Dogwood Health Trust and Independent Monitor Release
HCA Monitoring Report for 2025, Noting Two Areas of Potential Non-Compliance
Public invited to attend a community Q&A webinar on Aug. 4, 2026
Special Invitation for Media Partners: Dogwood will host a media opportunity via Zoom on Tuesday, July 28 at 10 a.m. with Rachel Ryan, general counsel for Dogwood Health Trust and Gerald Coyne with Affiliated Monitors to address any questions. Please email media@formationpr.com if you plan to attend. A Zoom link will be provided with email confirmation.
Asheville, N.C., July 24, 2026 – Today, Dogwood Health Trust and the Independent Monitor are releasing the annual compliance monitoring report and their letter to the North Carolina Attorney General’s Office (AGO). The release of the report follows Dogwood’s letter to the AGO sent on July 22, stating its intention to notify HCA Healthcare, Inc. (HCA) of two instances of potential non-compliance with the Asset Purchase Agreement (APA) for Mission Health System, as outlined in the Independent Monitor’s (IM) annual report for calendar year 2025.
Dogwood and the IM are extending a special invitation to the public to attend a community Q&A webinar on August 4, 2026, to learn more about the process and findings. Both the letter and the annual monitoring report are available on Dogwood’s website.
The 2025 calendar year monitoring report represents the seventh annual compliance review cycle for HCA and is the third annual report delivered by Affiliated Monitors, Inc. since being named the Independent Monitor in 2024.
What are the instances of potential non-compliance?
The IM’s report identifies two instances of potential non-compliance, found in Sections 7.13(a) and 7.13(h).
- Section 7.13(a) pertains to the continuation of services as outlined in the APA. In addition to degradation of Emergency and Trauma Services and Oncology Services currently being addressed by the NC Attorney General’s Office in the NC Business Court, the report notes the cessation of Industrial Rehabilitation services at CarePartners and continued diminishment of access to certain other services at Mission Hospital, Mission Children’s Hospital Reuter Outpatient Center and CarePartners.
- Section 7.13(h) notes that HCA shall remain “enrolled and in good standing” in Medicare and Medicaid. On Oct. 17, 2025, Mission Hospital received a 23-day notice of termination of its Medicare and Medicaid provider agreement. After revising its initial corrective action plan to meet the Centers for Medicare and Medicaid Services (CMS) requirements, the hospital’s Enhanced Plan of Correction was approved. Mission continues to work with CMS under that plan and has until July 26, 2026, to complete implementation.
“The Asset Purchase Agreement guides our monitoring and assessment process, directing us to conduct an annual review of HCA’s compliance with the APA for the previous year,” said Rachel Ryan, general counsel for Dogwood Health Trust. “At the same time, Dogwood and the IM are also aware of and monitoring issues occurring in real time that have the potential to affect future compliance reporting.”
For example, the 2025 compliance report and Dogwood’s notice to the NC Attorney General note that while HCA took the necessary actions to return itself to good standing with CMS, Dogwood “would be remiss not to state” that shortly after, in January 2026, Mission Hospital received another Immediate Jeopardy finding. The finding has subsequently been lifted, but oversight has continued under an Enhanced Plan of Correction.
Ryan notes that Dogwood is engaged in active, ongoing monitoring and continued discussions with HCA and the Attorney General’s Office with a focus on compliance.
“We have come to know and greatly respect the Western North Carolina community, particularly those who have so passionately expressed their feelings to us about not just the quality of healthcare in the region, but how healthcare impacts quality of life,” said Gerald Coyne of Affiliated Monitors, Inc. “Similarly, while we do not minimize the challenges facing Mission Hospital, it is important to realize that the overwhelming majority of those who staff the hospital remain singularly focused on providing the best medical care possible to those they encounter, sometimes under the most challenging of circumstances.”
Coyne and Ryan encourage community members to continue to share their experiences with the Independent Monitor. The IM website is the primary place where community members can share their experiences and concerns.
“We appreciate everyone who made time to attend the community meetings held in 2026,” said Coyne. “Whether it was individually with a small group or at one of our larger community meetings, your voices help us tremendously.”
How can I learn more about the 2025 calendar year compliance report for HCA?
Dogwood will host a Community Q&A webinar with the Independent Monitor on Tuesday, Aug. 4, from 9 to 10 a.m. Together, they will review the findings from the report, review the requirements of the APA, and respond to questions. Community members can register to attend here and are encouraged to submit questions in advance.
What happens after Dogwood notifies the NC Attorney General of instances of potential non-compliance?
Per the Independent Monitor’s monitoring timeline, the Attorney General has 30 days from receipt of Dogwood’s letter to provide notice to Dogwood if the AGO decides that Dogwood has failed to adequately exercise its right to enforce certain obligations of HCA. Then, on or before October 28, Dogwood must issue a notice of potential noncompliance to HCA. Throughout this process, Dogwood will continue to engage HCA in discussions to address the identified compliance instances and their resolution.
Where can I find more information about the Asset Purchase Agreement and the monitoring process?
The IM Website has helpful information and resources, including the Asset Purchase Agreement, a summary of HCA’s commitments, the monitoring timeline as outlined in the APA, and Frequently Asked Questions. Dogwood Health Trust’s website maintains a library of compliance reports and documents.
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Dogwood Health Trust
Dogwood Health Trust is a private foundation based in Asheville, North Carolina with the sole purpose of dramatically improving the health and wellbeing of all people and communities of 18 counties and the Qualla Boundary in Western North Carolina. Dogwood Health Trust focuses on innovative and equitable ways to address the many factors that contribute to overall health and wellbeing, with a focus on housing, education, economic opportunity, and health and wellness. Dogwood Health Trust works to create a Western North Carolina where every generation can live, learn, earn and thrive, with dignity and opportunity for all, no exceptions. To learn more, please visit dht.org.
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