Hospitals Across the Country Forced to Return Millions for Overcharging Patients

Behemoth Providence Health Care abandoned their defense for avoidance of providing charitable care to eligible patients and settled with Washington State’s Attorney General only weeks prior to trial, because they knew they would lose. Attorney General, Bob Ferguson (gubernatorial candidate) and his team, compelled Providence to refund 20 million dollars and forgive medical debt of 137 million, all owed to low-income patients. The suit impacts over 100,000 state residents. (Washington Attorney General, 2024)

Providence operates 14 hospitals in Washington State under that moniker as well as Swedish and Kadlec hospitals. Washington State was able to achieve this result for the people of the state because of the strength of its charitable care laws. For more information on Providence’s reach in other states, including Oregon, California, and New Mexico, read my former post from September 25, 2022.

https://healthpolicymaven.blogspot.com/2022/09/opportunistic-practices-based-on.html

 Summary of Charitable Care Standards in Other States

State	State Mandates for Charitable Care at Hospitals (Bosco, 2021)
California	Families without medical insurance, those with high medical costs, and people within 400% of the federal poverty rate are eligible for financial assistance.
Colorado	A 2022 law strengthens protections from medical debt and requires all hospitals to provide medical assistance.
Connecticut	Requires all hospitals to screen for financial aid, but only mandates aid consideration for persons not covered on Medicare, Medicaid, or other coverage and whose income is below 250% of the federal poverty rate.
Illinois	Hospitals must offer financial assistance to families within 600% of the poverty rate, free care is mandated for those within 200% of the poverty rate, and hospitals are prohibited from collecting more than 20% of a patient’s income for payment in a twelve-month period.
Massachusetts	Families whose incomes are within 200% of the federal poverty rate are eligible to receive financial assistance.
New Jersey	Specifies families without medical insurance and those with low reimbursement from insurance plans are eligible for charity care. Also stipulates that healthcare providers can only collect a portion of patient income for repayment and the law stipulates what that payment ceiling is based on income.
Oregon	Requires hospitals provide full financial aid for those within 200% of the federal poverty rate and a sliding fee scale for those within 400% of the poverty rate.
Texas	Requires financial aid for those with incomes equal or less than 21% of the federal poverty rate. And individuals must be ineligible for Medicaid.
Washington	Families with incomes below 100% of the federal poverty rate must receive free care; families within 200% of the poverty rate are eligible for financial assistance.

 Lawsuits Against Hospitals Elsewhere

North Carolina

HCA (Health Care of America) is once again charged in North Carolina in a case against Team Health brought by heroic emergency doctors at Mission Hospital. The lawsuit alleged:

HCA-Team Health used unnecessary trauma coding to get more money from insurers, the government, and patients. On average, patients using this trauma facility were overcharged $40,000 through unnecessary specialists, procedures, and drugs through this “upcoding scheme.” Doctors alleged that nonphysicians made these coding decisions in Mission Hospital, as a part of HCA’s business practices to optimize reimbursement. Most of the upcoding and overcharging were done on geriatric patients.

Tennessee

HCA and Team Health are also being sued in Tennessee for overcharging practices for billing practices in Bucumb County. (Jones, 2023)

HCA has the distinction of having the largest (2003) settlement of 631 million with the US government for overcharging Medicare and Medicaid. Interesting factoid, HCA was helmed by android Rick Scott, who went on to become Governor of Florida, and then Senator during the Trump Administration. Unfortunately, being a shyster, does not appear to hurt your chances of doing even greater damage to the American people.

 Widespread Aggressive Collection Practices

Kaiser Family Foundation found in 2022 that thousands of hospitals bring lawsuits against patients to collect unpaid bills, regardless of the patient’s ability to pay. They found at least 5,100 used aggressive collection practices, despite charitable care eligibility and other mitigating factors. Worse yet, 20% of these hospitals deny emergency care to patients who are in collections, which may be illegal under the federal Emergency Medical Treatment Act. And because these hospitals know the public would not approve of their collection practices, they do not make this information available to the public. And many directly flout their own edicts on charitable care, Lourdes, an Ascension Hospital in New York said they no longer practiced this technique in 2019, but New York court records show they were still doing it in 2021. (Levy, 2022)

Here is a nationwide map of the hospitals who have been found to practice aggressive collection:

https://kffhealthnews.org/news/article/medical-debt-hospitals-sue-patients-threaten-credit-khn-investigation/

 By shining a light on egregious and often illegal collection practices of healthcare organizations we can create some reforms.  Through the power of the free press and our collective actions we can make a difference. Remember, you do NOT have to let a collection action or lawsuit go unchallenged and it is highly likely a judge will take a more favorable view towards an individual than a large corporation, but you do need to show up in court. Get a nonprofit legal organization to assist in your action if you cannot afford legal representation. Any Google search will show plenty of law firms which specialize in defense of medical claim actions brought by hospitals.

 And this is the healthpolicymaven encouraging you not to sign blanket releases when you are going to have medical procedures, do stipulate that for which you agree and which you decline. No money was accepted from anyone in the healthcare industry for this article. Roberta Winter is an independent healthcare analyst and journalist.

 References

Jones, B. D. (2023, June 14). Doctors’ lawsuit: HCA Healthcare and TeamHealth overcharged patients. Retrieved from Asheville Watchdog.org: https://avlwatchdog.org/doctors-lawsuit-hca-healthcare-and-teamhealth-overcharged-patients/

Levy, N. M. (2022, December 21). Hundreds of Hospitals Sue Patients or Threaten Their Credit, a KHN Investigation Finds. Does Yours? Retrieved from KFF Health News.org: https://kffhealthnews.org/news/article/medical-debt-hospitals-sue-patients-threaten-credit-khn-investigation/

Washington Attorney General. (2024, February 1). AG Ferguson: Providence must provide $157.8 million in refunds and debt relief for unlawful medical charges to low-income Washingtonians. Retrieved from Washington State Office of the Attorney General: https://www.atg.wa.gov/news/news-releases/ag-ferguson-providence-must-provide-1578-million-refunds-and-debt-relief