The Service Line

The Department of Justice just handed down its first-ever decision not to prosecute a health care company under a brand-new corporate leniency policy, and the case centers on an ambulatory surgery center’s management company, not a hospital. On July 29, 2026, the Department of Justice’s Fraud Section declined to prosecute Campus Eye Management Holdings, LLC and its subsidiary Campus Eye Management, LLC, a management services organization (MSO) that provided billing and other administrative services to an optometry practice and its affiliated ambulatory surgery center (ASC) in Hamilton, New Jersey, where physicians performed cataract surgery, corneal surgery, and YAG capsulotomy. Prosecutors allege that from roughly 2015 through March 2023, the practice’s founder, E. Bruce DiDonato, billed Medicare for medically unnecessary diagnostic eye tests and paid bribes disguised as consulting fees to referring ophthalmologists in exchange for sending surgical patients to the ASC, a scheme prosecutors say generated approximately $3.4 million in fraudulent claims. Under the Department’s Corporate Enforcement and Voluntary Self-Disclosure Policy, announced by Acting Attorney General Blanche in March 2026, Campus Eye avoided prosecution entirely because it self-disclosed the misconduct, cooperated fully, and remediated the wrongdoing, though it still agreed the scheme produced $3.7 million in ill-gotten gains and paid $1 million toward restitution after asserting it could not pay the full amount; DiDonato himself was criminally charged with health care fraud and kickback offenses. Confidence: High on the case facts and declination, Medium on how far this leniency precedent extends to other ASC-affiliated MSOs weighing whether to self-report. Sources: Fraud Division Resolves Fraud Investigation of Eye Care Group Under New Corporate Enforcement Policy, Department of Justice, Fraud Division Resolves Fraud Investigation of Eye Care Group, Office of Inspector General, DOJ Announces First Declination of Prosecution for Health Care Company Under New Corporate Enforcement Policy, Paul, Weiss.

Reimbursement

The temporary formula ambulatory surgery centers have used to calculate their annual Medicare raise since 2019 is set to expire at the end of this year, and Congress’s permanent fix is still stuck in committee. CMS began trialing the hospital market basket index, instead of the smaller Consumer Price Index for All Urban Consumers, to set ASC payment updates in 2019, and has extended that trial repeatedly, most recently through calendar year (CY) 2026 in last November’s CY2026 OPPS/ASC final rule. The Outpatient Surgery Access Act of 2026, introduced as H.R.8091 by Representatives Beth Van Duyne and John Larson in March and as S.4963 by Senators Bill Cassidy and Richard Blumenthal in July, would make the market basket update permanent starting in 2027 and eliminate a budget-neutrality adjustment the Ambulatory Surgery Center Association (ASCA) says has suppressed ASC rates for years; ASCA has endorsed both versions, but neither bill has moved out of committee, and nearly identical legislation has failed every Congress since 2021. If the trial simply lapses without action, ASCs default back to the smaller CPI-U formula CMS used before 2019, right as the CY2027 OPPS/ASC proposed rule already promised only a modest 2.4 percent increase. Confidence: High on the trial’s CY2026 expiration and the bills’ mechanics, Low on passage given the legislation’s history. Sources: Calendar Year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule, CMS, S.4963, Outpatient Surgery Access Act of 2026, Congress.gov, ASC Payment Fight Returns as Lawmakers Move to Preserve Hospital Market Basket Update, Ambulatory Surgery Center News.

Enforcement

Days before the Campus Eye case broke, a drugmaker paid nearly $4.7 million to settle allegations it bribed surgery centers to stock its eye drug, part of a Department of Justice enforcement wave that hit ophthalmology-linked ASCs roughly four separate times in about two weeks. On July 20, 2026, Massachusetts-based EyePoint Pharmaceuticals agreed to pay the United States $4,657,463.18 to resolve False Claims Act allegations that it paid kickbacks, structured as an “Assurance Program,” to ambulatory surgery centers between 2019 and March 2023 to induce them to purchase and dispense DEXYCU, an injectable drug used to treat inflammation after cataract surgery; under the program, EyePoint reimbursed ASCs when insurers denied claims or paid less than the ASC’s purchase cost, on top of offering what prosecutors called excessive free samples. EyePoint also entered a five-year Corporate Integrity Agreement with the HHS Office of Inspector General, subjecting it to enhanced compliance oversight into 2031. For ASC operators, the case is a reminder that accepting a manufacturer’s financial cushion to stock a particular drug or device carries its own kickback exposure, not just the manufacturer’s. Confidence: High. Source: EyePoint Pharmaceuticals to Pay $4.6 Million to Resolve False Claims Act Allegations, Department of Justice.

