HCA Healthcare Notified of Potential Noncompliance

On July 29, 2024, Dogwood Health Trust informed the NC Attorney General’s Office that it plans to notify HCA—Hospital Corporation of America, owner of Mission Hospital in Asheville—of potential noncompliance with provisions of the Asset Purchase Agreement (APA).

The letter is based on findings from a review by the newly appointed independent monitor, Affiliated Monitors, in its report to Dogwood Health Trust. Both the letter and compliance report are available on Dogwood’s website.

“This past year, we heard requests from both the Attorney General and the communities we serve for more education and transparency regarding Dogwood’s compliance oversight of HCA,” said Dr. Susan Mims, CEO of Dogwood Health Trust. “We listened, which is why we are sharing this letter and report. Our hope is that sharing this letter and report will help educate the public on our compliance oversight work for the 2023 reporting year and help Affiliated Monitors engage the public for the upcoming 2024 reporting year.”

The original purchase agreement allowing for-profit HCA to acquire the nonprofit Mission Health in 2018 included certain restrictions and requirements, including maintenance of quality healthcare, which nurses at the hospital say has not fully been met. Among other things, the agreement requires that HCA provide an annual report for the preceding calendar year at the end of April, which is then given to Dogwood Health Trust, the independent monitor, NC AG Josh Stein, and the Mission Hospital Advisory Board.

The independent monitor reviews the report between May and July so as to evaluate HCA’s compliance for the preceding year and then sends its findings to Dogwood. Ninety days after receiving the annual report from HCA, Dogwood must provide notice to the Attorney General as to whether they intend to notify HCA of any potential noncompliance.

After reviewing HCA’s Annual Report for 2023, Dogwood intends to notify HCA of three instances of potential noncompliance: provision of Emergency and Trauma Services and Oncology Services at Mission Health; failure to remain “enrolled and in good standing” in Medicare and Medicaid; and issues with uninsured and charity care policies. Dogwood has now notified the Attorney General and intends to officially notify HCA of potential noncompliance.

“We hope that our report will inform the communities, provide a greater understanding of the monitoring process, and serve as a starting point for further productive discussions to improve the quality of healthcare in Western North Carolina,” said Gerald Coyne of Affiliated Monitors, Inc.

Thirty days after receiving Dogwood’s letter, the Attorney General has to inform Dogwood if it disagrees with its findings. By October 27, 180 days after receipt of HCA’s Annual Report, Dogwood or the AG must provide notice to HCA of any potential noncompliance, after which Dogwood will engage HCA in discussions to address the identified compliance issues.

In early 2025, Dogwood will share a summary of how issues of noncompliance were addressed and/or resolved.