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NC Justice Department Scolds HCA-Mission For High Prices, Declining Quality of Care

Greg Lowe

The North Carolina Department of Justice notified the Mission Health System last week that it was “extremely concerned” about ongoing citizen complaints over high prices, lack of transparency, anti-competitive behavior, chronic under-staffing, and declining quality of care at HCA-managed medical facilities in western North Carolina.  

In a letter to Greg Lowe, president of HCA Healthcare’s North Carolina division, Assistant Attorney General Llogan R. Walters wrote that his office was still receiving “troubling allegations regarding patients not receiving proper care, core functions being reduced and not replaced, and subpar conditions regarding basic sanitation and cleanliness” at Mission Hospital and other HCA facilities. The letter was provided to Asheville Watchdog this week by Attorney General Joshua H. Stein’s office.

Lowe responded to Walters in a letter dated March 30, writing that “MHS remains invested in having an ongoing dialogue with the North Carolina Department of Justice regarding any concerns it has related to MHS.”

Also this week, Stein, acting on behalf of the State of North Carolina, filed a legal brief in Buncombe County Superior Court urging the court to reject Mission Health’s request to dismiss a class-action lawsuit brought against it by local residents. Dismissal of the lawsuit would prevent an outside investigation into HCA-Mission’s business practices.

The lawsuit alleges anti-competitive behavior by Mission Health that results in higher prices for all healthcare consumers in western North Carolina, where HCA and Mission have an effective monopoly.

The plaintiffs in the class-action suit include Katherine Button, Faith Cook, and Will Overfelt of Asheville, Richard Nash of Candler, William Davis of Clyde, and Jonathan Powell of Morganton. The complaint was prepared by the law firms Wallace & Graham of Salisbury, N.C., and Fairmark Partners of Washington, D.C.

The “friend of the court” brief filed by Stein on Wednesday follows a similar amicus brief filed in support of the plaintiffs by Dale Folwell, North Carolina’s state treasurer, in December 2021. Stein, a Democrat who allowed the sale of nonprofit Mission Health to HCA Healthcare in 2019, and Folwell, a Republican, are widely regarded as potential rivals for future elected office.

“For many services, Mission Health charges insurers prices far higher than the state-wide average price for the same service,” Walters’ letter said. “Unsurprisingly, these costs are passed onto consumers.”

Walters continued, “Complaints note that, at the same time Mission Health charges high prices, Mission Health is enjoying significant profits while the quality of care at Mission Health facilities declines.”

Walters’ letter indicated it was in response to a letter Lowe wrote to the attorney general’s office in July 2021, in which Lowe argued that Mission Health’s chronic understaffing was the result of a “challenging labor market” and the ongoing COVID-19 pandemic.

“However,” Walters wrote, “health care systems across the state face these same issues without resulting in the same high number of complaints to this office.”

Lowe’s March 30 letter to the assistant attorney general promised “a more fulsome response on certain topics will follow,” but noted that “the amount a patient pays for the care she receives is impacted by a variety of factors” including insurance coverage, out of pocket costs, “and other factors not set by the prices negotiated between MHS and the insurer.”

Lowe noted that “MHS is compliant with all federal regulations regarding price transparency,” and that commercial insurance contracts contain terms negotiated at length between “highly sophisticated parties.”

As for chronic under-staffing, cleanliness, and long wait times at Mission hospitals, Lowe wrote that Mission Health “is taking a number of concerted steps to address staffing challenges.”

“Further, MHS has received high marks on recent surveys and inspections related to patient safety and quality,” Lowe wrote. — Peter H. Lewis

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