by Jane Winik Sartwell, Carolina Public Press
August 14, 2025

This week, HCA Healthcare settled an antitrust lawsuit that has plagued the Asheville-based Mission Health system for three years. 

In 2022, four Western North Carolina governments sued HCA Healthcare and Mission Health for predatory and monopolistic practices, which plaintiffs claim lead to more expensive and lower-quality health care across much of the mountain region. 

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HCA owns the only hospital in Asheville, as well as six rural hospitals across the region, all part of the formerly nonprofit Mission Health group that for-profit HCA acquired in 2019. 

Those four plaintiffs — the city of Brevard, the city of Asheville, Buncombe County and Madison County — will receive the following from Mission Health in the settlement of the antitrust lawsuit:

• A $1 million to a new charity fund that will be created to provide assistance with health care costs for families and individuals at up to 400% of the federal poverty level
• A promise that the company will continue to operate Transylvania Regional Hospital in Brevard until at least 2032
• A commitment to cooperate in the negotiations for a space for adult daycare services in Brevard 
• A promise to seek quality verification of Mission Hospital in Asheville as a trauma center
• A promise to provide the plaintiffs with additional information relating to Mission Health advisory boards

Brevard mayor Maureen Copelof is pleased with the terms of the antitrust lawsuit settlement.

“It hits a number of things that we really wanted,” Copelof told Carolina Public Press. “We’ve been lobbying for a long time to extend the period of the Asset Purchase Agreement for our hospital, so that additional three years is right in line with what our community wants. 

“In addition, adult daycare is something that the community doesn’t have that we’ve wanted for a long time. Having HCA commit to working a location for such a service is definitely good for our community.”

The creation of the charity care fund is of particular significance to local governments. 

“That million dollars is definitely appreciated,” Copelof said. “We’ve been wanting to get equity and the ability for anyone to get health care.”

Leaders with Buncombe County, home to Asheville, feel similarly about the antitrust lawsuit settlement.

“We are grateful to the dedicated medical professionals who work hard to provide care, even as costs can be out of reach for many,” Buncombe County spokesperson Kassi Day told CPP. 

“HCA’s contribution is a critical part of this settlement, helping close that gap.”

The resolution of the antitrust case comes at a time when HCA is fighting tooth and nail against the construction of a competitive hospital in Buncombe County. Recently, HCA’s case against AdventHealth’s planned 222-bed facility in Weaverville was elevated to the North Carolina supreme court. 

Still, HCA denies any anti-competitive behavior or monopolistic practices. 

“While Mission Health and HCA support this resolution, both deny the allegations made against them by Plaintiffs,” reads a press release from HCA.

“Mission Health and HCA believe that their conduct was, at all times, consistent with federal and state antitrust laws, that none of Mission Health’s contracts contained the provisions challenged by Plaintiffs, and that neither Mission Health nor HCA has done anything to exclude competition or limit insurance company innovation in Western North Carolina.”

However, HCA has been accused of monopolizing the mountains by players large and small for years now. One of the most notable is Gov. Josh Stein. Other elected officials have been outspoken too.

“HCA likes its monopoly — they’re going to do everything they can to hold onto it and keep any and all competition out of Western North Carolina,” State Sen. Julie Mayfield, D-Buncombe, told CPP last year. 

“They win when they are the only thing in town. People have no other option, and they’re taking advantage of that. My view is that they’re not actually interested in keeping people healthy. Their interest is in getting us into their hospitals.”

Although the antitrust case is resolved, problems continue to plague HCA’s operation of rural hospitals in the mountains, including the ones named in this case. In July, Transylvania Regional Hospital was given a one-star rating from the Centers for Medicare and Medicaid. That’s the lowest possible score, and indicates poor performance. 

This is the end of just one lawsuit in a complex web of litigation surrounding HCA’s operation of Mission Health. 

Still ongoing are the attorney general’s 2023 suit accusing HCA of degrading emergency and cancer care, and Buncombe County’s lawsuit alleging that ER understaffing at Mission Hospital led to millions of dollars of damages to the county’s EMS services.

This article first appeared on Carolina Public Press and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post Antitrust lawsuit against HCA settled with Western NC governments appeared first on carolinapublicpress.org

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

The content primarily criticizes a large healthcare corporation, HCA Healthcare, for alleged monopolistic and predatory practices, reflecting concern for consumer protection, healthcare affordability, and community welfare. It highlights perspectives from local Democratic officials and focuses on regulatory actions and lawsuits against a for-profit company in healthcare, which are generally themes more aligned with center-left viewpoints. However, the coverage remains factual and balanced, including responses from HCA denying wrongdoing, and does not exhibit partisan rhetoric or extreme positions.