--- title: "Government scrutiny of Steward: Congress, federal agencies and states" language: en canonical: https://dossiertwist.com/dossiers/steward-health-care/government-scrutiny/ as_of: 2026-10-14 keywords: ["Steward Health Care System","Ralph de la Torre","Cerberus Capital Management","Medical Properties Trust","Caritas Christi Health Care","Steward Health Care Investors","Chapter 11","sale-leaseback","IASIS Healthcare","Tenet Healthcare","CareMax","TRACO captive insurer","Senate HELP Committee","contempt of Congress","Malta hospitals concession","Vitals Global Healthcare","SHC Creditor Litigation Trust","Massachusetts hospitals","Space Coast hospitals","Stewardship Health"] --- # Government scrutiny of Steward: Congress, federal agencies and states **Question.** Which government bodies examined Steward and its former chief executive, and what came of each action? **Answer.** In 2024 Senators Elizabeth Warren and Edward J. Markey wrote to Ralph de la Torre and Cerberus with questions, and the Senate HELP Committee subpoenaed de la Torre; he did not appear, invoking his Fifth Amendment privilege, and on September 25, 2024 the Senate unanimously passed a criminal contempt resolution, but no prosecution appears in the record, and his suit against the committee was dismissed, a ruling the D.C. Circuit affirmed on July 31, 2026. A 2018 False Claims Act qui tam case against Steward and Cerberus ended in settlement and dismissal in May 2022, while a 2023 U.S. Attorney's complaint, the Arizona Attorney General's 2024 investigation and the federal investigations reported in 2024 have no recorded outcome; a July 2026 newspaper report stated that no criminal charges had been filed. ## Senators' letters, 2024 - Analysis: On February 15, 2024 Senators Elizabeth Warren and Edward J. Markey and members of the Massachusetts congressional delegation wrote to Cerberus Capital Management, L.P. about its relationship with Steward's Massachusetts hospitals and asked for answers by February 28, 2024. On March 7, 2024 the two senators wrote to Ralph de la Torre, as Chairman and Chief Executive Officer of Steward Health Care System in Dallas, that Steward's Massachusetts hospitals were in deep financial distress “because of years of mismanagement, private equity schemes, and executive profiteering,” and asked him to answer questions on executive compensation, Steward's arrangement with Medical Properties Trust (MPT), its debts and the Cerberus transactions by March 21, 2024. That letter states that Cerberus had refused to provide much of the information sought, telling the senators in a February 26, 2024 letter that the question was “more appropriately addressed to Steward and MPT,” and that de la Torre had not answered questions sent to him nearly a month earlier. The characterizations are the senators' own and cite press reports; Cerberus's February 26 letter is not in the reviewed record. Cerberus later published a statement on September 19, 2024 about its former investment in Steward and referred to a letter it said it had provided voluntarily to the Senate HELP Committee, which on July 25, 2024 had subpoenaed de la Torre to testify. [src-037] [src-002] [src-048] [src-041] - Analysis: In their March 7, 2024 letter to Ralph de la Torre the senators also gave their account, citing press reports, of the transactions they asked about. In 2016, they wrote, Steward made a $1.25 billion sale-leaseback deal with MPT, selling its hospital properties and leasing them back, that saddled the hospitals with long-term leases, while Cerberus and members of Steward's management acquired 10 million shares of MPT and MPT took a stake in Steward. Cerberus exited in May 2020 by transferring its ownership to a group of Steward physicians led by de la Torre, in a transaction that ultimately resulted in Steward borrowing another $335 million from MPT in January 2021, and in 2020 MPT invested $200 million in a joint venture with de la Torre acting in a personal capacity, separate from his role at Steward, to pursue international opportunities, which the senators said raised concerns about self-dealing and conflicts of interest. Steward then took a $600+ million loan from a lender consortium in late 2023, a $60 million loan from MPT in January 2024 and a $150 million bridge loan in February 2024. This is the senators' account, not a finding, and their February 15 letter gives the January 2021 MPT borrowing as $355 million. Cerberus stated