HCA has been in trouble before—when Rick Scott, now the governor of Florida, was in charge of the company, then known as Columbia/HCA. The father of former Sen. Majority Leader Bill Frist founded the company back in 1968. In the late 1990s, The Wall Street Journal reported the chain had begun looking at profitable diseases as “product lines,” and requiring hospital chief executives to meet ambitious goals—and sometimes beating their numbers by 15 to 20 percent each year. Eventually such pressures got the chain in trouble with the Feds; the FBI uncovered a Medicare billing fraud scheme. The chain settled with the government, paid a fine, and dismissed Scott, who was never accused of wrongdoing. Last year The Palm Beach Post discovered that Scott had used high pressure tactics at his chain of Soltanic Urgent Care clinics, which had just been sold to a private equity firm. The Post reported that the clinics with Scott in charge had used a bottom line, bonus-focused management that encouraged a culture of cheating. One doctor told state investigators “they care about how fast you see people.” He was later fired.

It’s hard to say if HCA patients know anything about the history of HCA, or about the kind of problems the Times reported on. How much can they really learn about a facility before undergoing risky heart procedures? HCA told the Times that more than 80 percent of its hospitals are in the top 10 percent of government rankings for quality. That, of course, raises another question: Whether quality rankings—no matter who puts them out—can reveal the kinds of practices the Times uncovered. How do unnecessary procedures that turn out well get factored in?

The history of HCA shows that big money and patient care don’t always mix. What happens when there are fewer and fewer systems owning the nation’s hospitals, giants with similar hunger for profit, perhaps jeopardizing patient care? More than ever we’ll need good investigative reporting to tell us.

And not just The New York Times. In a coming post, we’ll take a look at how the Tampa Bay Times demonstrates what a local news outlet with HCA hospitals in their communities can do. The Tampa Bay folks took The New York Times findings and pushed the story further, to good effect.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.