Michigan’s largest health care system continues to defy President Donald Trump, most recently by shipping nearly 200 Michigan jobs to India.

Corewell Health last week laid off about 186 remote Michigan workers responsible for the company’s billing and finance operations, offshoring those functions instead to India-based workers with AGSHealth, owned by New York private equity firm Altaris Capital Partners, Deadline Detroit reports.

“Like health systems across the country, we have made some staffing changes in some non-patient-facing, administrative roles,” the 21-hospital system said in a statement to Beckers Hospital Review. “These changes will help us continue to provide high-quality care for the long term in a challenging economic environment for healthcare. We are grateful for the contributions and service provided by our team members.”

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A Corewell Health spokesperson refused to divulge how many of the company’s 65,000 employees were impacted by the layoffs that took effect on Friday, but Beckers confirmed the figure was roughly 190 based on posts to Facebook and the Grand Rapids Reddit page.

The decision, part of Corewell Health CEO Tina Freese Decker’s efforts to cut costs, both defies Trump’s efforts to keep jobs in the U.S. and raises serious concerns about data security, with foreign nationals gaining access to critical personal patient information, from social security numbers, to medical records, to financial data.

“If I was a Corewell patient, I wouldn’t be comfortable if someone from another country was looking at my (private) information,” a fired Corewell worker told Deadline Detroit.

The news site notes 42% of U.S. residents were involved in healthcare security breaches last year.

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Corewell became Michigan’s largest health care system with the merger of Southfield-based Beaumont Health and Grand Rapids-based Spectrum Health in 2022. Corewell contractor Welltock exposed the personal information of 1 million Michigan residents in November 2023, while a separate data breach at Corwell contractor HealthEC a month later exposed the personal data of another 1 million, according to Michigan Attorney General Dana Nessel.

Nessel, who approved the Corewell merger in 2022, has called on lawmakers to require companies to notify her office when data breaches occur, but has otherwise offered no solutions to curb the repeated data breaches, which have also impacted millions of patients at McLaren Health Care and the University of Michigan.

Philip Abraham, cybersecurity experts who focuses on healthcare finance, told Deadline Detroit he expects last weeks layoffs to draw the attention of Trump and his Secretary of Health and Human Services Robert F. Kennedy, Jr.

“I’m shocked, shocked!” Abraham said. “This is beyond stupid. Why doesn’t (Freese Decker) send a letter to Trump and (RFK) and say, ‘Why don’t you audit us?”

“The last thing Corewell wants is Trump and RFK looking at Corewell,” he said.

An analysis of the Corewell layoffs estimates the impacted employees have a combined salary cost of about $9.3 million, or nearly $1 million less than the $10.2 million Corewell paid former Beaumont CEO John Fox upon his departure, Deadline Detroit reports.

The nonprofit “Corewell Health’s operating revenue was $8.1 billion for the first six months of 2024 ended June 30, a 9% increase from $7.5 billion during that same period in 2023,” according to Becker’s Hospital CFO Report.

A Fair Share Spending report from the Lown Institute shows Michigan is one of only five states where 97% or more nonprofit hospitals claim tax deductions that exceed required spending on financial assistance and community health investments. In 2021, that “fair share deficit” was $1.4 billion, the fifth highest among states.

Friday’s layoffs are at least the second time this month Corewell has taunted the Trump administration with decisions that defy the president’s America First agenda.

Just before Valentine’s Day, Corewell announced it reversed a decision days earlier to pause sex change treatments for kids.

Corewell became the first Michigan health system to comply with Trump executive order “Protecting Children from Chemical and Surgical Mutilation” when officials announced an end to new hormone treatments for minors, but reversed course under pressure from transgender activists at Equality Michigan, HIV/AIDS Alliance of Michigan, the NAACP Michigan State Conference, ACLU of Michigan and 37 other groups that signed on to a letter calling for the health system’s board of directors to reconsider the decision, Michigan Advance reports.

Trump’s EO promises to end federal aid to medical institutions that engage in gender affirming care for minors.

“The head of each executive department or agency (agency) that provides research or education grants to medical institutions, including medical schools and hospitals, shall, consistent with applicable law and in coordination with the Director of the Office of Management and Budget, immediately take appropriate steps to ensure that institutions receiving Federal research or education grants end the chemical and surgical mutilation of children,” the EO reads.

Corwell CEO Decker chairs the American Hospital Association, which was among three national organizations that led a legal challenge against Trump’s first term efforts to improve price transparency in health care.

Trump’s price transparency rules ultimately survived and went into effect, though the Biden administration largely ignored enforcement and penalties for those that did not comply, and many hospitals found new ways to shield costs from consumers, Deadline Detroit reports.