HCA Healthcare is the largest for-profit hospital operator in the United States. It was founded in 1968 in Nashville by Dr. Thomas Frist Sr., his son Dr. Thomas Frist Jr., and businessman Jack C. Massey, and today operates 191 hospitals and roughly 2,500 ambulatory and outpatient sites across 20 states and the United Kingdom. The company reported $75.6 billion in revenue in 2025 and carries a market capitalization above $120 billion.
The leadership orbit centers on CEO Sam Hazen, an HCA employee since 1983 who has run the company since January 1, 2019, and on the Frist family, which owns roughly 20 percent of the shares and holds the board chairmanship through Thomas F. Frist III. The family is among the wealthiest in America, and its reach extends into politics: former U.S. Senate Majority Leader Bill Frist is part of the family.
Beyond bedside care, HCA holds one of the largest private repositories of patient information in the country, and its dominant position in many metro areas gives it leverage over pricing, staffing, and access. A 2023 cyberattack that exposed data on about 11 million patients underscored how much sensitive information is concentrated in a single shareholder-driven company.
What they control
- 191 hospitals and roughly 2,500 outpatient and ambulatory sites across 20 states and the United Kingdom
- Dominant or near-dominant hospital market share in many metropolitan areas, from Nashville to parts of Florida, Texas, and western North Carolina
- One of the nation's largest private holdings of patient data, spanning clinical, demographic, and billing records
- Pricing, staffing, and capital-allocation decisions affecting millions of patients and tens of thousands of clinicians
- A leading hospital-industry lobbying and political-donation presence
- Frist family ownership of about 20 percent of shares plus the board chairmanship
Key institutions & holdings
Largest U.S. for-profit hospital operator; $75.6B revenue in 2025.
Thomas F. Frist III chairs the board; among the wealthiest U.S. families.
HCA is a leading voice in hospital-industry policy and payment fights.
Key facts
- Founded in 1968 in Nashville by Drs. Thomas Frist Sr. and Jr. and Jack C. Massey.
- Operates 191 hospitals and roughly 2,500 ambulatory sites across 20 states and the U.K. (2025).
- Reported $75.6 billion in revenue in 2025, with a market capitalization above $120 billion.
- The Frist family owns about 20 percent of outstanding shares; Thomas F. Frist III is board chair.
- CEO Sam Hazen, an HCA employee since 1983, has led the company since Jan 1, 2019; his total compensation has run around $26 million a year.
- A 2023 cyberattack exposed the personal data of about 11 million patients across 20 states.
Timeline
- 1968Founded as Hospital Corporation of America in Nashville, Tennessee.
- 1994Merges with Columbia Hospital Corporation (Rick Scott) to form Columbia/HCA.
- 1997-2003Federal Medicare-fraud investigation leads HCA to pay more than $1.7 billion in fines and penalties.
- 2006Taken private in a roughly $33 billion leveraged buyout (KKR, Bain Capital, Merrill Lynch, and the Frist family).
- 2011Returns to public markets in a major IPO.
- 2019Sam Hazen becomes CEO, succeeding Milton Johnson.
- 2023A criminal cyberattack exposes data on about 11 million patients.
- 2025Reports $75.6 billion in revenue; settles antitrust claims in North Carolina and a multistate nurse training-debt case.
Controversies
Largest health-care fraud case of its era · 1997-2003
After the 1994 Columbia/HCA merger, a federal investigation found systematic Medicare and Medicaid fraud, including kickbacks to physicians and inflated billing; HCA ultimately paid more than $1.7 billion in fines and penalties in settlements between 2000 and 2003.
Mission Health antitrust and service cuts · 2022-2025
After acquiring Asheville's Mission Health in 2019, HCA faced lawsuits from western North Carolina governments alleging monopolistic practices and service reductions; HCA settled in 2025, and federal regulators issued an 'immediate jeopardy' sanction over conditions at the flagship hospital.
Nurse training-debt scheme · 2025
The attorneys general of California, Colorado, and Nevada found HCA required entry-level nurses into a training-debt arrangement that effectively trapped them in their jobs; HCA agreed to a $3.5 million settlement in 2025.
2023 patient data breach · 2023
A criminal cyberattack exposed the personal information of about 11 million patients across 20 states, one of the largest health-care breaches on record, prompting class-action litigation.
Network
- Thomas F. Frist IIIBoard chairman / heirRepresents the founding family's continuing control of HCA.
- Sam HazenCEOCareer HCA executive leading the company since 2019.
- Thomas F. Frist Jr.Co-founder / family patriarchHelped build HCA into a national hospital chain.
- Bill FristFamily memberFormer U.S. Senate Majority Leader, tying the family to national health policy.
- Rick ScottFormer Columbia/HCA CEOLed the merged company until 1997; later Florida governor and U.S. senator.
Why this matters
As the largest for-profit hospital company, HCA's decisions about which hospitals to buy, where to cut staff, and how to set prices directly affect whether millions of Americans can get affordable care, often in regions where it faces little competition. Its vast holdings of patient data, exposed in a breach affecting about 11 million people, show how much sensitive information sits inside a single shareholder-driven company, while its history of fraud settlements and antitrust disputes raises the question of accountability when health care is run for profit.