on September 19, 2024 that no proceeds were exchanged at the time of the 2020 management buyout of its equity and that, when the note was prepaid in 2021, the proceeds came from the note's obligors, affiliates of de la Torre and MPT, not from Steward. Asked by an investigative outlet in October 2024 about the 2020 Cerberus exit deal, a spokesperson for de la Torre said the only benefit he received from the May 2020 recapitalization was to ensure that the hospitals were not put into bankruptcy in the middle of the pandemic and had sufficient funds to continue operating during COVID. [src-002] [src-037] [src-048] [src-065] ## The Senate HELP Committee subpoena and contempt - Analysis: The Senate Committee on Health, Education, Labor, and Pensions (HELP) opened an investigation into the bankruptcy of Steward Health Care System and scheduled a September 12, 2024 hearing titled “Examining the Bankruptcy of Steward Health Care: How Management Decisions Have Impacted Patient Care.” On July 25, 2024 then-Chair Bernie Sanders, with the committee's authorization, subpoenaed Ralph de la Torre, as Chairman and Chief Executive Officer, to testify at that hearing; it was the committee's first subpoena since 1981. On September 4, 2024 de la Torre's counsel submitted objections and indicated he would decline to comply, and on September 5 the committee overruled the objections in their entirety. His counsel wrote to the committee that his testimony would have to be postponed and that members appeared determined to turn the hearing into “a pseudo-criminal proceeding”, and his attorneys said he needed to remain silent to respect an ongoing hospital reorganization and settlement effort. A September 11, 2024 news report quoted Sanders as saying “We will not accept this postponement” and that he was prepared to pursue contempt charges if de la Torre failed to appear. [src-023] [src-041] [src-047] [src-117] - Attributed: Before the hearing, de la Torre’s counsel wrote to the committee that his testimony would have to be postponed and that members appeared determined to turn the hearing into “a pseudo-criminal proceeding”; his attorneys said he needed to remain silent to respect an ongoing hospital reorganization and settlement effort. A September 11, 2024 news report quoted Senator Bernie Sanders as saying “We will not accept this postponement” and that he was prepared to pursue contempt charges if de la Torre failed to appear. [src-117] [src-041] [src-047] - Qualification: Positions of the parties before the September 12, 2024 hearing. - Outcome: De la Torre did not appear at the hearing, and on September 19, 2024 the committee passed resolutions holding him in civil and criminal contempt of Congress (see the contempt claim). - Analysis: Ralph de la Torre did not appear at the September 12, 2024 hearing, and on September 18 his counsel sent a second letter invoking his Fifth Amendment privilege to refrain from testifying. On September 19, 2024 the HELP Committee passed resolutions holding him in civil and criminal contempt of Congress, and on September 25, 2024 the Senate passed the criminal contempt resolution, S. Res. 837 (118th Congress), unanimously. The resolution directs the President of the Senate to certify the committee's report to the U.S. Attorney for the District of Columbia so that de la Torre “be proceeded against in the manner and form provided by law” under 2 U.S.C. 192 and 194. [src-023] [src-041] [src-047] - Analysis: On May 6, 2025 Senators Warren and Markey wrote to Attorney General Pam Bondi about the Senate's September 25, 2024 resolution and its referral to the Department of Justice, noting that under 2 U.S.C. 192 a summoned witness who fails to appear is subject to a fine of up to $100,000 and imprisonment of up to twelve months, and urged the department to give appropriate weight to the bipartisan and unanimous referral. No response from the department appears in the reviewed record. On August 7, 2026 Markey stated that the department “continues to ignore the Senate's unanimous criminal contempt referral” for Ralph de la Torre, and that he and the HELP Committee continued to call on it to hold de la Torre accountable. No contempt prosecution of de la Torre appears in the reviewed record as of the evidence cutoff. [src-057] [src-047] ## De la Torre's suit against the committee - Analysis: On September 30, 2024 Ralph de la Torre sued the HELP Committee and twenty of its members in the U.S. District