Who’s Buying

Surgery Partners is selling off its remaining hospital stakes to double down on pure-play ambulatory surgery, agreeing to hand two Idaho hospitals to Intermountain Health for roughly $795 million a year after its board rejected a bid to go private. The publicly traded ASC operator (NASDAQ: SGRY) signed binding escrow documents July 21, 2026 to sell its ownership interests in Mountain View Hospital and Idaho Falls Community Hospital, facilities the company valued at $1.15 billion, to Intermountain Health, with the deal announced July 24 and completion contingent on physician, board, and Hart-Scott-Rodino antitrust clearance. Surgery Partners framed the sale as sharpening its focus on its core ASC portfolio while preserving Mountain View’s physician-ownership structure, and reaffirmed its 2026 revenue guidance of $3.35 billion to $3.45 billion excluding the transaction’s impact; the company reports second-quarter earnings Monday, August 10. The divestiture comes about a year after Surgery Partners’ independent board committee rejected Bain Capital’s $25.75-per-share, roughly $3.2 billion take-private offer, reinforcing the message that Surgery Partners intends to keep growing as a standalone, ASC-focused public company rather than sell out. Confidence: High on deal terms, Medium on close timing given the multiple required approvals. Sources: Surgery Partners Announces Entry Into Agreement to Sell Ownership Interests in Idaho Falls Facilities to Intermountain Health, GlobeNewswire, Surgery Partners Monetizes Idaho Assets As It Chases Faster Growth, Benzinga.

Clinical Policy

CMS finalized a wave of updates to its mandatory hospital bundled-payment model this week, while still weighing whether to pull ambulatory surgery centers directly into that model’s financial accountability, a decision that would end the free ride ASCs currently get from procedures shifting their way. The Fiscal Year (FY) 2027 Hospital Inpatient Prospective Payment System (IPPS) final rule, issued July 31, 2026 and published in the Federal Register August 4, finalizes changes to the Transforming Episode Accountability Model (TEAM), the mandatory bundled-payment program covering roughly 740 hospitals and five surgical episode types including lower extremity joint replacement and spinal fusion; the rule creates three new Medicare Severity Diagnosis-Related Groups (523, 524, and 525) to better classify complex spinal fusion cases by severity and refines how episodes are attributed when they overlap with the CJR-X bundled-payment model. Separately, an April 2026 request for information tied to the same rulemaking asked stakeholders whether ASCs should be brought directly into TEAM’s episode-accountability structure, since two of its five episode types, joint replacement and spinal fusion, can already be triggered in an outpatient setting; the Ambulatory Surgery Center Association (ASCA) opposed the idea, arguing ASCs are not built for 30-day post-discharge care coordination. CMS did not finalize an ASC-inclusion decision in this rule, but TEAM hospitals move to downside financial risk on January 1, 2027, sharpening their incentive to push joint and spine cases into ASCs to shrink episode spending, exactly the leakage ASCs today capture without sharing TEAM’s risk. Confidence: High on the finalized technical changes, Medium on whether and when CMS acts on ASC inclusion. Sources: FY 2027 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System Final Rule, CMS, CMS Explores Including Surgery Centers in Episode-Based Payment Model as Industry Raises Concerns, Ambulatory Surgery Center News.

The Operator Metric

44 percent. That is the share of ambulatory surgery centers that expect to pay anesthesia providers a stipend in 2026, up from just 28 percent two years ago, and the clearest sign yet that anesthesia has become a fixed cost ASC operators must budget for rather than negotiate away. VMG Health’s “ASC Leader Expectations for 2026” survey of 97 leaders at independent and joint-venture ASCs found 67 percent now rank anesthesia coverage among their top three financial challenges for the year, the highest share the firm has recorded on that question, and more than 80 percent expect to rely on some form of independent-contractor anesthesia arrangement, stipend-backed or not, rather than an employed or subsidized group model. For operators, the number to model into next year’s budget is not just the CRNA or anesthesiologist rate itself but the stipend layered on top of it, a cost line that barely existed for most ASCs three years ago and now shows up as a board-level item at two out of three centers. Confidence: Medium, the figures come from a single vendor’s self-reported operator survey rather than a claims-based dataset. Source: 5 Anesthesia Staffing Models ASCs Are Adopting in 2026, Becker’s ASC.