The Private Equity Stakeholder Project (PESP) released a report titled "Private equity's joint venture takeover of nonprofit healthcare," detailing more than 500 joint ventures between private equity firms and nonprofit healthcare providers. The report identifies arrangements involving rural hospitals, religiously affiliated health systems, and hospice care providers. PESP argues these arrangements could introduce risks to patients, payers, and employees, specifically citing concerns about profit extraction and a potential decline in the quality of care.

Jim Baker, founder and executive director of the Private Equity Stakeholder Project, stated that the private nature of private equity ownership makes comprehensive reporting difficult. "This is the challenge with private equity – it's private, so they don't have to report what they own," Baker said. "We think this just scratches the surface." The report states that 488 hospitals, representing 8.5% of all private hospitals, are owned by private equity firms.

Joint ventures between private equity-owned healthcare companies and nonprofit healthcare providers operate under Internal Revenue Service (IRS) decisions from 1998 and 2004. These rulings permit nonprofit organizations to retain their tax-exempt status if they maintain control over their mission, prioritize community health, and ensure the venture fulfills charitable purposes.

Steward Health Care, which was the largest private for-profit hospital system in the United States in 2017, filed for bankruptcy in 2024 with $9 billion in debt. Private equity firm Cerberus Capital Management and real estate investment trust Medical Properties Trust backed Steward Health Care. Hundreds of millions in profit were reportedly extracted for investors before its bankruptcy. The bankruptcy led to the closure of hospitals in Boston's Dorchester neighborhood and in Pennsylvania.

Wilson Medical Center in Wilson County, North Carolina, experienced scrutiny regarding patient care. Duke Lifepoint Healthcare acquired a controlling stake in the medical center in 2014. The Centers for Medicare and Medicaid Services investigated the facility due to two patient deaths between 2022 and 2023. The North Carolina Department of Justice also sent a letter to Wilson Medical Center, expressing concerns about patient care and alleged violations of regulations requiring hospitals to treat all emergent patients. Kimberley Sirk, director of marketing and communications for Wilson Medical Center, stated that the issues referenced were addressed previously. "The matters referenced in your inquiry relate to issues that were addressed years ago, and Wilson Medical Center has been in full compliance with Centers for Medicare & Medicaid Services requirements since 2024," Sirk said. "The hospital has undertaken extensive efforts to strengthen process, accountability and oversight."