Contractual disputes, compliance pitfalls and insurance denials driven by artificial intelligence are among the many legal issues that should be on ambulatory surgery center (ASC) operators’ radar in 2025.
Generally, legal experts expect litigation involving ASCs to rise this year, attorneys at ArentFox Schiff wrote in a recent JD Supra post, pointing to expanding case volume tied to operational, regulatory and transactional friction points.
As more high-acuity procedures shift from hospital outpatient departments to surgery centers, ASCs continue to gain ground in orthopedics, cardiology and other specialties. That growth, coupled with evolving payer behavior and regulatory scrutiny, may expose ASC operators to more legal action.
“As Centers for Medicare & Medicaid Services (CMS) continues to add procedure codes to ASCs’ Covered Procedure List, [the growth of ASCs] will only increase,” they wrote.
Many of the most pressing litigation risks stem from payer disputes, they wrote. ASC operators are increasingly pursuing legal action over reimbursement denials, underpayments and claims adjudication practices.
“When payment issues are ongoing and systemic, the financial consequences are significant,” the firm said, citing a recent $421 million jury verdict in Louisiana against Blue Cross Blue Shield over alleged fraud and payment shortfalls to a surgery center.
Operators should strengthen audit programs and train billing teams on ASC-specific issues, such as coding nuances, payer coverage criteria and CMS enrollment rules, they wrote.
Legal counsel can also support proactive efforts to recover payments and structure future contracts to minimize ambiguity.
Alongside payment challenges, compliance remains a perennial risk area. From HIPAA and anti-kickback laws to CMS quality reporting and state-specific regulations, ASC operators face a web of legal requirements.
Lapses in these areas can invite whistleblower complaints or government enforcement action, particularly in the wake of increased scrutiny of billing patterns like upcoding or improper unbundling, ArentFox Schiff attorneys wrote.
“ASCs must be vigilant regarding compliance concerns, including Health Insurance Portability Accountability Act compliance, anti-kickback laws, compliance with CMS guidelines and state-specific regulation,” they wrote.
ASC operators will also want to be particularly careful in light of changes in the federal government enforcement actions.
And as merger and acquisition activity continues across the ASC market, ownership disputes and employment-related litigation are also surfacing more frequently, ArentFox Schiff attorneys wrote. Conflicts may arise over non-compete terms, partner buyouts, or misaligned incentives during buy-in or exit events.
Another emerging trend to watch is the rising use of artificial intelligence by insurance companies to automate claims review. Algorithm-driven systems may lead to higher denial rates, fueling disputes and lengthening the revenue cycle, they wrote.
Ultimately, litigation risks in 2025 are not just the product of isolated missteps, but rather preventable issues.
“Protecting an ASC and its personnel against litigation involving these areas and risks requires up-to-date compliance policies, training for staff, ongoing monitoring/audits, and legal counsel to advise on risk mitigation and litigation strategy,” ArentFox Schiff attorneys wrote.
