Buy and Bust: Collapse of Private Equity-Backed Rural Hospitals Mired Employees in Medical Bills

The primary surprising invoice arrived in December, simply weeks earlier than Tara Lovell’s husband of 40 years died from bladder most cancers.

Lovell labored as an ultrasound technologist on the native Audrain Group Hospital, in Mexico, Missouri, and was paying greater than $400 a month for medical insurance by her job. The city’s struggling hospital, the only real well being care supplier and main employer, had modified possession lately, promoting in March 2021 to Noble Well being, a personal equity-backed startup whose managers had by no means run a hospital.

One 12 months later, dealing with staggering debt and a pile of lawsuits, Noble closed the hospital and one other one it owned in neighboring Callaway County. It’s now the main target of at the very least two federal investigations.

Because the hospitals collapsed, Lovell and the services’ doctors, nurses, and patients saw evidence that the brand new house owners had been skimping on companies — failing to pay for and inventory surgical provides and medicines. For instance, in Callaway, state inspectors deemed conditions in the hospital to be endangering patients. What was much less obvious, former staff mentioned, was that Noble had additionally stopped paying for worker well being, dental, imaginative and prescient, and life insurance coverage advantages. They had been unknowingly uninsured.

Lovell and others mentioned they realized — after evaluating notes about canceled dental appointments, out-of-pocket prices for glasses, and shock payments — that Noble had taken cash from their paychecks for advantages however did not pay for protection.

Lovell took day off to look after her husband in June 2021 and requested full-time go away in August. She retired Dec. 31, 2021, however paid Noble for insurance coverage till March 2022.

“None of us knew till it was too late,” Lovell mentioned. She mentioned she faces $250,000 to $300,000 in medical payments from the final months of her husband’s life. “All they needed to do was inform us that we didn’t have insurance coverage.”

The U.S. Division of Labor’s Worker Advantages Safety Administration, after receiving complaints from Lovell and different workers about shock medical payments and the lack of life insurance coverage advantages, launched an investigation in early March, based on a DOL letter despatched to the corporate and obtained by KHN. Scott Allen, an company spokesperson, declined to remark or verify the investigation.

The company confirmed a second investigation by a special division, Wage and Hour, into Noble’s administration of its Audrain hospital and clinic. DOL spokesperson Edwin Nieves didn’t provide particulars as a result of “it may jeopardize an investigation.” The inquiries may take greater than a 12 months and will end in penalties and cost of again advantages and wages, as required by federal regulation. The circumstances is also referred to the U.S. Justice Division for felony inquiries.

Noble closed the hospitals in late March, citing on social media “a technology issue” and a must “restructure their operations.” Interviews with former workers and a KHN assessment of Noble paperwork and inside communications provide a portrait of a enterprise in a free fall. Workers had been shorted their pay and advantages. Distributors sued over greater than $4 million in unpaid bills, lawsuits present. And as its disaster deepened, Noble borrowed almost $10 million in dangerous loans with rates of interest from 25% to 50%, based on former workers with information of the corporate’s funds.

No Noble govt responded to requests for interviews or to particular questions.

An empty parking lot in front of a hospital building.
After Noble Well being purchased Audrain Group Hospital final 12 months, workers started evaluating notes about canceled dental appointments, out-of-pocket prices for glasses, and surprising payments. They are saying they slowly realized that their employer had taken cash from their paychecks for advantages however did not pay for his or her medical, dental, imaginative and prescient, and life insurance coverage protection. (Matt Kile for KHN)

Why Noble was in such dire straits is unclear: The corporate, which acquired each hospitals throughout the pandemic, accepted almost $20 million in federal covid-19 reduction funds, together with $4.8 million from paycheck safety packages, based on public data.

On April 20, Noble offered each hospitals — for $2 — to Texas-based Platinum Neighbors, which assumed all liabilities, according to the sales agreement. The day earlier than, Platinum Well being Techniques President Cory Countryman, in a pointy blue swimsuit, promised to do proper by workers as they gathered within the Audrain hospital cafeteria, most carrying denims and sneakers, based on a video shared with KHN.

“A number of issues are going to be on the precedence listing for us. Get everyone paid as much as the place they need to be. That’s you guys,” Countryman mentioned. He additionally mentioned the corporate would reopen the hospitals. Months later, neither has occurred.

