a result of such allegations, DocGo
could be subject to civil and criminal penalties, its contracts could be found legally invalid and unenforceable, in whole or
in part, or DocGo could be required to restructure its contractual arrangements entirely. If found to be engaged in the corporate
practice of medicine, DocGo may not be able to restructure its operations or its contractual arrangements on favorable terms or
at all. Any failure to comply with these laws and regulations regarding the corporate practice of medicine and the consequences
of such non-compliance could have a material adverse impact on DocGo’s business, financial condition and results of
operations.
DocGo
believes its business is structured to comply with the applicable regulations governing fee-splitting and the corporate practice
of medicine in the states where it generates revenue; however, in many cases and as noted above, these laws and regulations applicable
to DocGo are subject to limited or evolving interpretations, and there can be no assurances that a review of DocGo’s business
or operations by a court, law enforcement or a regulatory authority might result in a determination of non-compliance.
Additional
Risks Relating to Ownership of Common Stock and Warrants
Nasdaq
may delist DocGo’s securities from trading on its exchange, which could limit investors’ ability to make transactions
in its securities and subject DocGo to additional trading restrictions.
Common
Stock and Public Warrants are listed on Nasdaq under the symbols “DCGO” and “DCGOW,” respectively. DocGo
will be required to meet continued listing requirements for its securities to continue to be listed on Nasdaq, including having
a minimum number of public securities holders and a minimum stock price. We cannot assure you that DocGo will continue to meet
those listing requirements in the future.
If
Nasdaq delists DocGo’s securities from trading on its exchange and DocGo is not able to list its securities on another national
securities exchange, we expect our securities could be quoted on an over-the-counter market. If this were to occur, we could
face significant material adverse consequences, including:
| ● | a
limited availability of market quotations for our securities; |
| ● | reduced
liquidity for our securities; |
| ● | a
determination that the Common Stock is a “penny stock” which will require brokers trading in Common Stock to adhere to more
stringent rules and possibly result in a reduced level of trading activity in the secondary trading market for our securities; |
| ● | a
limited amount of news and analyst coverage; and |
| ● | a
decreased ability to issue additional securities or obtain additional financing in the future. |
The
National Securities Markets Improvement Act of 1996, which is a federal statute, prevents or preempts the states from
regulating the sale of certain securities, which are referred to as “covered securities.” Since Common Stock and Public
Warrants are listed on Nasdaq, they are covered securities. Although the states are preempted from regulating the sale of covered
securities, the federal statute does allow the states to investigate companies if there is a suspicion of fraud, and if there
is a finding of fraudulent activity, the states can regulate or bar the sale of covered securities in a particular case. While
DocGo is not aware of a state having used these powers to prohibit or restrict the sale of securities issued by blank check companies,
other than the State of Idaho, certain state securities regulators view blank check companies unfavorably and might use these
powers, or threaten to use these powers, to hinder the sale of securities of blank check companies in their states. Further, if
DocGo was no longer listed on Nasdaq, its securities would not be covered securities and it would be subject to regulation in
each state in which it offers its securities.
An
active, liquid trading market for our securities may not develop, which may limit your ability to sell your securities.
An
active trading market for our securities may never develop or be sustained. A public trading market having the desirable characteristics
of depth, liquidity and orderliness depends upon the existence of willing buyers and sellers at any given time, such existence
being dependent upon the individual decisions of buyers and sellers over which neither we nor any market maker has control. The
failure of an active and liquid trading market to develop and continue would likely have a material adverse effect on the value
of our Common Stock and Warrants. An inactive market may also impair our ability to raise capital to continue to fund operations
by issuing securities and may impair our ability to acquire other companies or technologies by using our securities as consideration.
Because
there are no current plans to pay cash dividends on Common Stock for the foreseeable future, you may not receive any return on
investment unless you sell your Common Stock for a price greater than that which you paid for it.
DocGo
intends to retain future earnings, if any, for future operations, expansion and debt repayment and there are no current plans to pay any
cash dividends for the foreseeable future. The declaration, amount and payment of any future dividends on shares of Common Stock will
be at the sole discretion of DocGo’s board of directors. DocGo’s board of directors may take into account general and economic
conditions, DocGo’s financial condition and results of operations, DocGo’s available cash and current and anticipated cash
needs, capital requirements, contractual, legal, tax, and regulatory restrictions, implications on the payment of dividends by DocGo to
its stockholders or by its subsidiaries to it and such other factors as DocGo’s board of directors may deem relevant. In addition,
DocGo’s ability to pay dividends is limited by covenants of DocGo’s existing and outstanding indebtedness and may be limited
by covenants of any future indebtedness DocGo incurs. As a result, you may not receive any return on an investment in Common Stock unless
you sell Common Stock for a price greater than that which you paid for it.
