ASHEVILLE, N.C. (828newsNOW) — A new annual review of HCA Healthcare’s compliance with the agreement governing its purchase of Mission Health has raised concerns about several areas of potential non-compliance, including emergency services, oncology care, a Care Partners rehabilitation program and Mission Hospital’s Medicare status.

Dogwood Health Trust and the independent monitor overseeing the agreement provided more details Tuesday during a media Q&A, explaining why the findings are considered “potential” violations, what the review process requires and what happens next.

The review was conducted by Affiliated Monitors, which was selected to evaluate whether HCA is meeting obligations outlined in the 2019 asset purchase agreement after HCA acquired Mission Health.

Dogwood Health Trust was created as part of that transaction and is responsible for overseeing compliance with the agreement, which requires HCA to maintain certain services and commitments for 10 years following the sale.

Jerry Coyne, lead monitor with Affiliated Monitors, said the review identified concerns but does not represent a final determination that HCA violated the agreement.

Why the monitor says ‘potential’ non-compliance

One of the biggest questions raised during the Q&A was why the findings are described as “potential non-compliance” instead of violations.

Rachel Ryan, legal counsel for Dogwood Health Trust, said that language comes directly from the asset purchase agreement and is part of the process outlined in the document.

Under that process, the independent monitor reviews HCA’s compliance, Dogwood evaluates the findings, the Attorney General’s Office has an opportunity to review the concerns and Dogwood then provides formal notice to HCA.

Ryan said Dogwood expects to send that notice before Oct. 28.

After that, Dogwood and HCA will discuss the concerns and determine whether they can be resolved.

“The language in the asset purchase agreement is potential non-compliance,” Ryan said. “That’s the language and the mechanism that’s in the asset purchase agreement.”

Emergency, oncology services remain under dispute

Coyne said concerns involving Mission Hospital’s emergency department and oncology services have continued since the monitor’s first review.

In December 2023, the North Carolina Attorney General’s Office sued HCA, alleging reductions in certain emergency and oncology services at Mission Hospital had effectively discontinued services required under the asset purchase agreement.

That case remains pending in North Carolina Business Court.

Coyne said the monitor has continued identifying those areas as potential non-compliance because the legal dispute has not been resolved.

A key issue in the lawsuit is the meaning of language in the agreement stating HCA “shall not discontinue” certain services.

Dogwood officials said HCA’s interpretation is that services have not been discontinued as long as some patients continue receiving care.

The Attorney General’s Office has argued services should remain at the same level and quality that existed when Mission Health was sold.

Ryan said the issue will likely continue to affect future compliance discussions until the court resolves the dispute.

Care Partners program drops to zero patients

The review also identified a new concern involving Care Partners’ industrial rehabilitation program.

The program, which helps injured workers return to employment after an injury, was among the services HCA agreed to continue under the asset purchase agreement.

Coyne said the monitor found that no patients received services through the program after April 1, 2025.

“We’re beyond that one person continuing to use the service,” Coyne said. “There was not a single person treated from April on.”

According to Coyne, HCA told the monitor that the program relies on contracts with employers and that an employer contract ending resulted in the loss of patients.

HCA’s position is that the program was not discontinued because it could resume if new contracts were obtained.

The monitor disagreed, saying the program had been “functionally discontinued” after operating with no patients for nine consecutive months.

Mission Hospital Medicare status questioned

The report also identified concerns involving Mission Hospital’s compliance with Medicare and Medicaid requirements.

The asset purchase agreement requires covered hospitals to remain in good standing with those federal programs.

Coyne said Mission Hospital received “immediate jeopardy” findings from the Centers for Medicare and Medicaid Services during the review period.

Immediate jeopardy is one of CMS’s most serious findings and indicates regulators believe a facility’s failure to comply could cause serious harm, injury, impairment or death.

Although Mission Hospital corrected the issues and avoided suspension from Medicare and Medicaid programs, Coyne said the monitor determined the hospital was not in good standing for the entire review period.

“This finding is limited to Mission Hospital,” Coyne said.

The monitor said other hospitals reviewed under the agreement, including Highland-Cashiers Hospital, Transylvania Regional Hospital, Angel Medical Center and Blue Ridge Regional Hospital, were found to be in good standing.

Review follows years of oversight

Coyne said this year’s report includes findings from the 2025 calendar year.

Some concerns have continued from previous reviews, including emergency and oncology services and Medicare compliance issues.

Coyne said this is the third year the monitor has identified concerns related to Mission Hospital’s Medicare and Medicaid standing, although each year’s finding has been based on new CMS actions.

The monitor previously identified concerns related to charity care and uninsured care requirements.

Those concerns were not included in this year’s report after changes made by HCA, including participation in a statewide medical debt program.

What enforcement can look like

During the Q&A, Dogwood officials pointed to previous examples where compliance concerns resulted in action.

In one case involving surgical services at Highland-Cashiers Hospital, Dogwood said discussions with HCA and the Attorney General’s Office resulted in HCA extending its commitment to provide those services.

Ryan said the current process allows Dogwood to preserve its options if concerns cannot be resolved through discussions.

“If we can’t resolve them through conversation and dialogue and we have to bring it to court in the future, we want to make sure we’re retaining those legal rights,” she said.

Community meeting planned

Dogwood Health Trust and the Independent Monitor will host a public Q&A webinar from 9 to 10 a.m. Aug. 4 to allow residents to ask questions about the independent monitoring process and the asset purchase agreement.

Officials also encouraged community members who have concerns about services covered by the agreement to contact the independent monitor.