Court for the District of Columbia (No. 1:24-cv-02776), leaving out only Senator Rand Paul, the one member who had not voted for the contempt resolutions. As summarized by the appeals court, de la Torre alleged that the subpoena lacked a legislative purpose and that the senators' attempts to compel his testimony violated his Fifth Amendment rights, and claimed that their conduct caused him to resign as chief executive officer and chairman of Steward Health. The senators moved to dismiss, arguing that the Constitution's Speech or Debate Clause, which protects members of Congress from suits over their legislative acts, barred the suit. The district court dismissed it for lack of subject-matter jurisdiction under that clause and denied jurisdictional discovery (de la Torre v. Cassidy, 800 F. Supp. 3d 54 (D.D.C. 2025)); a research institute's timeline dates the dismissal to September 16, 2025. On July 31, 2026 the U.S. Court of Appeals for the D.C. Circuit (No. 25-5353; Circuit Judges Henderson, Millett and Garcia) affirmed, calling his arguments “wholly meritless under longstanding precedent” and noting that he “can still raise a constitutional defense should a contempt prosecution move forward.” [src-041] [src-064] ## Request for an SEC investigation of Medical Properties Trust - Analysis: In a separate letter of May 6, 2025, Senators Warren and Markey asked Securities and Exchange Commission Chair Paul S. Atkins to open an investigation into Medical Properties Trust, Inc. (MPT) and its relationship with Steward, writing, citing press reports, that the companies appeared to have “operated in concert,” secretly funneling money to each other to maintain a façade of financial stability in an arrangement with “all the hallmarks of a Ponzi scheme,” which raised questions whether MPT misled its investors and violated securities laws. The request is not a finding, and no SEC action appears in the reviewed record. Responding to an October 2024 investigative report on its dealings with Steward, an MPT spokesperson said “We strongly reject the false and misleading premise of these assertions,” adding that MPT's primary relationship to Steward “has always been that of a landlord.” In a March 30, 2023 letter to shareholders MPT had rejected a short seller's allegation of “pervasive revenue round-tripping”, saying it is not possible to round-trip funds sent directly to third parties. [src-057] [src-094] [src-065] ## Reported federal investigations - Analysis: A July 2024 news report stated that Steward had confirmed it was under federal investigation by the Department of Justice. A reference work states that the U.S. Attorney's office in Boston was investigating Steward as a whole for, among other things, violations of the Foreign Corrupt Practices Act, the U.S. law against bribery of foreign officials, which a Steward spokesperson later confirmed while declining to comment further. An investigation is not a finding of wrongdoing, and no charge against Steward appears in the reviewed record. [src-046] [src-079] - Analysis: Press-based accounts also describe investigations of Ralph de la Torre personally. A research institute's timeline, citing a newspaper, states that between September and December 2024 he was briefly detained as part of federal domestic and international corruption investigations exploring whether he spent Steward funds for personal use, and that in November federal agents obtained a search warrant for his and a colleague's phones. A July 14, 2025 magazine column reported that federal agents served him with a search warrant and seized his phone in fall 2024, that federal prosecutors were exploring embezzlement, fraud and Foreign Corrupt Practices Act charges, and that a February 2025 executive order paused new prosecutions under that act. An October 2024 investigative report, prepared with a newspaper and based on more than 295,000 documents, stated that Steward faced ongoing congressional and grand jury probes over the management of its U.S. hospitals and that Cerberus and de la Torre had extracted more than $1.3 billion from the financially troubled company. A spokesperson for de la Torre said media and “certain politicians” were “trying to fan flames with exaggerated numbers and factually inaccurate soundbites that do not tie to public or audited sources.” Cerberus has stated that its only distribution from Steward was received in 2016 via the MPT transaction and that no proceeds were exchanged