If
securities analysts do not publish research or reports about DocGo’s business or if they downgrade the Common Stock or DocGo’s
sector, DocGo’s stock price and trading volume could decline.
The
trading market for Common Stock will rely in part on the research and reports that industry or financial analysts publish about
DocGo or its business. DocGo will not control these analysts. In addition, some financial analysts may have limited expertise
with DocGo’s model and operations. Furthermore, if one or more of the analysts who do cover DocGo downgrade its stock or
industry, or the stock of any of its competitors, or publish inaccurate or unfavorable research about its business, the price
of Common Stock could decline. If one or more of these analysts cease coverage of DocGo or fail to publish reports on it regularly,
DocGo could lose visibility in the market, which in turn could cause its stock price or trading volume to decline.
Future
sales, or the perception of future sales, by DocGo or its stockholders in the public market could cause the market price for Common
Stock to decline.
The
sale of shares of Common Stock in the public market, or the perception that such sales could occur, could harm the prevailing
market price of shares of Common Stock. These sales, or the possibility that these sales may occur, also might make it more difficult
for DocGo to sell equity securities in the future at a time and at a price that it deems appropriate.
Certain
holders of our Common Stock and Warrants have entered into the lock-up and escrow agreements in connection with the Business
Combination. The counterparties to these agreements may, in certain instances, without notice, release all or any portion of the
securities subject to these lock-up and escrow agreements. See the section entitled “Securities Eligible for Future
Sale” for a description of these lock-up and escrow agreements. Upon the expiration or waiver of the lock-ups and
escrows described above, shares held by the Sponsor and certain other stockholders of DocGo will be eligible for resale, subject
to volume, manner of sale and other limitations under Rule 144, when such rule becomes applicable to DocGo. In addition,
pursuant to the A&R Registration Rights Agreement, the New Holders, Sponsor, and certain other stockholders have the right,
subject to certain conditions, to require DocGo to register the sale of their shares of Common Stock under the Securities Act.
By exercising their registration rights and selling a large number of shares, these stockholders could cause the prevailing market
price of Common Stock to decline. The shares covered by the A&R Registration Rights Agreement represent approximately 15.7%
of outstanding Common Stock.
As
restrictions on resale end or if these stockholders exercise their registration rights, the market price of shares of Common Stock
could drop significantly if the holders of these shares sell them or are perceived by the market as intending to sell them. These
factors could also make it more difficult for DocGo to raise additional funds through future offerings of DocGo’s shares
of Common Stock or other securities.
DocGo
currently has an aggregate of 6,366,638 Warrants outstanding, which became exercisable on December 5, 2021, provided that there is an
effective registration statement under the Securities Act covering the shares of Common Stock issuable upon exercise of the Warrants and
a current prospectus relating to them is available. DocGo has agreed to use reasonable best efforts to file such registration statement
within 15 business days and have it declared effective within 60 business days after the consummation of the Transactions. The
issuance of shares of Common Stock upon the exercise of Warrants could result in dilution to DocGo’s stockholders.
In addition, the shares of Common Stock reserved for future issuance
under DocGo’s equity incentive plans will become eligible for sale in the public market once those shares are issued, subject to
provisions relating to various vesting agreements, lock-up agreements and, in some cases, limitations on volume and manner of sale
applicable to affiliates under Rule 144, as applicable. The number of shares of Common Stock reserved for future issuance under its
equity incentive plans, including Substitute Options, represents approximately 24.5% of outstanding Common Stock. The compensation committee
of DocGo’s board of directors may determine the exact number of shares to be reserved for future issuance under its equity incentive
plans at its discretion. DocGo has filed a Form S-8 under the Securities Act to register shares of Common Stock and securities
convertible into or exchangeable for shares of Common Stock issued pursuant to DocGo’s equity incentive plan, and may file additional
registration statements on Form S-8 in the future. Any such Form S-8 registration statements will automatically become effective
upon filing. Accordingly, shares registered under such registration statements will be available for sale in the open market.
In
the future, DocGo may also issue its securities in connection with investments or acquisitions. The amount of shares of Common
Stock issued in connection with an investment or acquisition could constitute a material portion of DocGo’s then-outstanding shares
of Common Stock. Any issuance of additional securities in connection with investments or acquisitions may result in additional
dilution to DocGo’s stockholders.
Anti-takeover
provisions in DocGo’s organizational documents could delay or prevent a change of control.
