ASHEVILLE, N.C. (WLOS) — Dogwood Health Trust says its latest review of HCA Healthcare’s purchase of Mission Health found two areas of potential concern, including questions about certain healthcare services and federal Medicare and Medicaid compliance.

Dogwood Health Trust and an independent monitor are asking the North Carolina Attorney General’s Office to review those concerns following the release of the 2025 HCA Monitoring Report.

The report does not mean HCA has been found to have violated the agreement.

Instead, it identifies two areas where Dogwood and the independent monitor say HCA may not be meeting requirements outlined in the Asset Purchase Agreement (APA), the legal contract created when HCA purchased Mission Health.

What is the review process?

Each year, Dogwood Health Trust and an independent monitor review whether HCA is following the terms of the APA.

Under that process:

Dogwood Health Trust monitors the agreement.Affiliated Monitors conducts the independent review.The North Carolina Attorney General’s Office reviews concerns and determines whether further legal action is needed.

‘POTENTIAL NON-COMPLIANCE’ NOTED IN 2025 MISSION PURCHASE AGREEMENT

The latest report was released after Dogwood Health Trust sent a letter to the attorney general’s office on July 22, outlining the potential areas of non-compliance.

Rachel Ryan, general counsel for Dogwood Health Trust, said the attorney general’s office will now have time to review the concerns before Dogwood sends a formal letter to HCA by October 28.

First concern: Healthcare services

The first area identified in the report involves services included in the APA.

Gerald Coyne with Affiliated Monitors said the agreement included a list of services that were required to be maintained for 10 years.

“One of the specific requirements of the APA contained a list of services both for Mission Hospital and for the remaining hospitals that had to be maintained over the course of the next 10 years,” Coyne said.

The report points to the end of industrial rehabilitation services at CarePartners, along with concerns about continued access to some other services at Mission Hospital, Mission Children’s Hospital Reuter Outpatient Center and CarePartners.

AFTER HELENE, DOGWOOD HEALTH TRUST CREATES DISASTER RESPONSE PLAYBOOK

Coyne said the industrial rehabilitation program at CarePartners stopped seeing patients after April 1, 2025.

“Their caseload went down to zero,” Coyne said. “By dropping its caseload to zero, it had been functionally discontinued.”

Coyne said the monitor is also reviewing other areas where patient caseloads have declined. The issue of reduced services has also been part of ongoing litigation involving the state attorney general’s office.

Ryan said that case began in 2023 and has not yet gone to trial.

“The wheels of justice move pretty slow in this case,” Ryan said. “That case started in 2023, and it’s 2026, and it still has yet to go to trial.”Second concern: Medicare and Medicaid compliance

The second area involves Mission Hospital’s participation in federal Medicare and Medicaid programs. The report points to a notice Mission Hospital received last year that it could lose its participation in those programs because of compliance issues.

Mission avoided that outcome by submitting a corrective action plan that was approved by federal regulators. The hospital continues to work under that plan.

DOCUMENTS: PATIENT DEATHS, MEASLES EXPOSURE PRECEDED MISSION’S ‘IMMEDIATE JEOPARDY’ STATUS

Coyne said all Mission hospitals remain in good standing with Medicare and Medicaid, which he called critical funding sources.

“If a hospital fails to remain in standing with the Centers for Medicare and Medicaid Services, then it could potentially be suspended from those programs, which could have obviously a catastrophic impact,” Coyne said.

Mission Hospital responds

Mission Hospital disagrees with the findings and says it remains confident it is complying with the agreement.

In a statement, Mission said:

“We are confident in our compliance with the terms of the APA. As always, our foremost focus is providing high-quality care to the Western North Carolina communities we are proud to serve, and we remain committed to meeting the healthcare needs of our region.”Community webinar planned

Dogwood Health Trust and the independent monitor will hold a community question-and-answer webinar from 9 to 10 a.m. on Aug. 4 to discuss the reporting process and answer questions about the findings.

You can sign up through the link here.