Countryman didn’t reply to a reporter’s questions for this text.

Amy O’Brien, chief govt of the Audrain hospital, mentioned “the docs and employees are hanging in right here with us and actually combating for the group and the sufferers they serve.” Platinum hopes to open Audrain in September, O’Brien mentioned. She declined to touch upon Callaway.

Rural hospital closures aren’t uncommon — 140 have failed nationwide since 2010. Most frequently, they slowly fade away as a result of funds for the everyday affected person base — people who find themselves uninsured or lined by low-paying authorities packages — can not maintain fashionable care.

However Lovell mentioned Noble’s strategies felt significantly “evil.” At 64 years previous, she misplaced her husband and left her job. Now Lovell fears the unpaid medical payments will jeopardize her monetary safety: “I can’t consider they’d do that to human beings.”

Tara Lovell labored at Audrain Group Hospital for 44 years earlier than taking go away to look after her husband, Donald. He died in January 2022 from bladder most cancers, and the medical payments piled up. (Matt Kile for KHN)

‘The place Did All of the Cash Go?’

Noble’s funds had been buckling by the point Lovell and others mentioned they realized they had been uninsured.

Noble was launched in late 2019 by enterprise capital and private-equity agency Nueterra Capital. Nueterra purchased the Callaway County hospital in 2014 earlier than handing over administration to Noble in December 2019. Noble later purchased Callaway Group Hospital after which Audrain. Nueterra and Noble shared workplace area in Leawood, a suburb south of Kansas Metropolis, Kansas, based on former workers and public data.

A Missouri state filing lists Noble’s administrators as Nueterra Chairman Daniel Tasset and Donald R. Peterson. Its executives included Tom Carter and, finally, William A. “Drew” Solomon. In a March e mail to KHN, Peterson mentioned they created the corporate to “save a rural hospital that was about to shut.”

Tasset didn’t reply to requests for remark, and Peterson mentioned he was unavailable for an interview.

Though the Facilities for Medicare & Medicaid Providers vets such purchases, these appeared less-than-ideal patrons: None had expertise operating a hospital, and Peterson had been accused of Medicare fraud. Peterson settled that case with out admitting wrongdoing and agreed to be excluded for 5 years from Medicare, Medicaid, and all different federal well being care packages, according to the U.S. Health and Human Services Department’s Office of Inspector General.

Greater than a dozen lawsuits were filed in Missouri courts alleging that Noble owed cash to distributors and contractors that supplied companies together with nursing, landscaping, meals, and covid testing. In almost half, judgments have been entered towards Noble, lots of them for “failing to appear.”

Shortly after Noble took over the Audrain hospital, Kristy Melton, the power’s blood financial institution supervisor, obtained an e mail from its blood provider saying it hadn’t been paid for a number of months. Affected person care deteriorated: The Callaway hospital was thought-about so “at risk” that state well being division inspectors eliminated its sufferers.

Melton, 63, had labored on the Audrain hospital for almost 25 years. As of July, neither Noble nor Platinum had absolutely paid her wages, she mentioned. Melton and others are counting on unemployment advantages, she mentioned, including that hers are set to finish in September.

Kristy Melton was the blood financial institution supervisor for Audrain Group Hospital in Mexico, Missouri, when the hospital closed in March 2022. She says that her wages haven’t been absolutely paid and that her unemployment advantages are set to run out in September. (Matt Kile for KHN)

In late June, Platinum requested that Missouri officers lengthen a deadline to reopen the hospitals to September.

Whether or not Platinum, a personal firm, realized the extent of the liabilities, or debt, it accepted when buying Noble is unclear.

One former high-level Noble worker, who spoke on the situation of anonymity due to concern of litigation, estimated that Noble’s debt totaled $45 million to $50 million, together with what was owed to distributors and on greater than a dozen high-interest loans from a number of lenders.

Noble acquired its first high-interest mortgage in August 2021, the worker mentioned, and obtained the ultimate one — at 48% curiosity — the month earlier than the hospitals closed.

“The place did all the cash go for the taxes and advantages?” the worker mentioned in an interview. “I’d get a forensic auditor in there.”

One lender, Itria Ventures, which gives financing to companies, is a subsidiary of Biz2Credit, a New York-based on-line lender. In a lawsuit filed in April, Itria alleges that Noble did not pay on three loans it took out in January 2022.

