ROLEY, North Carolina (AP) — North Carolina’s seven largest hospital systems saw significant financial gains last year, even as they received billions of dollars in federal assistance during the pandemic. according to the report released Wednesday from the State Treasury.

The Public Employees Health Plan, overseen by Treasurer Dale Falwell’s agency, and the National Academy of Public Health Policy reviewed the audited financial records of hospital systems.

They found that the systems – Atrium Health, Cone Health, Duke Health, Novant Health, UNC Health, Vidant Health and WakeMed – reported a combined net income of $5.2 billion in 2021. The seven non-profit systems also saw a combined increase in cash and investment. $7.1 billion from 2019 to 2021, the report says.

The report, which was reviewed by a professor at the Johns Hopkins Bloomberg School of Public Health, said prosperity came when health plans accepted $1.5 billion in COVID-19 relief funds and $1.6 billion from Medicare to prepay for services during pandemics.

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Folwell, whose office issued two other reports since last fall, criticizing major non-profit hospitals for their financial and philanthropic practices, said such federal assistance should help struggling hospitals and care for patients in need.

“As wealthy systems gobbled up the lion’s share of North Carolina’s hospital aid dollars, rural and underprivileged hospitals starved,” the report said.

Falwell, a Republican first elected in 2016, said seven hospital systems should return federal taxpayer-funded dollars or cut rising patient spending on hospitals.

According to the North Carolina Health Association, which represents for-profit and non-profit hospitals, seven health systems represent more than 80 hospitals in the state.

Association stated in a written statement that the report “falsely demonizes health systems for supplying and using” COVID-19 relief funds for healthcare workers and “conveniently forgets” that hospitals were facing an “unknown virus” in 2020. Hospital systems did not receive additional money for the costs and lost profits associated with delta and omicron options, which increased the number of COVID-19 hospitalizations.

“Selecting financial data and then processing it doesn’t reflect many of the huge issues and challenges that the hospital industry faces,” it said in a statement.

Folwell also supports pending law this would require North Carolina hospitals to provide a minimum level of free or subsidized care to uninsured low- and middle-income residents.

“You have to take care of the massive transfer of wealth that’s going on in this state from the citizens to these multi-billion dollar nonprofits,” he said at a press conference. The state health plan covers nearly 750,000 teachers, government employees, retirees and their dependents, making them the state’s top beneficiary of hospital services.

Wednesday’s speakers paid a lot of attention to Charlotte-based Atrium Health, which has received more than $1 billion in COVID-19 relief and Medicare advances, according to the report. According to the report, Atrium had a net profit of $1.2 billion in 2021.

Atrium Health Representative Dan Fogleman said The News & Observer of Raleigh claims that the funds received by the system covered only a small part of what it lost due to the pandemic.

The funds helped pay for many needed services, including mass vaccinations and testing for COVID-19, as well as personal protective equipment and ventilators, he said. They also helped Atrium avoid layoffs and keep rural hospitals open in its system, Fogleman said.

“It is alarming that healthcare systems like Atrium Health are under attack while we are still taking care of communities that are recovering from the pandemic,” he said.

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