HCA Lawsuit History: Fraud, Antitrust, and Discrimination Cases

The lawsuit history of HCA Healthcare stretches from the largest healthcare fraud recovery in U.S. history to a wave of active cases over a 2023 data breach, the company’s acquisition of Mission Health in North Carolina, nurse training debt in three states, alleged billing fraud, employment discrimination, and consumer overcharging. Some matters have been resolved for hundreds of millions of dollars. Others are heading to trial.

The Columbia/HCA Federal Fraud Case

The defining case in HCA’s legal record predates its current name. When the company was known as Columbia/HCA, federal prosecutors alleged it had systematically defrauded Medicare, Medicaid, and TRICARE through inflated cost reports, billing for unnecessary tests and unallowable expenses, and kickbacks to physicians in exchange for patient referrals. The schemes reached back to the late 1980s and were largely surfaced by whistleblowers filing under the False Claims Act.¹

In December 2000, HCA subsidiaries pleaded guilty to criminal charges including conspiracy to defraud the United States and violations of the Medicare anti-kickback statute. That plea produced more than $840 million in criminal fines and civil penalties, along with an eight-year corporate integrity agreement.¹ A final settlement announced on June 26, 2003, added $631 million in civil damages from nine whistleblower suits and a $250 million administrative settlement with the Centers for Medicare and Medicaid Services. The total government recovery reached $1.7 billion. Whistleblowers collectively received more than $151 million, the largest combined qui tam award in U.S. history at that time.²

The 2023 Data Breach Class Action

On July 10, 2023, HCA disclosed that an unauthorized party had stolen patient data from an external storage system used to format automated emails such as appointment reminders. The company said it learned of the breach on July 5, the same day a suspected hacker posted a sample of the stolen data online.³ Approximately 11.27 million patients across 20 states were affected. The exposed information included names, cities, states, zip codes, email addresses, phone numbers, dates of birth, genders, service dates, locations, and upcoming appointment dates. HCA said clinical records, payment information, Social Security numbers, and passwords were not compromised.⁴

Within days, at least four class actions were filed in Tennessee federal court alleging negligence, breach of implied contract, and invasion of privacy. Plaintiffs argued HCA “knew or should have known” that patient data was a high-value target.⁵ The cases were consolidated as In re: HCA Healthcare, Inc. Data Security Litigation (Case No. 3:23-cv-00684) in the U.S. District Court for the Middle District of Tennessee, combining 27 putative class actions.⁶

HCA settled without admitting liability. Affected patients can receive up to $5,000 each for documented, unreimbursed out-of-pocket losses, plus one year of credit monitoring and identity theft restoration services backed by a $1 million insurance policy.⁷ The company must also maintain specified data security commitments for at least two years.⁶ The court granted preliminary approval on May 14, 2025, and final approval came in late October 2025. Plaintiffs’ attorneys were awarded $3.1 million, capped at no more than 8.75% of the total settlement value.⁸

Mission Health and the North Carolina Lawsuits

HCA’s 2019 purchase of the Mission Health system has generated the largest single cluster of active litigation against the company. Separate suits from the state attorney general, Buncombe County, four local governments, and a private class have all followed.

North Carolina Attorney General’s Suit

On December 14, 2023, then-Attorney General Josh Stein sued HCA, alleging the company breached the asset purchase agreement that required it to maintain emergency, trauma, and oncology services at Mission Hospital through at least 2029.⁹ The state’s fact sheet describes a hospital that no longer meets Level II trauma center standards, emergency department nurse-to-patient ratios regularly exceeding 4-to-1, ICU ratios of 3- or 4-to-1 against a best-practice standard of 2-to-1, and average emergency room wait times of 187 minutes against a national average of 143. On the oncology side, HCA employed zero medical oncologists as of the filing, down from five in 2021; oncology beds fell from 44 to 24; and 45 chemotherapy appointments were canceled in the first half of 2023.¹⁰

The case, now captioned Jeff Jackson, Attorney General, ex rel. Dogwood Health Trust v. MH Master Holdings, LLLP, is pending in North Carolina Business Court under Judge Julianna Theall Earp.¹¹ As of October 2025, both sides had filed competing motions for summary judgment.¹² Attorney General Jackson has said his office will not drop the case. Separately, Dogwood Health Trust — the nonprofit created from the Mission Health sale — and HCA entered a “specific performance” process to try to resolve compliance issues, with Dogwood signaling it will go to court if that process fails.¹³

Buncombe County’s Intervention

On April 3, 2024, Buncombe County moved to intervene in the attorney general’s lawsuit, adding claims that deliberate understaffing caused dangerous EMS transfer delays. Average EMS transfer wait times roughly doubled from about 9 minutes 41 seconds in early 2020 to 17 minutes 41 seconds by the third quarter of 2023, according to the county’s complaint, with 90th-percentile waits exceeding 32 minutes.¹⁴ The county says those delays kept paramedics from returning to answer 911 calls, and it seeks more than $3 million in damages.¹⁵

