The office of North Carolina Attorney General Josh Stein had "great concerns" about how Nashville, Tenn.-based HCA Healthcare was chosen to purchase Asheville, N.C.-based Mission Health System, according to a 2018 internal document obtained by Asheville Watchdog.
"We have great concerns about how HCA was selected to be the entity that purchased Mission," the document states. "Further, we have concerns about how the negotiations for the APA unfolded after the LOI was signed."
The $1.5 billion deal closed in 2019. Since then, Mission Health has dealt with physician departures and complaints over a variety of issues, including billing and quality of care.
The document claims that HCA was heavily favored to begin with, largely because Mission Health's then-CEO Ronald Paulus and his adviser Philip Green, a friend of Paulus, had a previous business relationship with HCA that was not disclosed to the Mission Health board.
It also claims that Mission Health chose not to put out a request for other bids or hold an auction "with no outside advice other than Phil Green." The only other systems considered were Winston-Salem, N.C.-based Novant Health and Charlotte, N.C.-based Carolinas HealthCare System, now Atrium Health, according to Watchdog.
"In the end, an outside observer could conclude that HCA rose to the top among a limited number of bidders because the deck had been stacked in its favor from the beginning by Dr. Paulus and Mr. Green," the notes from a 2018 meeting between North Carolina Justice Department investigators and HCA representatives at the North Carolina attorney general's office reveal.
Because of its concerns about the deal, the attorney general's office requested the Mission Health board to revote, the attorney general's deputy chief of staff, Laura Brewer, told Watchdog. The board unanimously approved it the second time.
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