An evaluation of courtroom data by the state treasurer and Duke researchers finds Atrium Health in Charlotte, N.C., accounted for nearly a 3rd of the authorized actions in opposition to North Carolina sufferers over roughly 5 years.
Logan Cyrus for KHN)
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Logan Cyrus for KHN)
An evaluation of courtroom data by the state treasurer and Duke researchers finds Atrium Health in Charlotte, N.C., accounted for nearly a 3rd of the authorized actions in opposition to North Carolina sufferers over roughly 5 years.
Logan Cyrus for KHN)
North Carolina hospitals — led by the state’s largest public medical system — have sued hundreds of their sufferers since 2017, in response to a new evaluation that sheds extra gentle on the aggressive ways U.S. hospitals routinely use to gather from individuals who fall behind on their payments.
The report, produced by the state treasurer and Duke University School of Law researchers, and associated affected person interviews supply harrowing accounts of individuals pursued for tens of hundreds of {dollars} and infrequently shocked by liens that hospitals positioned on household properties.
In some circumstances, spouses have been focused after their companions died. In others, sufferers interviewed by researchers mentioned they’d been shocked to find out about property liens solely after they tried to promote their properties or after a guardian who owned the house died.
“I do know my home won’t ever be mine. It goes to be the hospital’s,” mentioned Donna Lindabury, 70, whose residence was focused by Charlotte-based Atrium Health, which received a $192,000 judgment in opposition to her and her 79-year-old husband over his 2009 coronary heart surgical procedure. Interest on the debt represented greater than half of the couple’s steadiness.
Lindabury mentioned the hospital initially informed them they might get help with the payments, however then denied their functions for help. “People, the place their God is cash, they only do not care,” she informed researchers.
The North Carolina findings reinforce an investigation by KFF Health News and NPR, which discovered that almost all U.S. hospitals keep insurance policies to aggressively pursue sufferers for unpaid payments, utilizing ways equivalent to lawsuits, promoting affected person accounts to debt consumers, and reporting sufferers to credit standing businesses.
Nationwide, about 100 million individuals — 41% of adults — have some type of well being care debt, in response to a KFF ballot. Medical debt is most widespread within the South, the place continual illness is extra prevalent and lots of states have not expanded their Medicaid security web via the Affordable Care Act. (North Carolina solely expanded Medicaid this yr.)
‘Profits forward of sufferers’
The North Carolina state treasurer launched the brand new report as a rising variety of states, together with North Carolina, are working to increase protections for sufferers, usually within the face of hospital business lobbying.
“It’s simply one other instance of hospitals placing income forward of sufferers. It’s like an onion. The extra you peel it again, the extra you cry,” mentioned Treasurer Dale Folwell, a Republican who for years has challenged hospital pricing and debt assortment practices. “They ought to cease breaking individuals’s kneecaps to gather these money owed.”
Atrium and different massive tax-exempt well being programs are beneath scrutiny amid mounting proof that many aren’t offering enough monetary help to low-income sufferers and are leaving individuals who ought to qualify for help with large payments.
The new report, primarily based on an evaluation of 5½ years of courtroom data from 2017 to 2022, recognized 5,922 debt assortment lawsuits that focused greater than 7,500 sufferers and their relations.
The fits generated greater than $57 million in judgments for the hospitals, researchers discovered, together with tens of millions of {dollars} in curiosity costs and different charges assessed in opposition to sufferers and their households.
North Carolina regulation permits hospitals to cost 8% annual curiosity on excellent money owed, which added tens of hundreds of {dollars} to some households’ money owed over time, the researchers discovered. Overall, curiosity accounted for nearly a 3rd of the overall judgments recorded within the debt circumstances.
The report additionally famous that the lawsuits undermine the monetary safety of generations of North Carolinians. Hospitals can pursue relations for a affected person’s medical debt, and property liens sap the worth of a house, even after a affected person dies.
“These lawsuits can thus goal a household’s major supply of fairness for surviving spouses and kids,” the authors wrote. “Medical debt can gasoline an intergenerational cycle of poverty.”
Two hospitals file probably the most lawsuits
Researchers discovered that probably the most aggressive debt collector was Atrium, a medical system with roots as a public hospital in Charlotte that, following a merger final yr with Midwest-based Advocate Aurora, is now a multistate colossus with $27 billion in annual income. Atrium filed virtually 2,500 lawsuits in opposition to sufferers from Jan. 1, 2017, to June 30, 2022.
Atrium additionally pushes sufferers who cannot afford medical payments into loans from personal equity-backed lender AccessOne that may include rates of interest as excessive as 13%, an NPR and KFF Health News investigation discovered final yr.
Atrium declined to handle questions in regards to the lawsuits on the file or to make chief government Eugene Woods accessible to debate its debt assortment practices.
The second-most litigious system is way smaller. CaroMont Health in Gastonia, North Carolina, a small metropolis about 20 miles west of Charlotte, operates only one inpatient hospital. But it filed virtually 1,800 lawsuits in opposition to sufferers from 2017 to mid-2022, in response to the report.
CaroMont declined to make chief government Chris Peek accessible for an interview, however a spokesperson mentioned the system solely hardly ever sues. “We take significantly our obligation to accomplice with sufferers in all elements of medical care and repair, and we at all times attempt to resolve these issues with compassion,” Meghan Berney mentioned in a press release.
In distinction to Atrium and CaroMont, some North Carolina hospitals filed just one or two lawsuits in opposition to their sufferers from 2017 to 2022, the researchers, led by Duke regulation professor Barak Richman, discovered.
Hospitals suing sufferers is a nationwide sample
Similar analyses of courtroom data in Wisconsin, New York, Maryland, and different states lately have uncovered intensive use of the courtroom system by hospitals. And KFF Health News discovered final yr that greater than two-thirds of U.S. hospitals sue sufferers or take different authorized motion in opposition to them, equivalent to garnishing wages or putting liens on property. That evaluation was primarily based on an investigation of a pattern of greater than 500 hospitals nationwide.
The consideration on these debt assortment actions has helped catalyze state efforts to increase protections for sufferers. Several states, together with Arizona, Colorado, Maryland, and New York, have enacted medical debt legal guidelines lately.
In North Carolina, a bipartisan group of state lawmakers have been pushing laws that will prohibit some assortment actions by hospitals, together with capping rates of interest that medical suppliers may cost on affected person debt and limiting collections in opposition to relations. Earlier this yr, the state Senate unanimously handed the invoice, known as the Medical Debt De-Weaponization Act.
But the invoice has stalled within the House amid opposition from the state’s highly effective hospital business, whose political motion committee has made greater than $260,000 in marketing campaign contributions since 2022, in response to WBTV, the CBS affiliate in Charlotte.
Among the most important beneficiaries of hospital business largesse is the speaker of the North Carolina House, Republican Tim Moore, the station reported. Moore’s workplace didn’t reply to inquiries from KFF Health News.
KFF Health News, previously generally known as Kaiser Health News (KHN), is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF — the impartial supply for well being coverage analysis, polling, and journalism.