The New York Times and the Wall Street Journal both released a bombshell series of reports, called They Were Entitled to Free Care. Hospitals Hounded Them to Pay, Hospital System to Refund Poor Patients Who Were Entitled to Free Care and Hospitals Often Don’t Help Needy Patients, Even Those Who Qualify. These investigations describe a systematic effort by so-called “charity” hospitals to engage in predatory billing and collections efforts against poor patients who couldn’t afford their care. These patients qualified for federally-required financial assistance programs, but the hospitals paid millions of dollars to fancy consulting firms like McKinsey to figure out ways to avoid providing this charity care. Best to read this on an empty stomach. Here are some of the low-lights from these stories, starting with The NY Times:

• “In interviews, patients in California and Oregon who qualified for free care said they had been charged thousands of dollars and then harassed by collection agents. Many saw their credit scores ruined. Others had to cut back on groceries to pay what Providence claimed they owed. In both states, nonprofit hospitals are required by law to provide low-income patients with free or discounted care.”
• “Last October, an ambulance rushed Alexandra Nyfors to the Providence hospital in Everett, Wash. A diabetic, she was severely dehydrated, and her kidneys were failing. Providence put her on intravenous medications to treat an underlying infection. She spent about two weeks in the hospital.Ms. Nyfors, 66, is covered by Medicare, and her only income is about $1,700 a month in federal disability payments. Under Providence’s policies and state law, she was eligible for free care because of her low income. But Providence billed her $1,950 — the amount left over after Medicare covered its share.”
• “Even before the Rev-Up program, Providence was collecting money from poor patients, sometimes in violation of state laws, according to five current and former executives and a review of patient complaints filed with regulators. Harriet Haffner-Ratliffe, 20, gave birth to twins at a Providence hospital in Olympia, Wash., in 2017. She was eligible under state law for charity care. Providence did not inform her. Instead it billed her almost $2,300. The hospital put her on a roughly $100-a-month payment plan.”
• “One of the country’s largest nonprofit hospital chains, Providence, will refund payments made by more than 700 low-income patients who were wrongly charged for medical care that should have been free.”
• “In February, Bob Ferguson, the attorney general of Washington State, sued Providence, accusing it of violating state law in part by deploying debt collectors to go after more than 55,000 patient accounts. Providence is fighting the lawsuit.Under state law in Washington, where Providence is based, hospitals must provide free care to patients whose income falls below 300 percent of the federal poverty level, or about $83,250 in annual income for a family of four. The group typically includes anyone who qualifies for Medicaid, and, until 2019, Providence waived all medical costs for people covered by the program. That year, Providence — which operates 51 hospitals and more than 900 clinics across the country — changed its practices and began sending Medicaid patients to debt collectors, The Times reported last month.”
• “More than half the nation’s roughly 5,000 hospitals are nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes.” 
• “Some hospital systems have not only reduced their emphasis on providing free care to the poor but also developed elaborate systems to convert needy patients into sources of revenue. The result, in the case of Providence, is that thousands of poor patients were saddled with debts that they never should have owed, The Times found.”

Similarly, the Wall Street Journal recently released reported that Hospitals Often Don’t Help Needy Patients, Even Those Who Qualify. Some low-lights:

• “Hospitals put up obstacles, delay checking eligibility and sometimes press for payments that aren’t refunded even if a patient eventually gets qualified for assistance. That is according to a Wall Street Journal analysis of thousands of nonprofit hospital policies in filings to the Internal Revenue Service and posted by hospitals, as well as thousands of pages of internal documents from government hospitals obtained through public-record requests and the experiences of dozens of advocates and patients who have applied for aid.”
• “Though hospitals have the power to prequalify low-income patients for charity care and never send a bill, about 450 nonprofit facilities—roughly 15% of the 3,100 nonprofit facilities in the Journal’s analysis of tax documents—didn’t report using the option.”
• “Even among the hospitals that told the IRS they do prequalify people, many spent months chasing patients for payment before checking eligibility. The parent organizations for roughly 1,000 of those facilities reported pursuing at least $2 billion in billings to patients who likely qualified for aid.”
• “In scripts and other training material for staff who talk to patients about bills, obtained through public-record requests to more than 100 government hospitals, the possibility of financial assistance is sometimes raised only as a last resort, or not at all.”
• “Under tax laws, nonprofit hospitals are set up to function as charities benefiting their communities. Government facilities, whose policies the Journal also looked at, are also intended to serve the public, though they aren’t subject to all the same IRS requirements as private nonprofits. The Journal found that many of these hospitals act like for-profit businesses in their efforts to get paid, even by those who can’t afford it.”
• “Hospitals often have complex financial-aid applications that require patients to reveal sensitive personal information. Aspirus Health, a 17-hospital nonprofit system based in Wisconsin, has a 19-item checklist, including tax returns, pay stubs, retirement-account documentation, mortgage information and three months of bank statements showing all deposits and withdrawals. The form demands the make, model and loan balance on all vehicles, along with the applicant’s monthly costs for 17 categories, from water and sewer charges to cable-TV bills and alimony. It also asks if any member of the household is pregnant. Patients have 10 days to complete the application, the document says.”
• “Major companies, including Experian PLC and TransUnion, have in recent years sold hospital services that verify which patients qualify for financial aid. TransUnion recently sold its unit to a company now called FinThrive Revenue Systems LLC, which uses information on mortgages, student loans and credit cards to calculate whether patients lack the money to pay medical bills, said Jonathan Wiik, a vice president for FinThrive’s healthcare business.”
• “Nonprofit hospitals are largely allowed to decide for themselves how much medical care to write off for patients who can’t afford to pay. Nonprofit hospitals wrote off 2.3% of their patient revenue in the most-recent year available, the prior Journal analysis of Medicare filings found. That’s less than the 3.4% of revenue for-profit hospitals wrote off for free and discounted care. The Journal found government hospitals wrote off the largest amount, at 4.7% of patient revenue. Amounts varied widely across hospitals nationally.”
• “Federal rules require nonprofit hospitals to disclose the aid programs and make information about the policies available on their websites. They are also supposed to include a conspicuous written notice on billing statements and offer written summaries of the policy as part of the intake or discharge process. Advocates say patients are often unaware of the option. One 2020 poll of 820 registered voters in Maryland, commissioned by a consumer group, found that 29% of all respondents, and 50% of Black respondents, weren’t aware of bill forgiveness for low-income patients.”