at the 2020 management buyout of its equity, and according to a July 30, 2026 newspaper report it continued, under its settlement with Steward's unpaid creditors, to deny any wrongdoing or unlawful conduct. The same July 2026 report stated that no criminal charges had been filed; no grand jury charge appears in the reviewed record, and an investigation is not a finding of wrongdoing. [src-064] [src-084] [src-069] [src-065] [src-048] ## False Claims Act cases and HHS fines - Analysis: On October 11, 2018 a qui tam complaint, a False Claims Act suit filed by private relators on the government's behalf, was filed in the U.S. District Court for the District of Massachusetts on behalf of the United States and the Commonwealth of Massachusetts (United States of America v. Steward Health Care System LLC, No. 1:18-cv-12125). The defendants included Steward Health Care System LLC, Cerberus Capital Management, L.P., Steward Health Care Network, Inc., Steward Medical Group, Inc. and many Steward hospital companies, among them St. Elizabeth's, Good Samaritan, Norwood, Carney, Holy Family, St. Anne's, Morton, Nashoba Valley, Quincy, Sebastian River, Melbourne and Rockledge. The relators are private individuals, and the complaint's allegations are not in the reviewed docket text. The United States and Massachusetts filed a notice of intervention in part for settlement purposes and declination in part on April 27, 2022, and the court later recorded that the case was “resolved by way of settlement and dismissal... on May 20, 2022,” leaving only the relators' attorneys' fees; on October 11, 2023 Judge Richard G. Stearns granted the fee motion in part, ordering Steward to pay 12.5% of the relators' requested fees, costs and expenses, and the case was terminated on October 12, 2023. The settlement terms are not in the reviewed docket text, and a settlement is not an admission of liability. [src-045] - Analysis: On December 18, 2023 the U.S. Attorney's Office for the District of Massachusetts filed a complaint under the False Claims Act against Steward St. Elizabeth's Medical Center of Boston, Inc., Steward Medical Group, Inc. and Steward Health Care System, LLC, which it described as the owner of the other two defendants, alleging that they violated the Physician Self-Referral Law (the “Stark Law”, which restricts physicians' referrals of Medicare patients to entities with which they have financial relationships) and submitted, and caused the submission of, false claims and statements to Medicare. These are the government's allegations; no response from the defendants and no outcome appear in the reviewed record. [src-043] - Analysis: Two further federal matters are known only from a research institute's timeline. It records that on October 13, 2020 the Department of Health and Human Services (HHS) fined both campuses of Holy Family Hospital and Nashoba Valley Medical Center in Massachusetts for failing to maintain proper certifications, recertifications and treatment plans for inpatient psychiatry services, in violation of Medicare billing requirements, and that Holy Family paid a $6.95 million fine and Nashoba a $1.42 million fine; the HHS decisions and any statement by the hospitals are not in the reviewed record. It also records that between April and June 2022 Steward agreed to pay $4.74 million to resolve a federal False Claims Act matter in which Good Samaritan Medical Center had entered into agreements with local physician practices to set up specialized care centers that were never established and treated no patients, while doctors continued to refer patients in exchange for payments, and that as part of the resolution Good Samaritan entered a Corporate Integrity Agreement, a compliance agreement, with HHS. The settlement agreement and case number are not in the reviewed record, which does not establish whether this is the 2018 qui tam case resolved in May 2022, and a settlement is not an admission of liability. [src-064] [src-045] - Attributed: A timeline compiled by a research institute records that on October 13, 2020 the Department of Health and Human Services fined both campuses of Holy Family Hospital and Nashoba Valley Medical Center in Massachusetts for failing to maintain proper certifications, recertifications and treatment plans for inpatient psychiatry services, in violation of Medicare billing requirements; Holy Family paid a $6.95 million fine and Nashoba a $1.42 million fine. [src-064] - Qualification: