The country’s biggest hospital chain, HCA Healthcare, told the Centers for Medicare and Medicaid Services it doled out almost $1 billion more in financial assistance to needy patients than it reported on its financial statement in 2022, helping the enormously profitable company extract billions of dollars from taxpayer-funded programs.
It’s normal for hospital systems to report more charity care — free and discounted care provided to low-income patients — in their annual filings with CMS than on their financial statements. That’s because CMS lets them classify more types of transactions as charitable. But HCA puts that on hyperdrive, yielding a gulf that’s far bigger than that of its for-profit and nonprofit peers, partly because of the sheer size of the roughly 180-hospital chain operating in 20 states. It does so by packing its CMS charity care bucket with several categories of financial assistance, including discounts provided to patients who weren’t eligible for charity care. This appears to be allowed under CMS’ rules, but some argue it’s not true charity care.
“I wouldn’t say the numbers are fraudulent, but are they suspicious? Yes,” said Gerard Anderson, a health policy and management professor at Johns Hopkins University who has studied charity care.