HCA Healthcare

HCA Healthcare, Inc.
Company type	Public
Industry	Healthcare
Predecessor	Hospital Corporation of America
Founded	January 1, 1968; 58 years ago in Nashville, Tennessee, U.S.
Founder	Thomas F. Frist Sr., Thomas F. Frist Jr., Jack C. Massey
Headquarters	Nashville, United States
Area served	United States, United Kingdom
Key people	Sam Hazen (CEO), John Reay (CEO of HCA UK)
Products	Hospitals, surgery centers, emergency departments, urgent care clinics, physician offices
Revenue	$60.23 billion (2022)
Number of employees	309000 (2024)
Website	www.hcahealthcare.com

HCA Healthcare, Inc.—previously known as the Hospital Corporation of America—stands as a prominent American for-profit healthcare facility operator, established in 1968 and based in Nashville, Tennessee. By 2024, it manages 186 hospitals and approximately 2,400 additional care locations such as surgery centers, independent emergency departments, urgent care clinics, and physician offices throughout 20 U.S. states and the United Kingdom. Positioned at number 61 on the Fortune 500 ranking by revenue, HCA Healthcare generated $60.23 billion in revenue during 2022 and employs close to 309,000 individuals.

The organization’s operations are divided across several U.S. regions including Capital, Continental, Far West, MidAmerica, Mountain, North Carolina, South Atlantic, TriStar, Central Texas, West Texas, Gulf Coast, North Texas, San Antonio, North Florida, West Florida, and East Florida. Leadership figures include CEO Sam Hazen and John Reay, who serves as CEO of HCA UK.

In the 1990s, HCA Healthcare encountered substantial legal issues related to improper accounting practices that resulted in federal fines exceeding $2 billion and the removal of then-CEO Rick Scott by the board of directors. Despite these challenges, HCA has continued to strengthen its business approach by broadening its healthcare service offerings and increasing its market presence worldwide.

Founding period

The Hospital Corporation of America (HCA) was created in 1968 in Nashville, Tennessee by Thomas F. Frist Sr., Thomas F. Frist Jr., and Jack C. Massey. Their objective was to establish an organization that consolidated hospitals to improve patient care quality and optimize medical practices through shared resources. The company’s origins trace back to Park View Hospital in Nashville—established in 1960 by Thomas F. Frist Sr., who also served as its CEO.

At the time of its initial public offering on the New York Stock Exchange in 1969, HCA owned 11 hospitals and expanded rapidly to control 26 hospitals with a total capacity of 3,000 beds by the end of that year.

Expansion and corporate restructuring

Throughout the 1970s and into the early 1980s, HCA aggressively expanded by acquiring companies such as General Care Corporation, General Health Services, Hospital Affiliates International, and Health Care Corporation. By 1981, the company operated a network of 349 hospitals with more than 49,000 beds and reported revenues totaling $2.4 billion.

In 1987, HCA managed a portfolio of 463 hospitals—255 owned and 208 managed—and subsequently spun off HealthTrust into a private entity controlling 104 hospitals. Considering its stock undervalued at the time, chairman Thomas F. Frist Jr. orchestrated a leveraged management buyout worth $5.1 billion in 1988. The company re-entered public markets four years later in 1992.

In February 1994, HCA combined forces with Columbia Hospital Corporation from Louisville—which had recently acquired 73 hospitals from Galen Health Care—to create Columbia/HCA Healthcare Corporation. Important subsidiaries within this structure included HCA International and Health Corporation of America.

Columbia Hospital Corporation

Established in 1988 by Rick Scott and Richard Rainwater, Columbia Hospital Corporation began with each founder contributing $125,000 in initial capital. The company secured loans to purchase two underperforming hospitals in El Paso for $60 million and subsequently acquired a nearby hospital which was then closed to enhance operational efficiency. By 1989, Columbia’s portfolio included four hospitals totaling 833 beds.

In 1992, Columbia broadened its reach by acquiring Basic American Medical, which managed eight hospitals throughout southwestern Florida. The following year, it completed a $3.4 billion stock deal to absorb Galen Healthcare, a former division of Humana Inc.. This merger combined Galen’s nearly 90 hospitals with Columbia’s assets, creating a substantial healthcare organization. Galen shareholders held 82% ownership of the new entity, while Scott remained as chief executive officer.

Recent history

On November 17, 2006, HCA entered its third phase of privatization through a leveraged buyout valued at $33 billion. This transaction was spearheaded by private equity firms including Kohlberg Kravis Roberts, Bain Capital, Merrill Lynch, alongside founder Thomas F. Frist Jr., representing the largest LBO recorded at that time.

In May 2010, HCA revealed intentions for a $4.6 billion initial public offering, marking its return to public trading under the name HCA Holdings, Inc. The March 2011 IPO raised approximately $3.79 billion at $30 per share, setting a record as the largest private equity-backed public offering in U.S. history up to that point. The company adopted the name HCA Healthcare in May 2017.

By 2018, HCA achieved the No. 67 position on the Fortune 500 list based on revenue, underscoring its considerable expansion and influence within the healthcare sector.

Strategic collaborations have played a vital role in HCA’s technological advancement: in May 2021, it partnered with Google to create healthcare algorithms utilizing patient data; later that August, it joined forces with venture capital firm General Catalyst to foster digital innovations aimed at enhancing clinical workflows and patient care. As part of this agreement, HCA divested its app development subsidiary PatientKeeper.

