HCA Healthcare Accused of Inappropriately Transferring Patients to Hospice to Boost Profits and Executive Compensation

Findings from a new report suggest HCA may be transferring patients to hospice inappropriately to reduce its reported in-hospital mortality rate

WASHINGTON – A new report released today by SEIU reveals that the largest hospital corporation in the country, HCA Healthcare, may be transferring patients to hospice inappropriately in an effort to reduce its in-hospital mortality rate and boost executive compensation.

In Masking Mortality, stunning research points to potential profit-driven hospice care practices, including a lawsuit filed by a former HCA surgery chief who alleges he was pressured  to transfer patients to hospice inappropriately, and Statement of Deficiency citations issued by the Centers for Medicare and Medicaid Services (CMS) to HCA hospitals for failing to provide safe patient discharge planning.

The report also found that HCA’s executive compensation is tied to the company’s in-hospital mortality rate. Executives earn bonuses if they reduce the rate of patients who die in HCA hospitals, creating a possible incentive to encourage the practice of quickly shifting seriously ill patients – and patients who are likely to die imminently – to hospice.

“Decisions about treatment for seriously ill patients should never be made based on profits. In the last two years alone, HCA raked in $12.6 billion in profits and paid out $16 billion to shareholders – while short staffing its hospitals roughly 30% below the national average and paying workers poverty wages as low as $12.50 per hour,” said Mary Kay Henry, President of SEIU. “That HCA might also be boosting profits and executive compensation with questionable hospice practices is beyond troubling.”

Analysis of Medicare claims data in the report shows that HCA hospitals have a higher average rate of patient transfers to hospice than the national average, and HCA’s transfer rates are increasing. In fact, HCA’s average hospice transfer rate from its hospitals jumped more than 50% between 2017 and 2021. By 2021, the for-profit hospital giant had a hospice transfer rate nearly 40% higher than the national average, according to the report.

The rate of patients who die on the same day they are transferred to hospice from HCA hospitals has also increased significantly, from about 7% in 2017 to 18% in 2021 – a rate that is well out of line with national trends. These conclusions raise questions about possible corporate interference to decrease the number of in-hospital patient deaths that are counted among the hospital’s in-hospital mortality rate.

The report provides another window into HCA’s business model which is facing mounting accusations of putting profits over patient care. According to SEIU’s previous analysis of federal data, staffing levels at HCA hospitals are 30% below the national average – a situation that drives high levels of worker burnout and turnover and leads to patient care failures at HCA. Additionally, HCA has been accused of engaging in questionable ED admissions, such as admitting patients who may not need inpatient care in order to boost Medicare payouts. 

With the release of this report, SEIU members are calling on regulators to investigate HCA’s practices around patient discharges to hospice and other serious allegations.


More than one million healthcare workers across hospitals, home care, and in nursing homes are united in SEIU, the nation’s largest union of healthcare workers. SEIU is an organization of nearly 2 million members united by a belief in the dignity and worth of workers and the services they provide. SEIU is dedicated to improving the lives of workers, families, and communities to create a more just and humane society.

For more information, visit: https://www.seiu.org