Secondary account; the HHS decisions are not in the reviewed record, nor is any statement by the hospitals. The hospital names are mapped to the Steward operating companies of those hospitals. ## State actions in Arizona and Massachusetts - Analysis: On May 10, 2024 Arizona Attorney General Kris Mayes announced that she was opening an investigation into the circumstances leading up to Steward Health Care's May 6, 2024 bankruptcy filing in a Texas bankruptcy court and was considering intervening in the bankruptcy proceeding. The four Arizona hospitals affected were Florence Hospital, Mountain Vista Medical Center, St. Luke's Behavioral Health Center and Tempe St. Luke's Hospital, whose auction was then proposed for June 28, 2024. A September 11, 2024 news report said her office was still “closely monitoring the situation to ensure the best interests of Arizonans”, and the main bankruptcy docket lists the State of Arizona, through the Attorney General's Office, as a creditor; no result of the investigation appears in the reviewed record. [src-118] [src-117] [src-053] - Analysis: A research institute's timeline records a long dispute with the Massachusetts Center for Health Information and Analysis (CHIA), the state agency that collects health-care financial data: CHIA began fining Steward in September 2014 because it had not submitted required system-wide financial data; Steward sued CHIA over the fines on October 27, 2017 (case 1784CV03481); and in June 2023 a Massachusetts Superior Court judge ruled against Steward, which appealed, leaving the case unresolved. The court records are not in the reviewed record, and the outcome of the appeal is not known. [src-064] ## Lobbying registration - Analysis: Steward Health Care System LLC's 2020 client registration in the Massachusetts Secretary of the Commonwealth's lobbyist registry, whose status is shown as concluded, names Deputy General Counsel Nathalie F. Hibble as authorizing officer and lists as lobbying entities The Suffolk Group, LLC and Locke Lord Public Policy Group LLC, both from January 1, 2020, and Nelson Mullins, from January 1 to August 31, 2020, together with two individual lobbyists, one of them an in-house employee engaged from June 17, 2020. [src-092] ## Sources - [src-037] Letter from members of the Massachusetts congressional delegation to Cerberus Capital Management co-CEO Stephen A. Feinberg about Steward Health Care, Office of Senator Elizabeth Warren, U.S. Senate, 2024-02-15 - [src-002] Letter from Senators Elizabeth Warren and Edward J. Markey to Dr. Ralph de la Torre about Steward Health Care’s finances, Office of Senator Elizabeth Warren, U.S. Senate, 2024-03-07 - [src-048] Company statement source · src-048 - [src-041] Opinion of the U.S. Court of Appeals for the D.C. Circuit in de la Torre v. Cassidy, No. 25-5353, U.S. Court of Appeals for the District of Columbia Circuit, 2026-07-31 - [src-065] Media source · src-065 - [src-023] Draft Senate resolution authorizing certification of the HELP Committee report on the refusal of Dr. Ralph de la Torre to testify, U.S. Senate Committee on Health, Education, Labor, and Pensions, 2024-09 - [src-047] Statement of Senator Edward J. Markey on the Senate’s criminal contempt referral for the former Steward chief executive, Office of Senator Edward J. Markey, U.S. Senate, 2026-08-07 - [src-117] Media source · src-117 - [src-057] Letters from Senators Warren and Markey to Attorney General Pam Bondi and SEC Chairman Paul S. Atkins about Steward and Medical Properties Trust, Office of Senator Elizabeth Warren, U.S. Senate, 2025-05-06 - [src-064] Research source · src-064 - [src-094] Company statement source · src-094 - [src-046] Media source · src-046 - [src-079] Other source · src-079 - [src-084] Media source · src-084 - [src-069] Media source · src-069 - [src-045] Court record source · src-045 - [src-043] HHS-OIG enforcement action: United States files complaint against St. Elizabeth’s Medical Center, Steward Medical Group and Steward Health Care System, U.S. Department of Health and Human Services, Office of Inspector General, 2023-12-18 - [src-118] Arizona Attorney General press release on an investigation into Steward Health Care’s bankruptcy, Arizona Attorney General, 2024-05-10 - [src-053] Court record source · src-053 - [src-092] Massachusetts lobbyist registry: 2020 client registration of Steward Health Care System LLC, Secretary of the Commonwealth of Massachusetts, 2020