Certain
provisions of the Charter and the Bylaws may have an anti-takeover effect and may delay, defer or prevent a merger, acquisition,
tender offer, takeover attempt or other change of control transaction that a stockholder might consider in its best interest,
including those attempts that might result in a premium over the market price for the shares held by DocGo’s stockholders.
These
provisions provide for, among other things:
| ● | the
ability of DocGo’s board of directors to issue one or more series of preferred stock; |
| ● | advance
notice for nominations of directors by stockholders and for stockholders to include matters to be considered at DocGo’s annual
meetings; |
| ● | certain
limitations on convening special stockholder meetings; |
| ● | limiting
the ability of stockholders to act by written consent; and |
| ● | DocGo’s
board of directors to have the express authority to make, alter or repeal the Bylaws. |
These
anti-takeover provisions could make it more difficult for a third party to acquire DocGo, even if the third party’s
offer may be considered beneficial by many of DocGo’s stockholders. As a result, DocGo’s stockholders may be limited
in their ability to obtain a premium for their shares. These provisions could also discourage proxy contests and make it more
difficult for you and other stockholders to elect directors of your choosing and to cause DocGo to take other corporate actions
you desire. See “Description of Securities.”
The
Charter designates the Court of Chancery of the State of Delaware as the sole and exclusive forum for certain types of actions
and proceedings that may be initiated by stockholders, which could limit stockholders’ ability to obtain a favorable judicial
forum for disputes with DocGo or its directors, officers, employees or stockholders.
The
Charter provides that, unless DocGo, in writing, selects or consents to the selection of an alternative forum: (a) the sole and exclusive
forum for any complaint asserting any internal corporate claims (as defined below), to the fullest extent permitted by law, and subject
to applicable jurisdictional requirements, is the Court of Chancery of the State of Delaware (or, if the Court of Chancery does not have,
or declines to accept, jurisdiction, another state court or a federal court located within the State of Delaware) and (b) the sole
and exclusive forum for any complaint asserting a cause of action arising under the Securities Act, to the fullest extent permitted by
law, shall be the federal district courts of the United States of America; provided however, these provisions will not apply to suits
brought to enforce a duty or liability created by the Exchange Act. For purposes of this provision, internal corporate claims mean
claims, including claims in the right of the Corporation that are based upon a violation of a duty by a current or former director, officer,
employee or stockholder in such capacity, or as to which the DGCL confers jurisdiction upon the Court of Chancery. Any person or entity
purchasing or otherwise acquiring or holding any interest in shares of stock of the Corporation shall be deemed to have notice of and
consented to the provisions of this Article.
As
a result, (1) derivative action or proceeding brought on behalf of DocGo, (2) action asserting a claim of breach of
a fiduciary duty owed by any director, officer, stockholder or employee to DocGo or its stockholders, (3) action asserting
a claim arising pursuant to any provision of the DGCL or the Charter or the Bylaws, or (4) action asserting a claim governed
by the internal affairs doctrine shall, to the fullest extent permitted by law, be exclusively brought in the Court of Chancery
of the State of Delaware (or, if the Court of Chancery does not have, or declines to accept, jurisdiction, another state court
or a federal court located within the State of Delaware). Any person or entity purchasing or otherwise acquiring any interest
in shares of DocGo’s capital stock shall be deemed to have notice of and to have consented to the provisions of the Charter
described above. This choice of forum provision may limit a stockholder’s ability to bring a claim in a judicial forum that
it finds favorable for disputes with DocGo or its directors, officers or other employees, which may discourage such lawsuits against
DocGo and its directors, officers and employees. Alternatively, if a court were to find these provisions of the Charter inapplicable
to, or unenforceable in respect of, one or more of the specified types of actions or proceedings, DocGo may incur additional costs
associated with resolving such matters in other jurisdictions, which could adversely affect DocGo’s business and financial
condition.
The
Charter provides that the exclusive forum provision is applicable to the fullest extent permitted by applicable law, subject to
certain exceptions. Section 27 of the Exchange Act creates exclusive federal jurisdiction over all suits brought to
enforce any duty or liability created by the Exchange Act or the rules and regulations thereunder. As a result, the exclusive
forum provision does not apply to suits brought to enforce any duty or liability created by the Exchange Act or any other
claim for which the federal courts have exclusive jurisdiction.
Certain
of stockholders, including the Sponsor, may engage in business activities which compete with DocGo or otherwise conflict with
DocGo’s interests.
