Steward Health Care, the largest physician-led hospital operator in the U.S., filed for bankruptcy early Monday morning, US media report.

Over the past few days an “emergency operations plan” had been activated in response to Steward Health Care’s serious financial problems that came to light months ago, NBC Boston reports.

That plan includes a command centre to monitor all Steward locations in the state of Massachusetts and manage the potential fallout of a bankruptcy filing.

Now that Steward has filed for Chapter 11, the health care company said on its website that restructuring is in the best interests of its patients, physicians, employees and communities at this time.

Steward has 32 hospitals in eight states, including eight in Massachusetts, the report adds. It blamed its financial problems on the “highly challenging health care environment,” including insufficient government reimbursement, skyrocketing labour costs, inflation and impacts from the pandemic.

Steward reportedly owes hundreds of millions of dollars in unpaid rent and has been sued by at least two dozen venders who claim they weren’t paid for services or supplies.

In a statement, Steward’s CEO said under the bankruptcy process, “Steward will be better positioned to responsibly transition ownership of its Massachusetts-based hospitals, keep all of its hospitals open to treat patients, and ensure the continued care and service of our patients and our communities.”

Steward branched out in Malta via Steward Healthcare International when it had acquired the concession granted to the Vitals Global Healthcare by the Labour administration, back in 2017. In 2023, a court in Malta rescinded the deal with Steward Healthcare Malta which he described as having been fraudulent.

The deal was also the subject of a magisterial inquiry which was concluded last month. The details of the inquiry have not been made public, with the government under pressure to publish the entire report. The government, for its part, has complained about the timing of the conclusion of the inquiry, linking it to the European Parliament and local council elections to be held next month.