U.S. Anesthesia Partners and the Federal Trade Commission reached an agreement in principle on April 23 to resolve a landmark antitrust case that accused USAP of buying up nearly every large anesthesia practice in Texas to create a single dominant provider with the power to demand higher prices. A federal court paused the case on May 26 while USAP implements the required relief over the next 180 days.
The preliminary settlement resolves charges, brought in 2023, that accused USAP of violating antitrust laws by engaging in a decadelong scheme to consolidate anesthesia services in Texas.
The settlement terms remain confidential. USAP will not be required to admit wrongdoing. But the FTC has been explicit that if USAP fails to comply, it plans to relitigate the charges.
The case is widely viewed as a significant FTC win, and its implications extend well beyond Texas anesthesia.
Here is what ASCs, physicians and anesthesia leaders need to know:
How USAP was built
USAP is a portfolio company of private equity firm Welsh, Carson, Anderson and Stowe, which created the company in 2012. The FTC accused USAP and Welsh Carson of using their resulting market dominance to demand higher prices for anesthesia services, costing Texans tens of millions of dollars in extra healthcare costs each year.
Beyond acquisitions, the FTC accused USAP of engaging in price-setting arrangements with remaining independent anesthesia groups, using its higher negotiated rates to bill for their services, and struck a market allocation deal to sideline a potential competitor.
The FTC settled with Welsh Carson separately in early 2025, requiring the firm to limit its involvement with USAP and notify regulators of future acquisitions in anesthesia and other hospital-based physician practices. The case against USAP itself continued until the April agreement in principle.
The litigation had a significant procedural detour. In May 2024, a federal judge dismissed Welsh Carson from the FTC’s federal challenge, finding the commission lacked authority to bring the case against the firm in federal court because the complaint did not accuse Welsh Carson of currently violating the law. The FTC resolved its concerns with Welsh Carson through a separate administrative proceeding.
USAP’s response
USAP’s board chairman, Scott Holliday, DO, said USAP has “operated responsibly” in Texas and believes it has “strong defenses” against the FTC’s claims, but that “there are uncertainties in any legal proceeding and this exceptionally prolonged litigation has required enormous time, energy, and financial commitments.” He said the company chose to settle to remain focused on providing anesthesia services to its communities.
Private litigation continues
The FTC settlement does not resolve a related private class action. In Burbage v. USAP, Texas resident Christy Burbage continues to assert claims on behalf of a putative class of Texas patients who paid inflated prices for anesthesia services as a result of USAP’s alleged monopolization.
What it means for the industry
The USAP case established what regulators now call a template for “stealth consolidation,” or serial acquisitions that individually appear modest but cumulatively produce dominant market positions. Each transaction was small enough to avoid traditional merger review thresholds. Together, they produced a provider with the leverage to reprice an entire state’s anesthesia market.
The template is not unique to anesthesia. Private equity-backed roll-up strategies have reshaped gastroenterology, dermatology, ophthalmology and orthopedics using structurally similar approaches. The USAP settlement signals that the FTC is now willing to pursue those strategies retroactively, even after acquisitions have closed and market positions have been established.
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