Perhaps more than any other factor, the success of an ASC depends on the surgeon-owners who refer and perform cases there. It is important to recruit the best surgeons and equally important to ensure that the surgeons remain productive over time and comply with the policies, procedures, and regulatory and legal requirements that apply in the ASC. ASCs must be able to identify and address improper conduct by physicians. Legal challenges might arise from surgeons who don’t contribute sufficient cases or whose conduct includes billing fraud, noncompliance with safe harbor requirements, harassment, intimidation and bullying, or violation of the ASC’s policies and procedures.