Local Government Antitrust Settlement

In 2022, Asheville, Brevard, Buncombe County, and Madison County filed a federal antitrust suit alleging that the 2019 acquisition was intended to cement a monopoly in the region’s acute care market, where HCA controlled over 85% of general acute care in the Asheville area and roughly 90% of Buncombe County’s inpatient hospital care. The complaint accused HCA of using all-or-nothing provisions, anti-steering, anti-tiering, and gag clauses in insurer contracts.¹⁶

On August 13, 2025, the parties announced a settlement in the U.S. District Court for the Western District of North Carolina. HCA denied all allegations. It agreed to contribute $1 million to a charity care fund for households up to 400% of the federal poverty level; keep Transylvania Regional Hospital in Brevard open for at least three additional years, until at least 2032; help secure space for adult daycare services in Brevard; seek quality verification for Mission Hospital as a trauma center; and provide additional information about Mission Health advisory boards.¹⁷¹⁸

Davis v. HCA: A Private Antitrust Class Action Headed to Trial

A separate antitrust case brought by private plaintiffs, Davis v. HCA Healthcare Inc., is proceeding in North Carolina Business Court under Special Judge Mark A. Davis and is scheduled for trial in 2026. Named plaintiffs — western North Carolina residents who paid commercial health insurance premiums — include William Alan Davis, Jonathan Powell, Faith C. Cook, Katherine “Katie” Button, and Brunk Auctions, Inc. They allege HCA violated North Carolina’s unfair trade practices statute by using near-monopoly power to slash staffing and impose anticompetitive contract language on insurers.¹⁹

Court filings revealed that HCA’s initial plan upon closing the Mission purchase was to cut roughly 800 full-time equivalent employees. Former Mission president Jill Hoggard Green testified that she was “very, very concerned” when she learned the company was modeling reductions to nursing staff. Direct patient care staffing fell 36% within two years of the acquisition, and the staff-to-bed ratio at Mission Hospital dropped from 9.1 in 2018 to 4.7 in 2023, according to data cited in the proceedings. On October 13, 2025, Judge Davis denied HCA’s motion for summary judgment and rejected the company’s attempt to exclude expert testimony from healthcare economist Robert J. Town. The denial was without prejudice. If found liable, plaintiffs may seek damages and a court order requiring HCA to restore staffing to pre-acquisition levels.¹⁹

The Multistate Nurse Training Debt Settlements

On July 24, 2025, the attorneys general of California, Colorado, and Nevada simultaneously announced settlements with HCA and its workforce subsidiary, Health Trust Workforce Solutions, over the company’s use of training repayment agreement provisions, known as TRAPs. Investigators found that HCA required newly hired nurses to complete its Specialty Training Apprenticeship for Registered Nurses (StaRN) residency as a condition of employment, then required them to sign contracts obligating them to repay training costs averaging about $10,000 if they left or were fired before completing two years. Nurses who departed early had the debt sent to collections or deducted from final paychecks.²⁰²¹

Combined penalties across the three states reached $2.9 million:

California: Over $1 million in state penalties, plus approximately $83,000 in restitution to nurses who had already made payments.²⁰
Colorado: Nearly $1.4 million total, including more than $400,000 in direct restitution to affected Colorado nurses.²²
Nevada: $862,276 total, with approximately $75,776 in restitution to Nevada nurses at Mountain View, Sunrise, and Southern Hills hospitals, and $786,500 in state penalties.²¹

All three settlements prohibit HCA from enforcing TRAPs or collecting on outstanding training debt from nurses who signed the agreements. The company must void existing TRAP contracts and notify affected employees.²²

Whistleblower Fraud Allegations at Mission Hospital

In June 2022, emergency physicians Allen Lalor and Scott Ramming filed a whistleblower suit against HCA and its physician staffing partner, TeamHealth, alleging violations of the federal False Claims Act at Mission Hospital. The case was unsealed in April 2023 after the U.S. government declined to intervene. The doctors allege that HCA and TeamHealth systematically ordered unnecessary “trauma alerts” and redundant diagnostic tests to inflate Medicare and Medicaid billing, citing examples of elderly patients with minor injuries and individuals with no traumatic injuries being coded for trauma to generate higher fees. HCA has called the allegations “meritless.”²³

A related suit filed in November 2022 by Buncombe County against TeamHealth in U.S. District Court in Tennessee alleges deceptive coding that inflated the severity of emergency room visits, harming nearly 3,700 county employees covered by a self-funded health plan.²³

