The contracts behind Colorado’s anesthesia dispute

A dispute over who could staff the operating rooms

USAP continues to advertise Colorado anesthesia services, clinician recruitment and local clinical leadership. Its April 2026 statement describes an operating national practice. source: inspect evidence ↗source: inspect evidence ↗

The Colorado complaint identifies physician partners and private-equity investors, including Welsh Carson, as owners of the parent. Physician ownership and private-equity investment coexist; the record does not establish the current ownership percentages. source: inspect evidence ↗

This document-based investigation follows a market allegation and the terms of a settlement. It does not claim to have measured every patient’s bill, verified all required transitions or conducted original patient interviews.

Sixteen hospitals, one anesthesia group

A hospital could remain open while losing an alternative supplier of a service its operating rooms needed. Colorado said USAP began buying local anesthesia practices in 2015 and later secured contracts across the region’s major hospital systems.source: inspect evidence ↗

This is a defined market, not every hospital in Colorado. Hospitals employing their own anesthesia staff sit outside the state’s open-staffing comparison. The 16-of-21 figure describes contracts, not a share of patients or a measured change in clinical quality.source: inspect evidence ↗

An acquisition could change the rate paid for the same clinicians

The state’s complaint says successive purchases let USAP move acquired clinicians to its higher rates. It alleged rates 30%–40% above other independent groups in the Denver metropolitan area. That comparison is an allegation about negotiated reimbursement, not a measured increase in every patient’s bill.source: inspect evidence ↗

The mechanism is concrete: buying a practice can change the contract under which an insurer pays for its work. A higher allowed payment can affect an insurer or employer plan without increasing a particular patient’s out-of-pocket bill by the same percentage. The documents do not supply a complete claims dataset or a patient-level cost estimate.source: inspect evidence ↗

A shortage was harder to cover without another provider

Colorado’s account also identifies physician attrition, recruitment difficulties and pandemic effects. It says hospitals struggled to supplement USAP staffing because rival groups had disappeared and departing clinicians faced non-compete restrictions. Those conditions distinguish a claim about restricted alternatives from a claim that ownership created the national labor shortage.source: inspect evidence ↗

USAP disputed the attorney general’s account. In a statement reported by Becker’s, Colorado physician Henri Acosta said the agreement preserved the company’s physician-led model and continued service, and that resources were better spent caring for patients than defending the litigation.source: inspect evidence ↗

The settlement targeted contracts and restrictions on clinicians

The February 2024 agreement names five CommonSpirit hospitals, including Mercy Hospital in Durango. It allows clinicians at those facilities to leave USAP and keep serving the hospitals. It also sets an 18-month phase-out for non-compete provisions, or an earlier legislative deadline.source: inspect evidence ↗

The agreement denies liability and resolves disputed claims without trial. Its terms describe required transitions; this investigation has not independently verified each completed transition or a subsequent reduction in rates. The remedies are not proof that patients’ costs fell.source: inspect evidence ↗

A continuing business and a separate federal case

In May 2025 the FTC finalized a separate order limiting Welsh Carson’s involvement with USAP and requiring notice of specified future investments. Welsh Carson had been dismissed from the federal lawsuit in May 2024; the administrative settlement and the lawsuit against USAP are different proceedings.source: inspect evidence ↗

On April 23, 2026, the FTC and USAP announced an agreement in principle in the Texas case. The FTC said the terms were confidential while USAP worked to execute them, and a final order would require further approvals. The agency’s case page still labels the matter pending.source: inspect evidence ↗source: inspect evidence ↗

USAP said it believed it had strong defenses and had acted responsibly, but wanted to avoid disruption and litigation costs. Any final agreement would contain no admission of fault, it said. Its Colorado service and recruitment pages remain active. Neither that operating status nor a settlement announcement establishes the present price of anesthesia.source: inspect evidence ↗source: inspect evidence ↗