HCA Healthcare, Inc. (historically known as Hospital Corporation of America) is an American global for-profit operator of health care facilities that was founded in 1968. It is based in Nashville, Tennessee, and, as of May 2020, owned and operated 186 hospitals and approximately 2,400 sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics in 20 states and the United Kingdom.[5] As of 2024, HCA Healthcare is ranked #61 on the Fortune 500 rankings of the largest United States corporations by total revenue.[6] In the 1990s, the company engaged in illegal accounting and other crimes that resulted in the payment of more than $2 billion in federal fines and other penalties, and the dismissal of the CEO Rick Scott by the board of directors.[7]
History
Early years
The Hospital Corporation of America (HCA) was founded in 1968 in Nashville, Tennessee, by Thomas F. Frist Sr., Thomas F. Frist Jr. and Jack C. Massey.[8] The founders envisioned a company that would bring together hospitals to deliver patient-focused care while using the combined resources of the organization to strengthen hospitals and improve the practice of medicine.[9] The company began with Nashville's Park View Hospital, which the elder Frist had founded in 1960 with other doctors and where he was serving as chief executive.[9]
The company included 11 hospitals when it filed its initial public offering on the New York Stock Exchange (NYSE) in 1969[9] and had 26 hospitals and 3,000 beds by the end of the year.[8][9]
Growth and merger
The 1970s were characterized by rapid growth in the industry and for HCA Healthcare. In the early 1980s, the focus shifted to consolidation with HCA Healthcare acquiring General Care Corporation, General Health Services, Hospital Affiliates International and Health Care Corporation. By the end of 1981, the company operated 349 hospitals with more than 49,000 beds.[10] Operating revenues had grown to $2.4 billion.[8]
In 1987, HCA Healthcare, which had grown to operate 463 hospitals (255 owned and 208 managed), spun off HealthTrust, a privately owned, 104-hospital company. Believing its stock was undervalued, the company completed a $5.1 billion leveraged management buyout led by chairman Thomas F. Frist Jr.[11] in 1988.[8] HCA Healthcare re-emerged as a public company in 1992.
In February 1994, HCA Healthcare merged with Louisville, Kentucky-based Columbia Hospital Corporation, which earlier had acquired 73 hospitals of Galen Health Care from Humana,[12]
Columbia Hospital Corporation
In 1988, Rick Scott and Richard Rainwater each put up $125,000 in working capital in their new company, Columbia Hospital Corporation;[14] they borrowed the remaining money needed to purchase two struggling hospitals in El Paso for $60 million. Then they acquired a neighboring hospital and shut it down. Within a year, the remaining two were doing much better.[15] By the end of 1989, Columbia Hospital Corporation owned four hospitals with a total of 833 beds.
In 1992, Columbia made a stock purchase of Basic American Medical, which owned eight hospitals, primarily in southwestern Florida. In September 1993, Columbia did another stock purchase, worth $3.4 billion, of Galen Healthcare, which had been spun off by Humana Inc. several months earlier.[16] At the time, Galen had approximately 90 hospitals. After the purchase, Galen stockholders had 82% of the stock in the combined company, with Scott still running the company.[17]
Recent history
On November 17, 2006, HCA became a private company for the third time when it completed a merger in which the company was acquired by a private investor group including affiliates of Kohlberg Kravis Roberts and Bain Capital, together with Merrill Lynch and HCA Healthcare founder Thomas F. Frist Jr. The total transaction was valued at approximately $33 billion, making it the largest leveraged buyout in history at the time, eclipsing the 1989 buyout of RJR Nabisco.[18]
In May 2010, HCA announced that the corporation would once again go public with an expected $4.6-billion IPO as HCA Holdings, Inc. In March 2011, HCA sold 126.2 million shares for $30 each, raising about $3.79 billion, at that time, the largest private-equity backed IPO in U.S. history.[19] In May 2017, the corporation was renamed HCA Healthcare.[20]
In December 2018, a historical marker was installed in the parking lot of HCA's Sarah Cannon Cancer Center in Nashville, formerly the location of HCA's first hospital, Park View Hospital.[21]
Facilities
United States
As of 2024, HCA has 186 hospitals.[29] They also report operating more than 2,400 additional sites of care, including surgery centers, freestanding ERs, urgent care centers, and physician clinics located in 20 U.S. states and in the United Kingdom.[30] A significant portion of those hospitals are situated in Florida and Texas. As of 2022, HCA had 47 hospitals and 31 surgery centers in Florida,[31] and 45 hospitals and 632 affiliated sites of care in Texas.[32] In 2021, it announced plans to build 3 new hospitals in Florida.[33] In 2022, The Dallas Morning News reported that HCA will build 5 new hospitals in Texas.
Significant areas of operation
Medical education
In recent years, HCA Healthcare has become a significant provider of clinical and medical education. It is the largest sponsor of graduate medical education programs in the U.S., with 56 teaching hospitals in 14 states, primarily in regions with a deficit of physician training programs. The company includes Research College of Nursing and Mercy School of Nursing, and has several advanced nursing simulation training centers.[51] In early 2020, it completed the purchase of a majority stake in Galen College of Nursing,[52] which operates 21 campuses in 12 states, offering Bachelor of Science and Associate of Science nursing degrees.[53]
Controversies
Medicare billing practices lawsuit
In 1993, lawsuits were filed against HCA by former employees who alleged that the company had engaged in questionable Medicare billing practices.[7] In 1997, with a federal investigation by the FBI, the IRS and the Department of Health and Human Services in its early stages, the Columbia/HCA board of directors forced Rick Scott to resign as chairman and CEO amid growing evidence that the company "had kept two sets of books, one to show the government and one with actual expenses listed."[7] Thomas Frist, a co-founder of HCA and brother of U.S. Senator Bill Frist, returned to the company as CEO in 1997[7] and called on longtime friend and colleague Jack O. Bovender Jr. to help him turn the company around.[54]
The federal probe culminated in 2003 with "the government receiving a total of over $2 billion in criminal fines and civil penalties for systematically defrauding federal health care programs."
See also
- Private medicine in the United Kingdom
Further reading
External links
References
- HCA Healthcare Fact Sheet HCA Healthcare, June 2019, retrieved 23 June 2020^
- John Reay President and Chief Executive Officer HCA Healthcare, retrieved 23 June 2020^
- HCA Healthcare Form 10-K U.S. Securities and Exchange Commission, July 30, 2025