The $220 Million Florida Overcharging Settlement

In 2018, HCA resolved a class action in Florida alleging that its hospitals had overcharged patients with Personal Injury Protection insurance for emergency radiology services. In Herrera et al. v. JFK Medical Center Ltd. et al. (Case No. 8:14-cv-02327), plaintiff Marisela Herrera alleged that JFK Medical Center and HCA Holdings charged PIP patients significantly more than standard South Florida Medicare rates for X-rays and CT scans, in violation of Florida’s Deceptive and Unfair Trade Practices Act. On August 24, 2018, the parties reached a settlement valued at approximately $220 million, structured primarily as discounts on future medical bills for qualifying patients over a four-year period, along with $3 million in attorneys’ fees.²⁴

The EEOC Discrimination and Retaliation Suit

On July 31, 2023, the U.S. Equal Employment Opportunity Commission sued HCA Healthcare, Tennessee Healthcare Management, Inc., and GME Overhead in the U.S. District Court for the Middle District of Tennessee. The case, EEOC v. HCA Healthcare, Inc. et al. (Civil Action No. 3:23-cv-00777), alleges that HCA denied a promotion to a 58-year-old Asian American employee at its facility in Osceola, Florida, in favor of a 37-year-old white woman whom the EEOC says did not meet the position’s minimum qualifications. After the employee filed an internal complaint, HCA allegedly retaliated through disciplinary write-ups, verbal berating, and termination.²⁵ The EEOC brought claims under Title VII of the Civil Rights Act and the Age Discrimination in Employment Act, seeking injunctive relief and monetary damages after pre-litigation conciliation efforts failed.²⁶

Louisiana: HCA as Plaintiff

Not every recent case has featured HCA as defendant. In April 2023, HCA sued in the U.S. District Court for the Eastern District of Louisiana seeking a declaration that its sale of three New Orleans-area hospitals to LCMC Health was exempt from federal antitrust filing requirements under the Hart-Scott-Rodino Act. The Louisiana Department of Justice had already approved the sale through a Certificate of Public Advantage; the Federal Trade Commission argued federal review was still required.²⁷ In September 2023, Judge Lance Africk granted summary judgment to LCMC and the State of Louisiana, ruling that the state’s certificate brought the transaction under the state action doctrine and exempting it from federal antitrust law. The court dismissed the FTC’s claims with prejudice, and LCMC proceeded to integrate the hospitals it had purchased from HCA for approximately $150 million.²⁸

1
U.S. Department of Justice. HCA the Healthcare Company and Subsidiaries to Pay $840 Million
2
U.S. Department of Justice. Largest Health Care Fraud Case in U.S. History Settled
3
HCA Healthcare. HCA Healthcare Reports Data Security Incident
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CBS News. HCA Healthcare Data Breach Affects 11 Million Patients
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Fierce Healthcare. HCA Healthcare Hit With at Least 4 Class Action Lawsuits
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HIPAA Journal. HCA Healthcare Data Breach Settlement
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HCA Healthcare Settlement. HCA Healthcare Data Breach Settlement
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Becker’s Hospital Review. HCA Gets Final Approval for Data Breach Settlement
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NC Department of Justice. Attorney General Josh Stein Sues HCA Healthcare
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NC Department of Justice. HCA Fact Sheet
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North Carolina Courts. Second Order on Defendant’s Motion to Compel
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Law360. NC Attorney General, HCA Duel Over Merger Commitments
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Carolina Public Press. Attorney General Jackson, NC HCA Mission Health Noncompliance
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Asheville Citizen-Times. Buncombe County Seeks $3 Million in Damages From HCA Mission Hospital
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AVL Watchdog. Buncombe County Seeks to Join AG’s HCA Lawsuit
16
Fierce Healthcare. HCA Healthcare Mission Health Settle Antitrust Allegations
17
North Carolina Health News. HCA Settles Antitrust Lawsuit With Western NC Local Governments
18
Asheville Citizen-Times. Deal Reached in HCA Mission Health Federal Antitrust Lawsuit
19
AVL Watchdog. HCA Arrived With Plans to Cut 800 Staff
20
Courthouse News Service. Nurses Win $1.5 Million Settlement Over Hospital Training Debt Scheme
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Nevada Attorney General. Attorney General Ford Secures $862,000 Settlement With HCA
22
Colorado Attorney General. Attorney General Phil Weiser HCA Training Repayment Policies Settlement
23
North Carolina Health News. Doctors Lawsuit HCA Healthcare TeamHealth Overcharged Patients
24
Counsel Financial. $220 Million Settlement Reached in Florida Hospital Overcharge Class Action
25
EEOC. EEOC Sues HCA Healthcare for Race, National Origin, Age Discrimination and Retaliation
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Tennessee Bar Association. EEOC Sues HCA Healthcare
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Georgetown Law Litigation Tracker. HCA v. Garland et al.
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Fierce Healthcare. Federal Judge Sides With LCMC Health in Louisiana