The
Sponsor and its affiliates are in the business of making investments in companies and may from time to time acquire and hold interests
in businesses that compete directly or indirectly with DocGo. The Charter provides that none of the Sponsor, any of its affiliates
or any director who is not employed by DocGo (including any non-employee director who serves as one of DocGo’s officers
in both his director and officer capacities) or his or her affiliates will have any duty to refrain from engaging, directly or
indirectly, in the same business activities or similar business activities or lines of business in which DocGo operates. The Sponsor
also may pursue acquisition opportunities that may be complementary to DocGo’s business and, as a result, those acquisition
opportunities may not be available to DocGo.
DocGo
may redeem your unexpired Warrants prior to their exercise at a time that is disadvantageous to you, thereby making your Warrants
worthless.
DocGo
has the ability to redeem outstanding Warrants at any time after they become exercisable and prior to their expiration, at a price
of $0.01 per Warrant, provided that the last reported sales price of Common Stock equals or exceeds $18.00 per share (as adjusted
for stock splits, stock dividends, reorganizations, recapitalizations and the like) on the trading day prior to the date
on which we send the notice of redemption to the Warrant holders. If and when the Warrants become redeemable by DocGo, DocGo may
not exercise its redemption right if the issuance of shares of Common Stock upon exercise of the Warrants is not exempt from registration
or qualification under applicable state blue sky laws or it is unable to effect such registration or qualification. DocGo will
use its best efforts to register or qualify such shares of Common Stock under the blue sky laws of the state of residence in those
states in which the Warrants were offered. Redemption of the outstanding Warrants could force you (i) to exercise your Warrants
and pay the exercise price therefor at a time when it may be disadvantageous for you to do so, (ii) to sell your Warrants
at the then-current market price when you might otherwise wish to hold your Warrants or (iii) to accept the nominal
redemption price which, at the time the outstanding Warrants are called for redemption, is likely to be substantially less than
the market value of your Warrants. None of the Private Warrants will be redeemable by DocGo so long as they are held by the Sponsor,
or its permitted transferees.
Warrants are exercisable
for Common Stock, which would increase the number of shares eligible for future resale in the public market and result in dilution to
our stockholders.
DocGo
currently has an aggregate of 6,366,638 Warrants outstanding, representing the right to purchase an equivalent amount shares of Common
Stock. The Warrants became exercisable on December 5, 2021. The exercise price of the Warrants is $11.50 per share. To the extent such
Warrants are exercised, additional shares of Common Stock will be issued, which would result in dilution to our stockholders and increase
the number of shares eligible for resale in the public market. Sales of substantial numbers of such shares in the public market or the
fact that such Warrants may be exercised could adversely affect the market price of our Common Stock. However, there is no guarantee that
the Warrants will ever be in the money prior to their expiration, and as such, the Warrants may expire worthless.
The
Warrants may never be in the money, and they may expire worthless and the terms of the Warrants may be amended in a manner adverse
to a holder if holders of at least 50% of the then-outstanding Warrants approve of such amendment.
The
Warrant Agreement provides that the terms of the Warrants may be amended without the consent of any holder to cure any ambiguity
or correct any defective provision, but requires the approval by the holders of at least 50% of the then-outstanding Warrants
to make any change that adversely affects the interests of the registered holders of the Warrants. Accordingly, we may amend the
terms of the Warrants in a manner adverse to a holder if holders of at least 50% of the then-outstanding Public Warrants
approve such amendment. Although our ability to amend the terms of the Warrants with the consent of at least 50% of the then-outstanding Public
Warrants is unlimited, examples of such amendments could be amendments to, among other things, increase the exercise price of
the Warrants, shorten the exercise period or decrease the number of Common Stock purchasable upon exercise of a Warrant.
The
market price and trading volume of Common Stock and Warrants may be volatile.