Itria’s agreements work a lot the identical approach as payday loans do: Noble borrowed almost $2 million, with rates of interest of 25%, promising to pay it off inside seven months. Itria anticipated weekly installments of $67,000. Noble stopped paying in early March, in accordance to the lawsuit. Noble has not responded to Itria’s claims, however courtroom data present it has requested for extra time to take action.

Kristy Melton, who was the blood financial institution supervisor for Audrain Group Hospital, says that months earlier than the hospital closed, she started amassing messages from the hospital’s house owners, printing out emails, and monitoring unpaid payments.(Matt Kile for KHN)

‘I Didn’t Have Actual Insurance coverage’

In early April, Noble Health emailed employees, saying “we will’t let you know how sorry we’re that you simply’re on this state of affairs” and assuring them that their medical, dental, and imaginative and prescient protection would stay in place “at the very least by April 30, 2022.”

By then, hospital staff knew higher. Radiology technician Jana Wolthuis had taken screenshots exhibiting that her dental and imaginative and prescient protection was “terminated as of 1/31/2022.” Later, the insurer would ask Wolthuis to assist claw back $240.40 it “overpaid” the dentist.

The blood financial institution’s Melton was calling the insurer earlier than each appointment. She had already paid greater than $1,400 for dental payments that weren’t lined. “I used to be extraordinarily gun-shy,” she mentioned, noting that she had an insurance coverage card however “I didn’t have actual insurance coverage.”

In March 2022, the Well being Cooperative of Missouri, which had been employed in January as Noble’s insurance coverage dealer, detailed the lacking funds to Noble’s management workforce in a presentation. As of March 16, Noble owed greater than $307,000 in excellent premiums to Principal, Humana, HealthEZ, and the Hartford.

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“Over the previous 11 weeks all the worker advantages plans have been terminated or have had potential termination for lack of cost,” the presentation deck acknowledged, including that Noble was the dealer’s solely consumer that didn’t have an automated digital withdrawal.

This had come up earlier, too. In 2021, Meritain administered Noble’s self-insured advantages plan, which meant it was paid a charge to course of claims for hospital workers’ medical, dental, and imaginative and prescient insurance coverage. Noble was presupposed to pay the charge and fund the plan.

Peterson, Noble’s govt chairman, had not accredited the automated financial institution withdrawals for Meritain’s administration charges, based on a Noble e mail shared with KHN. When despatched kinds to arrange digital withdrawals, the e-mail exhibits, Peterson handed the message on to others, writing: “I hope you guys are dealing with this. — Don.”

The e-mail confirmed Meritain couldn’t entry funds to pay its charges for Audrain hospital since Noble purchased it in March 2021. Callaway charges had not been paid in July and August 2021.

Noble’s Meritain account seems to be a spotlight of the Labor Division’s worker profit investigation, based on the March 2 letter despatched to Solomon. Federal investigator Casey Branning requested paperwork and interviews with Noble leaders and indicated the company would look at the Noble Individuals Worker Profit Plan, the corporate’s human useful resource subsidiary. Solomon couldn’t be reached for remark.

The investigator’s eight-page letter requested for agreements, payroll data, and extra. One bulleted merchandise: copies of payments to Meritain. Another was for “any and all correspondence with workers relating to the Plan and any failure to fund claims.”

Tara Lovell’s husband, Donald, the most cancers affected person, was not the one former worker or member of the family to undergo:

The household of Michael Batty, 63, a hospital janitor who had an aortic aneurysm at work in January 2022, mentioned that they had no thought his life insurance coverage had been terminated for nonpayment. His daughter, Stephanie Hinnah, was the beneficiary of the coverage — with an anticipated payout of $60,000. She was initially instructed she wouldn’t get a cent as a result of the policy had lapsed before her father’s death.

Hinnah, who endured months of stress, mentioned her father wouldn’t have wished to depart his daughter in debt. Sadly, she mentioned, “my dad doesn’t actually have a voice to discuss it.”

To pay for her father’s cremation, Hinnah raised $700 by promoting Batty’s belongings in a storage sale. She mentioned she owed the funeral dwelling about $8,000. She filed an attraction to the Hartford, and months handed. In late July, after KHN contacted the Hartford, a spokesperson, Suzanne Barlyn, instructed KHN that “after additional assessment” the insurer would pay the advantages.

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