Antitrust Law Daily Wrap Up, ANTITRUST—N.C. Super.: Judicial economy no longer seen in expedited adjudication of claims against HCA Healthcare, (Oct 15, 2025)

By Justin Marcus Smith, J.D.

The parties got ahead of themselves presenting issues and evidence the court was not expecting when it said, earlier, that it would be willing to decide pure contract law questions on an expedited schedule.

A North Carolina Superior Court declined to adjudicate the merits in an antitrust action against HCA Healthcare in “piecemeal” fashion after having previously indicated a willingness to consider expedited summary judgment on pure questions of law. The court found the parties recently raised unanticipated complexities that strayed well beyond pure legal interpretation of contractual provisions the HCA defendants allegedly used to monopolize the healthcare market near Asheville, North Carolina. The court said it wanted a more complete factual record. The court accordingly denied the HCA defendants’ motion for summary judgment without prejudice. The court also denied the HCA defendants’ motion for more case management adjustment as moot (Davis v. HCA Healthcare Inc., No. 2021CVS3276 (N.C. Super. Oct. 13, 2025)).

Background. In August 2021, a number of North Carolina resident insurance buyers brought a state court antitrust class action HCA Healthcare, Inc. and related HCA entities, as well as ANC Healthcare, Inc. (ANC) and related Mission Hospital, Inc. (Mission) (collectively, defendants). The North Carolina residents asserted the following claims: (1) monopolization in violation of the North Carolina Constitution and state statute; (2) attempted monopolization in violation of North Carolina statute; and (3) restraint of trade in violation of North Carolina statute.

HCA acquired the ANC defendants in 2019. The disputed geographic market encompasses the Asheville, North Carolina area and surrounding western North Carolina region, where HCA presently operates the ANC hospital system. Before the acquisition, ANC operated with the benefit of a Certificate of Public Advantage (COPA) protecting it from antitrust scrutiny. The insurance buyers alleged the COPA law enabled the defendants to monopolize inpatient services in Buncombe and Madison counties. Residents of western North Carolina alleged they paid higher prices for healthcare services because of the defendants’ putative antitrust violations.

In September 2022, the instant North Carolina Superior Court for Buncombe County dismissed the insurance buyers’ monopoly claims; however, it ruled they stated a claim for relief for restraint of trade. In April 2023, the court declined to dismiss amended monopoly claims for inpatient services and monopoly maintenance claims. The insurance buyers alleged the defendants engaged in anticompetitive negotiating tactics with commercial health plans and used tying, anti-tiering, and anti-steering contractual provisions that caused higher insurance premiums and lower quality care. The court found sufficient facts to support monopoly maintenance and leveraging claims for inpatient services in some areas. However, the court also found that claims about monopoly leveraging of outpatient services were deficient in the absence of market share or price control allegations.

In June 2023, the insurance buyers filed a Second Amended Class Action Complaint, and the parties thereafter engaged in discovery. In February 2025, the court entered a case management order providing for an early motion for summary judgment (February 2025 order).

In August 2025, the defendants moved for summary judgment pursuant to the February 2025 order. After receiving the insurance buyers’ opposition, the defendants additionally moved for more adjustment of the case management schedule to allow the ANC defendants to (1) file a separate reply brief in support of the defendants’ motion for summary judgment; (2) depose two plaintiffs’ expert witnesses; and, (3) file a motion to exclude the plaintiffs’ expert witnesses. The plaintiffs opposed further adjustment.

In September 2025, the court deferred on the adjustment issues, but it ordered it would allow the HCA defendants and ANC defendants to file separate reply briefs in support of summary judgment. In support of the motion for adjustment, the defendants contended the plaintiffs’ designation of expert witnesses was premature while the contract interpretation issues the defendants raised for summary judgment were matters of law that did not require any expert analysis. The defendants reiterated they should be allowed to depose the plaintiffs’ expert witnesses and to file motions to exclude them.

The plaintiffs countered that the court did not previously prohibit them from offering expert affidavits in opposition to summary judgment. They also contended they had to have expert analysis for the court to decide the effects of contractual provisions the defendants allegedly used to monopolize the market.

Unanticipated complexities. The court recalled how it believed, at the time it issued its February 2025 case management order, that judicial economy favored a potential ruling on pure questions of law about the core claims in this matter. In contrast, the present disputes “raised added complexities” the court did not anticipate. The court further noted that the parties did not confine their submissions to the disputed contracts. Instead, they filed nearly 300 exhibits, 25 deposition transcript excerpts, and multiple excerpts of written communications between key witnesses.

The court concluded that “piecemeal” adjudication of the merits was not in the interest of justice. The court said it wanted a more complete factual record before it would consider all desired grounds for summary judgment. The court accordingly denied the defendants’ motion for summary judgment without prejudice. The court also denied the motion for adjustment as moot.

The Case is No. 2021CVS3276.

Judge: Davis, M.

Attorneys: Mona Lisa Wallace (Wallace and Graham, P.A.) for William Alan Davis. John A. Robinson (Roberts & Stevens, P.A.) for HCA Healthcare, Inc.

Companies: HCA Healthcare, Inc.

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