By Ted Clifford
Three years ago, nationally renowned litigators brought a class action lawsuit against Mission Hospital and its parent company HCA Healthcare. It claims that HCA was using the regional monopoly Mission built up as a nonprofit to force insurers into anticompetitive contracts leading to higher healthcare costs and worse services for residents of western North Carolina.
Some in the community hoped the court challenge would rein in the changes that came with HCA’s acquisition of Mission Hospital in 2019.
But now, that lawsuit has hit a roadblock.
In a Sept. 8 ruling, North Carolina business court judge Mark Davis denied “class” certification – an essential test to decide whether a group of people can be assembled to move forward together in a single lawsuit.
In his 48-page order, Davis said that the plaintiffs had not met the requirement of demonstrating that Mission and HCA’s alleged anticompetitive behavior had lowered the quality of healthcare for the potential class of plaintiffs.
“Plaintiffs have failed to show that common evidence predominates with respect to their theory of class-wide antitrust impact based on a decrease in the quality of services offered by Mission Health,” Davis wrote in his order.
Opportunity to try again
Davis did not dismiss the plaintiff’s motion with prejudice, leaving the door open for them to address the judge’s concerns and file again asking for class certification. As part of his order, Davis asked both parties to come up with a schedule for filing a new class certification motion.
The lawsuit, filed in 2021 in Buncombe County, was brought by Raleigh-based Wallace & Graham, one of the law firms leading class action litigation over contaminated water and Marine Corps base Camp Lejune, and Fairmark Partners, a national antitrust and civil rights law firm.
Mona Lisa Wallace, a founding partner at Wallace & Graham and attorney for the plaintiffs, said she was unable to comment on the order as the litigation was still pending.
Defendants in the case include HCA Healthcare, Mission Hospital, Mission Health System and holding companies for Mission Hospital. It also names ANC Healthcare, a so-called “wind down entity” created to manage the transfer of assets from the sale of Mission Hospital.
In response to emailed questions from the Watchdog, HCA spokesperson Katie Czerwinski said that the company appreciated the court’s decision.
“We have maintained from the outset that the claims in this lawsuit are without merit, and we will continue to vigorously defend against them throughout the legal process,” Czerwinski wrote in her response.
Prior to its acquisition by Nashville-based HCA in 2019, the lawsuit alleges, nonprofit Mission Health had been allowed to develop an unusually dominant share of the region’s healthcare market. In Madison and Buncombe Counties, Mission had a 93% market share, according to the lawsuit.
Now part of a for profit company, the lawsuit alleges that HCA used this market power to require insurers to agree to anticompetitive practices. These, according to the lawsuit, included requiring insurers to contract with all hospitals in the Mission Health network, so-called “anti-steering” and “anti-tiering” agreements, which prevented insurers from encouraging customers to seek cheaper or higher quality healthcare at places other than Mission, and gag clauses to prevent insurers from disclosing contract prices with Mission to the public.
As a result, the lawsuit alleges that the cost of health insurance is roughly 50 to 60 percent higher in Mission’s service area than other parts of North Carolina. Additionally, the lawsuit claims that patients receive “lower quality care than they would in a competitive market.”
The complaint named several “class representatives.” Chief among them is William Allan Davis (no relation to Judge Mark Davis), who saw his doctor’s office close and his doctor’s office close and his premiums rise after HCA acquired Mission, according to the complaint.
Other plaintiffs included a machinist from Burke County whose doctor’s office was closed down after HCA acquired Mission, as well as an Asheville-based auction house, an executive chef and a Black Mountain psychologist who all allegedly had to pay higher health insurance due to Mission’s monopolistic pricing.
Judge: Assumptions too broad
But outside of these named class representatives, Davis said that the lawsuit relied on assumptions that were too broad to determine a class of plaintiffs.
“The Court cannot simply assume that all (or even a significant number) of the putative class members… received in-patient treatment at a Mission Health facility during the relevant time period,” Davis wrote.
Davis based his conclusion in part on the dismissal of a report prepared by one of the plaintiff’s experts, Dr. Robert Town, a healthcare economist and chair of the economics department at the University of Texas at Austin.
It claimed, among other findings, to demonstrate that Mission’s regional monopoly and anticompetitive practices allowed it to demand higher reimbursement rates from insurers, which were then passed on to consumers in the form of higher insurance costs.
In his ruling siding with a defense motion to have the report excluded from the case, Davis wrote that Town’s findings suggested “in the abstract” a correlation between the prices charged by healthcare providers like Mission Hospital and the costs of premiums imposed by commercial health insurers.
But the basis of these conclusions was too broad, according to Davis. In his ruling, the judge found that Town did not develop an economic or statistical model for this particular case, and developed conclusions “based solely on general economic principles” derived from scholarly articles and depositions of insurance company representatives.
This was, Davis wrote, “not a valid substitute for an actual analysis of the real-world effects on the premium amounts paid by the putative class members in this case (emphasis in original) as a result of Defendants’ alleged anticompetitive conduct.”
In August, 2025, Mission and HCA settled a separate antitrust lawsuit with the cities of Asheville and Brevard, as well as Buncombe and Madison Counties. As part of the agreement, Mission Health agreed to donate $1 million to a newly established charitable fund to provide assistance with healthcare costs for people at up to 400 percent of the federal poverty level. It also committed to keeping Transylvania Regional Hospital in Brevard open for three years beyond the 10 it originally promised.
Davis’ ruling follows other significant legal news for Mission this summer when a state judge threw out several of Mission’s key arguments and cleared the way for trial in a case brought by the North Carolina Attorney General’s Office. The lawsuit, originally brought under now-Governor Josh Stein, accused HCA and Mission of violating key provisions of the asset purchase agreement signed prior to the sale, which required the hospital to maintain emergency and oncology services.
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Ted Clifford is The Watchdog’s investigative reporter focusing on healthcare. He can be reached at tclifford@avlwatchdog.org. The Watchdog’s local reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.
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