[9] Steward began in 2010 in Massachusetts, when private equity firm Cerberus Capital Management acquired the failing non-profit Caritas Christi Health Care system.

[7] Internationally, Steward is known for its role at the center of a major corruption scandal in Malta, the result of a nullified public–private partnership to run and improve several of the island nation's public hospitals which has led to criminal charges against multiple former Maltese government officials.

[15] In May 2024, Maltese authorities recommended charges against Ralph de la Torre and multiple other Steward executives in relation to accusations of bribery, misappropriation, and money laundering.

[21] Following these failed attempts, Massachusetts Attorney General Martha Coakley commissioned a report from an outside agency to review Caritas' finances and make recommendations for its future.

According to Coakley, the complexity of operating a hospital system had, at that point in time, led "virtually all religious organizations throughout the nation to transfer control to lay boards.

[25] Coinciding with de la Torre's revamp of Caritas, 2009 saw private equity firms begin to show increased interest in healthcare investments in anticipation of passage of the Affordable Care Act (ACA).

[27] De la Torre sought one of these firms as a potential investor, and in 2009 met with Robert Nardelli, an executive at Cerberus and former CEO of Chrysler and Home Depot.

In September 2011, AG Coakley approved Steward's acquisition of Morton Hospital in Taunton and Quincy Medical Center, both of which were previously non-profit facilities at risk of closing due to financial struggles.

[30] In November 2011, Steward took its first step into the type of sale-leaseback deals that would partially define its long-running business model when it put 11 of its medical office buildings up for sale with the intent of leasing the properties for continued use.

Steward and Cerberus were further able to provide hundreds of millions of dollars in dividends to investors from this sale,[38] including to de la Torre,[10] and fund a massive national expansion.

Following a failed attempt in 2021 to sell its Utah hospitals to HCA Healthcare,[47] abandoned after the Federal Trade Commission filed an antitrust lawsuit,[48][49] Steward successfully sold its statewide operation to CommonSpirit Health.

[...] According to the president, the hospital's corporate office determined which vendors to pay and made the payments (or not).Unpaid bills also led to work stoppages in multiple construction projects.

In Texarkana, Texas, construction started in 2021 on a $227 million project to replace Steward's Wadley Regional Medical Center with a new campus 5 miles north of the current location.

[60] On February 5, construction firm Robins & Morton sent a memo to subcontractors stating they had "requested evidence of [Steward] having made financial arrangements that will allow them to fulfill their payment obligations under the contract."

[70] On May 5, 2024, The Wall Street Journal reported that Steward Health Care was expected to file for Chapter 11 bankruptcy protection within the coming days, blaming rising costs, insufficient revenue and cash crunches as part of the decision.

[74] While the use of private intelligence agencies is neither uncommon for corporations to engage in, nor necessarily illegal, one expert stated, "even if legal, it’s weird for a hospital system to be spending resources on this.

[73] On July 11, CBS News reported that according to anonymous sources, federal prosecutors with the United States Attorney's Office for the District of Massachusetts were investigating Steward for fraud and violations of the Foreign Corrupt Practices Act.

[95] The first two permanent closures to result from Steward's bankruptcy occurred on August 31, when Carney Hospital and Nashoba Valley Medical Center, both of Massachusetts, shut down.

Prior to the filing, Massachusetts lawmakers all but committed to ruling out a bailout, stating that the system had already received $54 million in previous years in the form of COVID-19 relief aid.

[103] In addition, conditions of Steward's January 2024 bridge loan required that the company demonstrate an ability to begin paying its debts by April 30, the end of their forbearance period.

[43] Vitals, an embattled Maltese healthcare company, was the center of a controversial 2015 public-private partnership in which it entered a concession agreement with the government to operate three of the island nation's hospitals for thirty years.

Separately, a public relations firm representing Steward International maintained that they entered and executed the concession in good faith and that they were not consulted in the magistrate's inquiry.

[18] While Steward International assured the Colombian public in May 2024 and later that year that their recently-announced bankruptcy in the U.S. would not affect its hospitals in Colombia, saying the two divisions were not codependent, and that "there is no impact that could materialize in Colombia as a result of what happened in the United States,"[134] local media reported that the hospitals there were facing many of the same issues the company was facing in the United States, including unpaid vendors, unpaid employees (in some instances behind by up to six months), and lack of emergency equipment.

[135] The president of Steward Colombia responded to those reports, confirming that they were experiencing these challenges, but reiterating that they were independent of the U.S. operation and attributing these issues not to the U.S. bankruptcy, but mainly to low reimbursement rates by the country's public health system.

The company has largely financed its expansions retroactively by purchasing other health systems or individual hospitals and subsequently selling their newly-acquired facilities' real estate to MPT, thereby recouping significant percentages of the cost of the acquisitions.

In addition, it comprises several subsidiaries which manage different aspects of its integrated healthcare model: Steward has received criticism for its approach to health care and transparency, especially following the revelation of significant financial struggles in the beginning of 2024.

House Representative Stephen Lynch said in January, "we had not had advance notice prior to a week ago that they were in difficulty, or that they were contemplating exiting the Massachusetts health care market.

[153] Steward has attributed much of its financial woes in Massachusetts to the COVID-19 pandemic, as well as their system mainly comprising community hospitals which serve low-income populations, where 70% of their patients are recipients of Medicare and Medicaid.

They also complained of what they described as a gap between the reimbursement rates which public and private insurers pay community hospitals versus larger academic medical centers.

[155] Massachusetts Governor Maura Healey, in a February 2024 letter to Ralph de la Torre, criticized the system's handling of the crisis, what brought them there, and their seeming opacity with state officials throughout.