ASHEVILLE – Buncombe County and the city of Asheville have filed a joint class-action lawsuit against HCA Healthcare and Mission Health, alleging the companies have been involved in anti-competitive practices.
The lawsuit is the third of its kind filed in less than a year by Western North Carolina entities. The first was filed in August 2021 by six Asheville-area residents. The second was filed by the city of Brevard.
Previous coverage:Plaintiffs in HCA/Mission antitrust lawsuit double down on anti-steering accusations
“The County Commissioners are concerned that HCA’s business operations monopolize healthcare while artificially inflating prices, and self-insured organizations like ours have no other recourse,” Buncombe County Board of Commissioners Chair Brownie Newman said in a news release.
More about the first WNC antitrust lawsuit against HCA:
“On behalf of our public employees and our community, we have a responsibility to challenge these unfair business practices that harm patients and families at a time they are often most vulnerable.”
Download the full lawsuit here:Buncombe County, city of Asheville v. HCA Healthcare, Mission Health
Asheville Mayor Esther Manheimer said the legal action was taken with careful consideration.
“The Asheville City Council and the Buncombe County Board of Commissioners felt it was necessary to take this step to bring an end to predatory practices that limit HCA Healthcare’s competition and clearly result in overpriced and limited choices in people’s healthcare,” Manheimer said. “We believe this lawsuit will not only address the damages sustained by local governments and other self-insured organizations, but will also result in a fair and improved healthcare system for our entire community.”
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“We are disappointed in this action and we continue to be proud of the heroic work our team does daily,” said Mission and HCA spokesperson Nancy Lindell. “Mission Health has been caring for Western North Carolina for more than 130 years and our dedication to providing excellent healthcare to our community will not waiver as we vigorously defend against this meritless litigation.”
Lindell noted Mission’s “demonstrated” contributions to the community including $270 million in charity care and uninsured discounts it provided 2021, expansion of hospital services, a new pediatric emergency room, a new 120-bed behavioral health hospital, and its A grade from hospital assessment group Leapfrog.
“Mission Health is committed to the health and well-being of every person who comes to us for care and we are proud of our dedicated hospital teams and the exceptional care they provide to our patients,” Lindell said.
HCA Healthcare and Mission Health have 21 days to respond to a summons in the case, filed July 28.
The 59-page complaint “details of an extensive pattern of behavior by HCA intended to monopolize healthcare markets in western North Carolina,” according to the release. It was filed in the US District Court of Western North Carolina.
The result of these practices, the city and county allege, is artificially high prices for healthcare services and a reduced standard of care that has damaged, and continues to damage, local governments and private entities who act as self-insurers for their employees.
The Asheville-Buncombe complaint’s language overlaps with the Brevard lawsuit’s. In early paragraphs, they both mentioned “working families and governmental employees” who need affordable health care options.
HCA and Mission limit these options, the lawsuits allege, through practices that limit competition.
More:NC Attorney General Stein says state should ‘deny Mission’ hospital expansion application
“This case arises at a time when providing affordable health care insurance plans for working families and governmental employees, such as firefighters, police, and teachers, and controlling health care costs have been top priorities for Plaintiffs and members of the proposed Class, the business they serve communities, and state and local governments in Western North Carolina,” the Asheville-Buncombe lawsuit states. “As described in detail in this Complaint, Defendants’ conduct has restricted competition in the health care markets defined, thereby substantially and artificially inflating health care prices paid by Plaintiffs and proposed Class member health plans.”
The lawsuit also repeats market share numbers discussed in both the August 2021 suit and the Brevard suit. HCA Healthcare, the new suit alleges, holds a monopoly market share — 70% or more — in seven counties: Yancey (88.3.9%), Madison (89.1%), Buncombe (88.6%), Mitchell (85.4%), Transylvania (78.7%), McDowell (76.4%) and Macon (74.7%). The market share percent in the new lawsuit is slightly higher than it was when cited in the 2021 lawsuit.
And they could be even higher.
“Given the high entry barriers facing new hospitals, and also Defendants’ Scheme allegedly entered, these market shares have not been materially reduced, and have likely increased, since HCA bought Mission,” the Asheville-Buncombe lawsuit stated.
HCA Healthcare and Mission Health are currently vying with AdventHealth and Novant Health to build 67 new acute care beds in Buncombe. The other two hospital systems want to build new facilities. Mission wants to expand its main Asheville campus.
North Carolina Department of Health and Human Services’ Division of Health Service Regulation will make a decision on which hospital is granted a certificate of need for the new beds.
Currently the process is in a public comment period, and anyone can send feedback to DHSR.CON.Comments@dhhs.nc.gov and email@example.com. That process closes July 31.
There will be a public hearing on the CON applications Aug. 12.
The Asheville-Buncombe lawsuit wasn’t the only piece of stormy weather HCA and Mission have been through in the past few days.
On July 25, North Carolina Attorney General Josh Stein sent a letter to NCDHHS asking they not consider HCA’s CON application. Stein also cited noncompetitive practices and said his office had received numerous complaints about the cost and quality of health care in WNC since HCA bought Mission in 2019, a $1.5 billion deal he approved at the time.
Andrew Jones is Buncombe County government and health care reporter for the Asheville Citizen Times, part of the USA TODAY Network. Reach him at @arjonesreports on Facebook and Twitter, 828-226-6203 or firstname.lastname@example.org. Please help support this type of journalism with a subscription to the Citizen Times.