Physicians are at the center of some of the most consequential legal and regulatory battles in healthcare over who controls their practices, what their contracts can demand and whether the employers they work for are playing by the rules. Here are five controversies that have moved from dispute to national significance in the past six months.
1. The PeaceHealth-ApolloMD case
Eugene Emergency Physicians, an emergency medicine group with about 41 providers in Lane County, Ore., sued to block Vancouver, Wash.-based PeaceHealth from replacing it with Atlanta-based national staffing company ApolloMD after PeaceHealth declined to renew its contract with EEP in February 2026, ending a relationship that had staffed Lane County emergency departments since 1991.
All 41 EEP clinicians declined offers to reapply under ApolloMD’s newly formed entity, Lane Emergency Physicians, pledging not to join for at least 90 days. Medical staff at all three hospitals issued a vote of no confidence in PeaceHealth leadership and voted to restore EEP as the provider group.
The lawsuit is the first test of Oregon’s SB 951, which restricts MSO control over physician practices. In 2025 alone, 37 state bills related to consolidation and competition were enacted. How the Oregon court rules will shape how similar legislation plays out nationally.
2. The California fertility case
A California state appellate court is set to hear arguments in a lawsuit brought by a fertility practice physician who says a private equity-backed MSO fired him after he refused to dismiss an employee physician. The case, Art Center Holdings Inc. v. WCE CA Art, stems from a 2019 transaction in which physicians sold a 51% stake to Women’s Care Enterprises. When the PE firm demanded the physician-owner fire two employees, he refused, and the firm triggered a contractual provision allowing it to replace him with a physician of its choosing.
California Attorney General Rob Bonta filed an amicus brief supporting the trial court’s finding that the arrangement violated California’s century-old corporate practice of medicine law. The California Medical Association also filed, urging the court to take a fact-based approach rather than issue a categorical prohibition on removal clauses, which are common across physician-MSO arrangements statewide.
PE investment in physician practices has grown roughly sixfold since 2012, from 75 firms to 484 by 2021, according to AMA amicus materials. In specialties such as dermatology, gastroenterology, and ophthalmology, PE involvement now exceeds 30% of practices. The appellate ruling will affect most such arrangements in California.
3. The Aspirus noncompete investigation
The Minnesota Attorney General’s Office opened an investigation into Wausau, Wis.-based Aspirus Health after several Duluth, Minn.-based physicians filed antitrust complaints over amended employment contracts issued following Aspirus’ 2024 merger with Duluth-based St. Luke’s. The physicians allege they were given an ultimatum to sign new contracts that changed pay and scheduling expectations while retaining noncompete clauses.
The case is significant because Minnesota enacted one of the country’s most expansive noncompete bans, and the investigation tests whether a post-merger contract revision that retains restrictive covenants violates that ban. For any physician employed at a system that has recently merged, the Aspirus investigation is a direct warning that contract changes triggered by acquisitions carry their own legal exposure.
4. The Erlanger Stark law case
Chattanooga, Tenn.-based Erlanger Health System is in active litigation on two False Claims Act lawsuits after a federal judge denied its motions to dismiss in early 2026. The government alleges Erlanger structured physician compensation around downstream referral revenue rather than fair market value for personally performed services, a violation of Stark law, dating back to 2014.
Erlanger has maintained it paid physicians based on outside consultants’ fair market value determinations in every instance. The Justice Department has not disputed that. It has argued the compensation was structured around referral revenue regardless of what those opinions said.
The HHS-OIG responded with an April 2026 update to its fraud and abuse FAQs: fair market value documentation alone is insufficient. The agency stated that the better practice is to pair FMV with documentation of a legitimate business purpose that would withstand scrutiny absent any referrals. Potential damages and penalties could exceed $100 million.
5. Aetna vs. Radiology Partners
Aetna sued Radiology Partners and its affiliate MedBridge Billing, alleging the practice exploited the No Surprises Act’s independent dispute resolution process by initiating numerous arbitrations for services that should have been billed under existing in-network agreements.
Radiology Partners pushed back directly. “Aetna’s actions appear to reflect a broader response to its terrible track record for reimbursing medical practices under the federal No Surprises Act,” the company said in a statement, citing MBB’s 98% win rate through NSA arbitration. “This overwhelmingly clear trend indicates neutral third parties applying federal law conclude Aetna uniformly fails to fairly compensate providers.”
The case captures a broader war playing out across specialties between large physician groups and commercial payers over how the No Surprises Act’s IDR process is being used by both sides.
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