In April 2022, HCA committed $1.5 million to a collaboration with Florida International University's Nicole Wertheim College of Nursing and Health Sciences to develop nursing infrastructure addressing nationwide workforce shortages.

Recent asset sales include the October 2022 divestiture of Tulane Medical Center and associated facilities to LCMC Health and Tulane University for $150 million (subject to regulatory approval), as well as the March 2024 transfer of West Hills Hospital and Medical Center in Los Angeles to UCLA Health for an undisclosed sum.

United States

As of 2024, HCA operates a network of 186 hospitals along with over 2,400 additional care locations—such as surgery centers, freestanding emergency rooms, urgent care clinics, and physician offices—across 20 states in the U.S. and within the United Kingdom. Its primary markets include Florida and Texas; Florida hosts 47 hospitals and 31 surgery centers as of 2022, while Texas features 45 hospitals plus 632 affiliated care sites. Recent expansions include plans announced to construct three new hospitals in Florida (2021) and five new facilities in Texas (2022). Tennessee remains a core market with 13 hospitals reported in 2019.

Between 2003 and 2017, HCA refrained from entering new markets but exited Switzerland in 2007. Growth resumed through acquisitions: in 2017, it purchased Memorial University Medical Center in Georgia along with three Houston hospitals from Tenet Healthcare. In 2019, HCA acquired Mission Health System located in North Carolina.

In January 2020, HCA added Valify—a healthcare cost management technology company—to its portfolio. Later that year, it increased its presence in Florida by acquiring Shands Starke and Shands Live Oak Regional Medical Centers from CHS, operating them as off-campus emergency departments. Concurrently, HCA sold Garden Park Medical Center to Singing River Health System.

During 2021, HCA divested Redmond Regional Medical Center to AdventHealth for $635 million and transferred four Georgia hospitals to Piedmont Healthcare for $950 million. It also acquired Meadows Regional Medical Center, further bolstering its position within strategic markets.

United Kingdom

HCA International, representing the UK branch of Hospital Corporation of America, manages care for approximately half of all private patients in London. Prominent hospital locations include:

In March 2018, HCA launched urgent care walk-in centres at London Bridge and Portland Hospitals, reporting average wait times of seven minutes for nursing staff and seventeen minutes for physicians. By February 2022, outsourced cleaning personnel at London Bridge Hospital raised concerns regarding insufficient PPE, lack of sick leave, inadequate training, and notifications about COVID-19 contamination risks.

Princess Grace Hospital is recognized for its expertise in breast cancer treatment, with founders Kefah Mokbel and Nick Perry having established The London Breast Institute in 2005 to support this focus.

HCA intends to inaugurate The Harborne Hospital adjacent to Queen Elizabeth Hospital Birmingham in January 2024.

Medical education

HCA Healthcare stands as a leading provider of clinical training and is the largest sponsor of graduate medical education within the United States. It operates 56 teaching hospitals across 14 states, concentrating efforts in areas experiencing physician shortages. Its educational resources comprise the Research College of Nursing and Mercy School of Nursing, alongside advanced nursing simulation facilities. Early in 2020, HCA acquired a controlling interest in Galen College of Nursing, which maintains 21 campuses across 12 states offering both Bachelor’s and Associate degrees in nursing.

Medicare billing practices lawsuit

In 1993, former employees initiated legal action against HCA alleging improper Medicare billing. By 1997, following federal probes by the FBI, IRS, and Department of Health and Human Services, the Columbia/HCA board compelled CEO Rick Scott to step down after uncovering that the company maintained dual sets of accounting records—one for government reporting and another reflecting true expenditures. Co-founder Thomas Frist resumed the CEO role that year and brought on Jack O. Bovender Jr. to assist with corporate restructuring.

The investigation concluded in 2003 with Columbia/HCA agreeing to pay over $2 billion in criminal fines and civil penalties for orchestrated fraud against federal healthcare programs. The company admitted guilt to 14 felony counts, marking this as the most extensive and expensive healthcare fraud case in U.S. history.

2005 insider trading suit

In July 2005, Senator Bill Frist divested all his HCA shares held within a blind trust just two weeks prior to disappointing quarterly results that caused a sharp decline in stock value. He explained this move as an effort to avoid conflicts of interest amid considerations for a presidential campaign. Subsequent disclosures revealed other executives also sold shares concurrently, prompting shareholders to accuse the company of inflating profits to boost stock prices artificially. Eleven high-ranking officers faced lawsuits alleging accounting fraud and insider trading.

HCA resolved these claims in August 2007 by paying $20 million to shareholders without admitting liability or facing formal charges.

COVID-19 PPE

Throughout the COVID-19 pandemic in the United States, staff at HCA hospitals voiced concerns over inadequate personal protective equipment (PPE). In April 2020, criticism escalated after two nurses—Celia Yap-Banago and Rosa Luna—who worked at HCA facilities in Kansas City and California succumbed to COVID-19, underscoring alleged failures in safety protocols despite prior warnings about PPE shortages.

Mission Hospital Acquisition Legal Dispute

On December 14, 2023, the North Carolina Attorney General initiated legal action against HCA, alleging violation of the acquisition agreement terms related to Mission Health. The complaint claimed that HCA's takeover resulted in a decline in the standard of care.

HCA Healthcare responded on February 13, 2024, rejecting all accusations, filing a motion to dismiss the case, and launching a counter-lawsuit against the Attorney General. The company contested the allegations of contractual breaches and deterioration in care quality.

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