Healthcare Union Issues Blistering Report Targeting HCA for Alleged Malfeasance

The report cites “possibly illegal, unethical patient care.”  

One of the largest unions in the country and one of the largest healthcare organizations in the country are suddenly engaged in a very public war of words.

It all started when the Service Employees International Union (SEIU) last week issued a 41-page report alleging wrongdoing by the Nashville-based HCA Healthcare for what the union said were “practices that maximize profits at the expense of patient care, working conditions, and responsible corporate behavior.”

“HCA’s hospital markups are generally more than twice the national average, and many HCA hospitals have markups as high as 12 or 13 times the cost of care. At the same time, HCA pays tens of thousands of its employees poverty wages, and staffing levels in its hospitals lag the national average by about 30 percent, despite the fact that higher staffing levels are associated with better patient care,” the report read. “Given this unbridled pursuit of profit over all else, it should be no surprise that HCA’s profits are astonishingly strong – they made $3.75 billion in profit just last year despite the pandemic – and since 2010, the company has paid out more than $29 billion to investors in dividends and share repurchases.”

The report overview was just getting started.

“Based on the new research contained in this report, these high profits and payments to investors may originate, in part, from apparent fraud: HCA appears to routinely admit patients for inpatient hospital stays regardless of medical need, as illustrated by SEIU analysis of Medicare data and lawsuits filed against HCA,” it read. “This analysis, described in our report, indicates that HCA’s practice of over-admitting patients may have brought in nearly $2 billion in excess Medicare payments since 2008.”

SEIU labeled the practice “possibly illegal” and “unethical,” saying it “pads HCA’s pockets by costing taxpayers and consumers billions in reimbursement for unnecessary procedures and services, while also exposing patients to unnecessary risk.”

“These business practices – all of which preceded the pandemic and may be continuing – are extremely troubling in a moment when we need our nation’s hospitals to safely treat large numbers of COVID patients, as well as patients who require lifesaving procedures,” the report read. “In particular, HCA’s staggeringly low staffing levels leave nurses and other healthcare workers overworked and shorthanded. As the pandemic has raged on since March 2020, HCA’s continued practice of understaffing has only further exacerbated the strain and burden placed on our nation’s frontline healthcare workers. HCA’s over-admittance practice, moreover, has serious patient care implications. Over-admitting without medical justification may unnecessarily put tens of thousands of HCA hospital patients every year at increased risk of hospital-acquired infections – including exposure to COVID-19.”

HCA, which runs hospitals in 20 states, concentrated mostly in the Southeast, strongly denied the allegations in a statement issued to Becker’s Hospital Review.

“It is disappointing, but not surprising, that the SEIU labor union is once again resorting to antics like this to gain publicity. Throughout the pandemic, the SEIU continually has chosen to attack hospitals that are focused on providing the best care to their patients during an unprecedented and challenging time,” the statement read. “Our hospitals are staffed by physicians, clinicians and nurses who work tirelessly to ensure our patients receive medically necessary care in the appropriate clinical setting. We are confident that our operational processes and procedures are working well and that we are meeting the healthcare needs of our patients and communities.”

Becker’s noted that SEIU is one of the largest unions in the U.S., representing about 2 million members in healthcare, the public sector, and property services. HCA has been a repeated target for the union, with prior announcements slamming what it described as a failure to protect employees from COVID while its CEO earns nearly $27 million annually.

It remains to be seen whether the current issue at hand will lead to litigation or review by federal oversight entities.


Mark Spivey

Mark Spivey is a national correspondent for,, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade.

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