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Hca Hr Business Partner Salary – The North Carolina attorney general’s office had “major concerns about how HCA was selected” to buy Mission Health System, including that “the deck was stacked in its favor from the beginning” by then-CEO Ronald A. Paulus and his advisers Philip D. Green, according to a 2018 internal document obtained by
“With no outside counsel other than Phil Green,” who investigators wrote had an undisclosed “prior business relationship with HCA,” Mission Health’s board of directors decided not to issue requests for competitive bids or hold an auction before agreeing sold Asheville’s flagship hospital system to HCA Healthcare for $1.5 billion, according to a filing prepared ahead of a meeting between Justice Department lawyers and HCA representatives on Oct. 30, 2018.
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Instead, as Paulus “coached HCA behind the scenes on how best to present its case to the Mission Board,” the board invited only one other health care company — identified in other documents as Novant Health of Winston-Salem — to submit a formal bid.
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“Ultimately,” the document says, “an outside observer could conclude that HCA rose to the top among a limited pool of applicants because the deck was stacked in its favor from the beginning by Dr. Paulus and Mr. Mr. Green.”
The attorney general’s office was so concerned about potential conflicts of interest between Paulus and Green that it asked the mission board to re-vote the transaction, wrote Deputy Chief of Staff Laura Brewer
Requests for comment. Green declined an interview request, but noted that the attorney general, after a thorough review, did not object to the sale.
The Oct. 30 document, written by Special Deputy Attorney General Jennifer T. Harrod, who led the North Carolina Department of Justice investigation, was among more than 6,000 records released Feb. 25 by Attorney General Josh Stein’s office in a partial response to public records requests filed by
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The documents contain details not previously made public about the sale of the 133-year-old for-profit hospital system, including that besides HCA and Novant, Carolinas HealthCare System (now Atrium Health) is the only other health care company the Mission is seriously considering. But Carolinas was quickly dismissed and not even invited to make a presentation to the board, records show.
Previous reports on the role of Paulus and Green. They show Green’s negotiated terms — nonbinding proposals — for both a $1.5 billion sale of nearly all of Mission’s assets to HCA and a $650 million joint venture with HCA that would retain some local control. HCA provided Paulus with a written affiliation offer on August 12, 2017, six weeks before the mission board authorized Paulus to engage in conversations and meetings with potential affiliation partners.
Overall, the newly released documents raise serious questions about the role of Paulus, the mission’s president and CEO; his longtime personal friend and advisor Greene; and the mission’s 18-member board of directors, which investigators say appears to have accepted HCA’s arguments for cost savings and improved quality of care “uncritically.”
Under state law, the attorney general has the authority to review any transaction in which a nonprofit corporation sells nearly all of its assets. An investigation into the proposed mission deal began in May 2018.
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By October 2018, Harrod and other attorneys in the attorney general’s office had reviewed thousands of documents related to Mission’s decision to sell, including Paulus and Green’s email exchanges with HCA and other potential partners, as well as board meeting minutes of Mission.
On the afternoon of October 30, 2018, Harrod, at least two other attorneys from the North Carolina Department of Justice, and four HCA representatives met at the Attorney General’s office in Raleigh. No one from the mission attended, records show.
“We see HCA’s purchase of Mission bringing something new and dynamic to the region,” Harrod wrote in an opening statement. She said DOJ investigators had met the previous week with the chair and vice chair of the mission board, who spoke “about how impressed they were with HCA’s efficiency, commitment to patient care and sophisticated data analysis.” .
“At the same time,” she continued, “we have major concerns about how HCA was chosen to be the entity that purchased Mission.”
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Harrod had already expressed concern to the Mission that the terms set out in the letter of intent (LOI) negotiated by Paulus and Greene did not go far enough in protecting the public interest.
“Given Mission Health’s strong operating and financial position, we believe Mission should be well positioned to negotiate robust terms to protect public health interests, as it has done in other similar transactions,” she wrote to mission staff on August 8, 2018.
Instead, on August 30, 2018, HCA and Mission signed a formal contract, called an asset purchase agreement (APA), on terms that the attorney general’s office believed favored HCA.
“Dr. Paulus and Mr. Green were the lead negotiators on the APA,” Harrod wrote in a memo before the meeting on October 30, 2018. “It appears that by comparing the terms of the LOI to the terms of the APA, HCA has significantly improved its position.”
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“One of the primary incentives for Mission to enter into the LOI with HCA was the promise that the hospitals and services would be preserved,” Harrod wrote. “We and others advised the mission prior to signing the APA that such commitments must be specific and measurable to be enforceable.”
“The emails we have seen show that Dr. Paulus eventually overcame HCA’s resistance and decided that Mission should simply trust HCA,” she wrote.
Harrod wrote, “Even now, the board believes that HCA is committed to maintaining the current level of services … even though the APA says no such thing.” For example, the agreement allowed HCA to eliminate some services and close facilities if they became “commercially unreasonable,” documents show.
Harrod also wrote that “the mission agreed to allow HCA to use its existing charity care policy, even though it seems to us that most patients would be much better off under the mission’s policy.” Weeks earlier, attorneys both HCA and Mission wrote to Harrod that HCA’s charity care policies were “more generous in most respects” than Mission’s policies.
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In January 2017, six months before it began discussions with Paulus and Greene, HCA agreed to pay $188 million to settle litigation over its purchase of Kansas City-area for-profit hospitals Health Midwest, a deal , similar to hers later dealt with Mission Health.
In a letter dated September 10, 2018, Harrod asked Mission Senior Vice President Donald R. Esposito to “[e]laborate on the assurances the Mission has received that HCA will comply with its contractual obligations in light of the failure to do so regarding with its acquisition of Health Midwest.”
In his October 30, 2018 meeting document, Harrod stated, “Despite Missouri Health Foundation’s efforts, the Mission agreed to challenge the terms of the dispute resolution, which overwhelmingly favors HCA.”
The attorney general’s investigation intensified over the next two months and included ensuring that Mission’s board knew of Green’s prior business dealings with HCA.
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“We asked that the board be fully informed of this relationship and then vote on the deal again,” said Brewer, the deputy chief of staff,
This week. “We also ensured that Mr. Green would not receive any compensation contingent on the completion of the transaction, including a ‘bonus’ or ‘success fee’ and that neither he nor his company would otherwise benefit from the transaction.” “
The mission board held special sessions on December 13 and 20, 2018 and on January 8, 2019 to discuss the final details of the pending transaction, including the findings of the Harrod investigation.
Ultimately, mission board chairman John R. Ball wrote in a letter to Stein after the Jan. 8 meeting that the board had considered the attorney general’s concerns and “concluded that the mission’s management team and its outside advisers have engaged through all the while securing the best possible deal for Mission with potential merger partners, ultimately leading to the deal with HCA.”
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“No member of the mission’s leadership or its advisers has taken any action or failed to take anything to the detriment of the mission’s interests,” Ball wrote.
The mission board, Ball wrote, “believes it has been and remains fully informed regarding all of these matters” and is “unwavering” in its goal to close the sale of HCA. The board’s re-vote was again unanimous.
Stein said state law limited his authority to halt the sale despite the information uncovered by his investigation. Because of the limitations of the law, Stein said, he asked for specific enforceable covenants, a number of concessions from HCA and 15 additional terms to be added to a revised asset purchase agreement.
Stein’s terms included hiring an independent monitor to monitor HCA’s compliance with the agreement; enforceable commitments to maintain current levels of service at all six hospitals in the mission system, not for the five years that Paulus and Green agreed upon in some cases, but for 10 years; and requiring the HCA to accept what he considered to be a more generous mission
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