Dive Brief:
- The Federal Trade Commission has reached a settlement with U.S. Anesthesia Partners over allegations that the private equity-backed provider illegally consolidated control of the anesthesia market in Texas before hiking prices.
- The settlement is confidential for now, as negotiations around how USAP will execute terms are ongoing, the FTC said in a Thursday press release. But the deal will restore a competitive market structure, antitrust regulators promised — and if USAP fails to comply, the FTC plans to relitigate the charges.
- USAP, which denies any wrongdoing, said it agreed to a settlement to avoid the cost and disruption of protracted litigation.
Dive Insight:
In 2023, antitrust regulators accused USAP — a portfolio company of private equity firm Welsh, Carson, Anderson and Stowe — of systematically purchasing large anesthesia practices in Texas with the goal of creating a single dominant provider in the state.
USAP and Welsh Carson then used that market dominance to demand higher prices for anesthesia services, costing Texans tens of millions of dollars in extra healthcare costs each year, according to the FTC’s complaint.
The FTC settled with Welsh Carson early 2025. Now, over a year later, antitrust regulations have reached an agreement with the anesthesia provider itself.
In a statement, Dr. Scott Holliday, the chairman of USAP’s board, said that USAP has “operated responsibly” in the state of Texas, and believes it has “strong defenses” against the FTC’s claims.
But “there are uncertainties in any legal proceeding and this exceptionally prolonged litigation has required enormous time, energy, and financial commitments,” Holliday said. “In considering the best interests of our patients, clinicians, and hospital partnerships, we felt it was important to resolve this now so that USAP can remain laser focused on providing high-quality anesthesia services to our communities.”
Though particulars of the settlement are still being ironed out, it won’t require USAP to admit wrongdoing, according to the company.
That’s similar to the FTC’s deal with Welsh Carson, which didn’t force the PE firm to admit liability — and included no monetary penalties, though Welsh Carson was forced to limit its involvement with USAP.
At the time, Welsh Carson called the settlement “benign.”
Still, the FTC appears on stronger footing heading into the deal with USAP. A federal judge had tossed the agency’s lawsuit against Welsh Carson, arguing that private equity firms are not responsible for the actions of their portfolio companies. The FTC only secured a settlement with Welsh Carson after threatening another suit, this time in its own administrative court.
However, the court case against USAP remained ongoing. The USAP settlement “will be consistent with longstanding FTC settlement best practices,” the FTC said in its release.
New York-based Welsh Carson started USAP in Texas more than a decade ago. By 2023, the anesthesiology provider had grown steadily to make up practices in 12 states and Washington, D.C., through a serial acquisition strategy favored by PE firms called “roll-ups.”
(USAP is also backed by PE firm Berkshire Partners and GIC Capital, Singapore's sovereign wealth fund.)
As USAP grew, so too did allegations that the company was snapping up anesthesiology groups in order to raise prices, attracting the interest of the FTC before the agency eventually lodged its Texas complaint in 2023.
USAP has trimmed its footprint since. The provider is currently operational in nine states, according to its website.
PE firms have acquired hundreds of physician practices across the U.S. in recent years, despite controversy over their negative effects on medical quality and cost.
Research has shown that PE ownership of healthcare providers leads to higher prices, lower customer satisfaction and poorer medical outcomes. Practices themselves often struggle — there have been a number of recent bankruptcies tied to PE ownership, including multistate health systems Prospect Medical Holdings and Steward Health Care.
Roll-ups have historically been a difficult type of M&A for regulators to tackle. However, refreshed merger guidelines released by the FTC during the Biden administration could give regulators more leverage to challenge the deals, potentially cooling roll-up activity.
The Biden administration also updated premerger notification forms in a way that would have made it easier for enforcers to spot and prevent roll-ups.
Though the Trump administration kept the stricter merger guidelines in place, a federal judge tossed out the expanded premerger reporting requirements earlier this year.
Under President Donald Trump, the FTC has proved more willing to go after potentially anticompetitive healthcare M&A than some Washington watchers had expected, given Republicans’ traditional pro-business bent. Still, the president has been criticized for efforts to expand his authority over agencies like the FTC that have historically operated with a degree of independence.
And currently, the FTC is operating with just two commissioners, after Trump fired two Democrat commissioners in early 2025 and another Republican commissioner left for another post later that year.
Current Chairman Andrew Ferguson and Commissioner Mark Meador, both Republicans, voted in support of authorizing the preliminary settlement with USAP. The FTC’s healthcare division has filed for a stay in the litigation while USAP works to implement the settlement, the agency said. The district judge will need to approve the motion.
