(press release)
On July 29, 2025, Dogwood Health Trust and the Independent Monitor (IM) released the annual monitoring report assessing the compliance activities of HCA Healthcare, Inc. operating under the Asset Purchase Agreement (APA) for Mission Health System during calendar year 2024. In addition to releasing the report to the public on July 29, Dogwood provided notice to the North Carolina Attorney General’s Office (AGO) that it intends to notify HCA of three issues of potential non-compliance, as outlined in Affiliated Monitors’ report to Dogwood Health Trust. Both the letter and the compliance report are available on Dogwood’s website.
The monitoring report identifies three instances of potential non-compliance for 2024, including the 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. While the review found HCA addressed two of the three areas of compliance, the report notes the organization was potentially non-compliant for much of 2024.
“This review process can be confusing at times,” said Rachel Ryan, general counsel for Dogwood Health Trust. “The Asset Purchase Agreement guides our monitoring and assessment process, directing us to conduct an annual review of HCA’s compliance with the APA for the previous year. At the same time, we know the community is interested in sharing their experiences that happen in real time, and that is why engaging with the Independent Monitor is so very important.”
Potential Non-compliance
One issue of potential non-compliance remains unresolved: APA Section 7.13 (a) – Continuation of Mission Hospital/Care Partners Services. In the IM’s report for 2023, Affiliated Monitors stated, “We believe that the Superior Court – and not the IM – is the most appropriate forum to resolve this issue.” Because this case remains pending in Superior Court, the IM once again has determined that HCA Healthcare is potentially non-compliant with the terms of the APA.
Areas of Compliance
On Dec. 19, 2023, and through June 11, 2024, HCA was under Immediate Jeopardy findings by the Centers for Medicare and Medicaid Services (CMS) and the North Carolina Department of Health and Human Services following a survey of operations at Mission Hospital. During 2024, HCA took the necessary actions to return itself to good standing with CMS, and therefore, its potential non-compliance for this issue has been resolved.
HCA also resolved a potential non-compliance issue related to its Uninsured and Charity Care policies. HCA adopted a revised Uninsured and Charity Care Policy, effective Jan. 1, 2025, that states HCA will not “pursue litigation activity that involves suing patients or filing liens on patient bad debt accounts.” Because of this change, HCA’s potential non-compliance with this issue has been addressed.
“We remain focused on engaging the community in our monitoring process,” said Gerald Coyne of Affiliated Monitors, Inc. “Our website is a primary place where community members can share their experiences and concerns, but even better is joining us when we’re in the community and holding community meetings. We appreciate everyone who made time to attend the meetings held in 2024. Whether it was individually with a small group or at one of our two larger community meetings, your voices help us tremendously.”
Next Steps
Dogwood will host a Community Q&A webinar with the Independent Monitor on Thursday, Aug. 7, from 12 to 1 p.m. to provide an opportunity for community members to learn more about the 2024 monitoring report, have their questions addressed and share additional feedback. Community members can register to attend here. Participants are encouraged to submit questions in advance.
Per the monitoring timeline, the Attorney General has 30 days from receipt of Dogwood’s letter in which to provide notice of its findings pertaining to issues of potential non-compliance, as noted in the report and letter. Throughout this process Dogwood will continue to engage HCA in discussions to address the identified compliance issues and their resolution.
About Dogwood Health Trust
Dogwood Health Trust is a private foundation based in Asheville, North Carolina with the sole purpose of dramatically improving the health and wellbeing of all people and communities of 18 counties and the Qualla Boundary in Western North Carolina. Dogwood Health Trust focuses on innovative and equitable ways to address the many factors that contribute to overall health and wellbeing, with a focus on housing, education, economic opportunity, and health and wellness. Dogwood Health Trust works to create a Western North Carolina where every generation can live, learn, earn and thrive, with dignity and opportunity for all, no exceptions. To learn more, please visit www.dht.org.
