Independent monitor: HCA broke Mission purchase deal; ER, charity care, Medicare

ASHEVILLE - An independent monitor has said the for-profit owner of Mission Health violated the 2019 deal it signed when it bought Western North Carolina's main health care provider, then a nonprofit.

"The independent monitor recommends to Dogwood Health Trust that HCA Healthcare be found to be not in compliance with the Asset Purchase Agreement for reporting year 2023," Affiliated Monitors Inc. said in its July 12 report released a week later by Dogwood, the entity created when Mission was sold for $1.5 billion.

AMI cited issues under HCA involving the emergency and oncology services, Medicare and Medicaid compliance and charity care.

Dogwood notified the office of Attorney General Josh Stein July 29 that will tell HCA Healthcare of the potential noncompliance. That is the first step in corrective actions by HCA − or possibly litigation.

Responding to the report, Mission/HCA spokesperson Nancy Lindell did not dispute the opinion the company had violated the agreement, but characterized the issues as resolved or unintentional.

"We value the work of the independent monitor and are confident that we continue to be in compliance with the terms of the asset purchase agreement," Lindell said in a statement to the Citizen Times July 30.

Release of the report comes a week after the announcement of a new coalition of doctors, elected officials and others who are seeking to pressure HCA to sell the health system to a nonprofit. It also comes after Dogwood hired a new monitor , saying it wanted increased transparency and community engagement. Mission is the second most profitable in the portfolio of HCA, the country's largest owner of hospitals.

Regarding ER and cancer care, AMI in its report pointed to concerns that drastic reductions in staff "so degraded the level of those services" that they were essentially discontinued, something forbidden in the agreement.

More: Patients arrive at Mission Hospital in ambulances, then the waiting begins

While the monitor said it determined HCA was not in compliance with those services, it also said the ultimate decision was best made by the court, which is hearing a 2023 lawsuit brought over the same issues by Stein, the attorney general and Democratic gubernatorial candidate.

HCA declined to directly address ER or cancer care in its statement.

With Medicaid and Medicare, the monitor noted federal regulators had threatened to stop payment of those government insurance programs for the poor, disabled and elderly. That was because of regulators' findings that multiple patients had been put into "immediate jeopardy" by hospital practices that also resulted in four deaths.

Lindell, the Mission/HCA spokesperson, said the issues had been resolved.

"At no time was the hospital suspended from treating Medicare or Medicaid patients," she said.

AMI Managing Director Gerald Coyne, speaking to the media July 30, said a plan of correction had been submitted by HCA to the Centers for Medicare and Medicaid Services. But the actions described in the plan had not been completed, he said, and the health system would be subject to an enhanced level of monitoring.

"Even though they have taken the first steps, I would say there is work to be done," Coyne said.

The monitor's citation over charity care centered on HCA eliminating a policy of putting claims on the properties of patients who owed money. That policy had said they would not place liens on properties less than $300,000 in value. Such changes require approval by an advisory board, the independent monitor or a similar third party, AMI said.

Mission responded July 30, saying the policy was a holdover from Mission and that it already had a policy of not using any liens.

"As an organization we do not pursue litigation activity that involves suing patients or filing liens on patient debt accounts," Lindell said.

But Coyne, speaking to the media, said the $300,000 policy added another level of protection in case Mission chose to change its approach to liens, which it has a right to do.

Following Dogwood's notification of the attorney general's office, Stein has 30 days to tell Dogwood if he disagrees. If he doesn't, his office or Dogwood will provide the notice of potential noncompliance to HCA. Dogwood and HCA will then engage in discussions over how to address the problems. If Dogwood isn't satisfied that could lead to a lawsuit said the trust's attorney, Rachel Ryan.

Stein wants to stop Mission expansion

In a different matter involving HCA, Stein has sent a letter to state health regulators opposing a proposed Mission expansion.

HCA, and two nonprofit health systems, AdventHealth of Florida and Novant of Winston-Salem, want to expand or build 26-bed acute care facilities in Buncombe County and have applied with the state for a Certificate of Need. A CON is required by N.C. and some other states that regulate the number of certain types of health care facilities that can be built

HCA had proposed expanding Mission's main Asheville campus. But Stein in his July 29 letter to the N.C. Department of Health and Human Services said choosing HCA over the other applicants would not promote the state's goals of improving regional health.

"The large market share for acute care services that Mission already enjoys in WNC makes it a poor candidate to promote competition in that region. And Mission is failing to provide safe, quality, accessible and affordable care in the region at its existing facilities," the attorney general said.

Lindell, spokesperson for Mission/HCA responded, saying that demand for its intensive-care unit and medical and surgical beds is high.

"Currently, Mission Hospital accepts thousands of patient transfers from other hospitals across the region. These transfers reflect a need for the addition of higher acuity beds and services offered by Mission which will meet the needs of patients in WNC," she said.

If approved, Lindell said Mission believes it could built out the expansion faster than other applicants.

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Joel Burgess has lived in WNC for more than 20 years, covering politics, government and other news. He's written award-winning stories on topics ranging from gerrymandering to police use of force. Got a tip? Contact Burgess at jburgess@citizentimes.com, 828-713-1095 or on Twitter @AVLreporter. Please help support this type of journalism with a subscription to the Citizen Times.

This article originally appeared on Asheville Citizen Times: Independent monitor: HCA broke Mission purchase deal; ER, charity care, Medicare