Rest assured KKR (private equity owner) secured their bag ($) before GenesisCare went down. Don't think for a second they are on the hook for that debt when the music stopped (well after they sucked the marrow out of the business). The "losers" in this situation are the employed physicians... and of course patients. The other winners were the GenesisCare equity holders when they sold out to KKR (2012). This is the (PE) way. (see also the story of KKR-owned Envision Health care:
Envision Healthcare - Wikipedia)
KKR likely employed the usual tactics of things like leasebacks (liquidating the real estate), dividend recaps (company borrows money, then. gives it to the PE), operating optimizations (eg layoffs, quality cuts), then strategic bankruptcy (to avoid paying the debt)
Hard to say how much the State of Rad Onc contributed to this, but would definitely be an oversimplification. The actual mechanics involving healthcare (reimbursement, patterns of care, etc) are likely secondary contributors here
communitydoc13 gets it