HCA Healthcare faces another antitrust lawsuit tied to 2019 Mission Health merger

HCA Healthcare’s 2019 acquisition of Mission Health has yielded a second antitrust lawsuit against the for-profit hospital operator, this time filed by the city of Brevard, North Carolina.

Filed Friday, the complaint petitions the court to recognize HCA’s alleged violations of the Sherman Act and, alongside awarding damages, enjoin the healthcare organization “from seeking, agreeing to or enforcing any provision in any agreement that prohibits or restricts competition” as described in the lawsuit.

The city wrote that HCA chose to purchase Mission Health’s assets “because Mission had monopoly power in the [general acute care] market in the Asheville Region—monopoly power that HCA knew it could exploit to maintain and enhance Mission’s monopoly power in the [general acute care and outpatient care] markets.”

HCA now controls over 85% of the Asheville region’s general acute care market and more than 70% of the market in surrounding counties as measured by patient volume, according to the complaint.

The city’s claims—abuse of a market monopoly resulting in higher prices, reduced quality, limited patient access to care and other anti-competitive practices—echo those cited in similar litigation filed last summer in the state’s adjacent Buncombe County by residents who said they had to pay higher amounts through their health plans due to HCA’s conduct.

In that case, the plaintiffs pointed to HCA’s roughly 90% market share for inpatient hospital care in Buncombe County.

Both lawsuits allege Mission Health had achieved an effective monopoly as far back as 1995, when it merged with St. Joseph’s Hospital, and had employed “a continuing, multifaceted coercive scheme designed to foreclose competition from rivals, to maintain or enhance its monopoly power in the relevant markets and ultimately to charge supracompetitive prices.”

Included within that scheme were “all-or-nothing” arrangements with payers, “anti-steering” and “anti-tiering” provisions that prevent payers from directing members to less expensive or higher quality options, and gag clauses to impede price transparency, plaintiffs wrote in the lawsuits.

“HCA continued and reinforced each of the foregoing elements of the scheme after it acquired Mission in January 2019,” the city of Brevard wrote in its complaint.

HCA took control of Mission Health in February 2019 following “extensive negotiations” between the chain and North Carolina Attorney General Josh Stein.

Fierce Healthcare has reached out to HCA for comment on the lawsuit. A spokesperson for the company told press that the lawsuit was “beyond disappointing” in light of recent meetings between the city and HCA leadership.

HCA tallied nearly $59 billion in total revenues this past year and nearly doubled its net income to almost $7 billion. It owns and operates more than 180 hospitals across the country.