Stock
markets, including Nasdaq, have from time-to-time experienced significant price and volume fluctuations. Even if an active, liquid and
orderly trading market develops and is sustained for Common Stock and Warrants, the market price of Common Stock and Warrants may be volatile
and could decline significantly, whether or not any price changes are related to matters specific to DocGo. In addition, the trading volume
in Common Stock and Warrants may fluctuate and cause significant price variations to occur. If the market price of Common Stock and Warrants
declines significantly, you may be unable to resell your shares of Common Stock and Warrants at or above the market price of Common Stock
and Warrants. We cannot assure you that the market price of Common Stock and Warrants will not fluctuate widely or decline significantly
in the future in response to a number of factors, including, among others, the following:
| ● | the
realization of any of the risk factors presented in this prospectus; |
| ● | actual
or anticipated differences in DocGo’s estimates, or in the estimates of analysts, for DocGo’s revenues, results of operations,
level of indebtedness, liquidity or financial condition; |
| ● | additions
and departures of key personnel; |
| ● | failure
to comply with the requirements of the Nasdaq; |
| ● | failure
to comply with the Sarbanes-Oxley Act or other laws or regulations; |
| ● | future
issuances, sales or resales, or anticipated issuances, sales or resales, of Common Stock; |
| ● | perceptions
of the investment opportunity associated with Common Stock relative to other investment alternatives; |
| ● | the
performance and market valuations of other similar companies; |
| ● | future
announcements concerning DocGo’s business or its competitors’ businesses; |
| ● | broad
disruptions in the financial markets, including sudden disruptions in the credit markets; |
| ● | speculation
in the press or investment community; |
| ● | actual,
potential or perceived control, accounting or reporting problems; |
| ● | changes
in accounting principles, policies and guidelines; and |
| ● | general
economic and political conditions, such as the effects of the COVID-19 outbreak, recessions, interest rates, local and national
elections, fuel prices, international currency fluctuations, corruption, political instability and acts of war or terrorism. |
In
the past, securities class-action litigation has often been instituted against companies following periods of volatility
in the market price of their securities. This type of litigation could result in substantial costs and divert DocGo’s management’s
attention and resources, which could have a material adverse effect on DocGo.
Future
issuances of debt securities and equity securities may adversely affect DocGo, including the market price of Common Stock and
may be dilutive to existing stockholders.
There
is no assurance that DocGo will not incur debt or issue equity ranking senior to Common Stock. Those securities will generally
have priority upon liquidation. Such securities also may be governed by an indenture or other instrument containing covenants
restricting its operating flexibility. Additionally, any convertible or exchangeable securities that DocGo issues in the future
may have rights, preferences and privileges more favorable than those of Common Stock. Separately, additional financing may not
be available on favorable terms, or at all. Because DocGo’s decision to issue debt or equity in the future will depend on
market conditions and other factors beyond DocGo’s control, it cannot predict or estimate the amount, timing, nature or
success of DocGo’s future capital raising efforts. As a result, future capital raising efforts may reduce the market price
of Common Stock and be dilutive to existing stockholders.
The
JOBS Act permits “emerging growth companies” like us to take advantage of certain exemptions from various reporting
requirements applicable to other public companies that are not emerging growth companies.
DocGo
qualifies as an “emerging growth company” as defined in Section 2(a)(19) of the Securities Act, as modified by the
JOBS Act. As such, we take advantage of certain exemptions from various reporting requirements applicable to other public companies
that are not emerging growth companies for as long as we continue to be an emerging growth company, including (i) the exemption
from the auditor attestation requirements with respect to internal control over financial reporting under Section 404 of the Sarbanes-Oxley
Act, (ii) the exemptions from say-on-pay, say-on-frequency and say-on-golden parachute voting requirements and (iii)
reduced disclosure obligations regarding executive compensation in our periodic reports and proxy statements. As a result, our
stockholders may not have access to certain information they deem important. We will remain an emerging growth company until the
earliest of (i) the last day of the fiscal year (a) following the fifth anniversary of our Initial Public Offering, (b) in which
we have total annual gross revenue of at least $1.07 billion or (c) in which we are deemed to be a large accelerated filer,
which means the market value of the Common Stock and Warrants that are held by non-affiliates exceeds $700 million as
of the last business day of our prior second fiscal quarter, and (ii) the date on which we have issued more than $1.0 billion
in non-convertible debt during the prior three-year period.
In
addition, Section 107 of the JOBS Act also provides that an emerging growth company can take advantage of the exemption from complying
with new or revised accounting standards provided in Section 7(a)(2)(B) of the Securities Act as long as we are an emerging growth
company. An emerging growth company can therefore delay the adoption of certain accounting standards until those standards would
otherwise apply to private companies. The JOBS Act provides that a company can elect to opt out of the extended transition period
and comply with the requirements that apply to non-emerging growth companies, but any such election to opt out is irrevocable.
We have elected to avail ourselves of such extended transition period, which means that when a standard is issued or revised and
it has different application dates for public or private companies, we, as an emerging growth company, can adopt the new or revised
standard at the time private companies adopt the new or revised standard. This may make comparison of our financial statements
with another public company that is neither an emerging growth company nor an emerging growth company that has opted out of using
the extended transition period difficult or impossible because of the potential differences in accounting standards used.
We
cannot predict if investors will find the Common Stock and Warrants of DocGo less attractive because we will rely on these exemptions.
If some investors find the Common Stock and Warrants less attractive as a result, there may be a less active trading market for
the Common Stock, and Warrants and more stock price volatility.