\n\tDan Weissmann<\/span><\/p>\n

Some hospitals sue patients who can\u2019t afford to pay their medical bills. Such lawsuits don\u2019t tend to bring in much money for the hospital but can really harm patients already experiencing financial hardships.<\/p>\n

In this episode of \u201cAn Arm and a Leg,\u201d Dan Weissmann goes toe-to-toe with Scott Purcell, CEO of ACA International, a trade association for the collection industry, on the effects these lawsuits have on patients.<\/p>\n

With help from The Baltimore Banner<\/a> and Scripps News<\/a>, Weissmann pulls back the curtain on hospital bill lawsuits in three states \u2014 Maryland, Wisconsin, and New York \u2014 and discovers some good news for a change.<\/p>\n

\tDan Weissmann<\/p>\n

\t\t\t
\n\t\t\t\t@danweissmann\t\t\t<\/a><\/p>\n

\t\t\tHost and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.\t\t<\/p>\n

\n\t\tCredits\t<\/h3>\n
\tEmily Pisacreta
\n\tProducer<\/p>\n
\tAdam Raymonda
\n\tAudio wizard<\/p>\n
\tEllen Weiss
\n\tEditor<\/p>\n
\t\t\t\t\tClick to open the Transcript\t\t\t\t<\/p>\n
\t\t\t\t\t\tTranscript<\/strong>: \u2018An Arm and a Leg\u2019: When Hospitals Sue Patients (Part 2)<\/strong>\t\t\t\t<\/p>\n
Note: \u201cAn Arm and a Leg\u201d uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.<\/em><\/p>\n
Dan:<\/strong> Hey there \u2013 So, this is part two of a two-part story. If you missed part one, or just want a refresher, here\u2019s three quick things:\u00a0<\/p>\n
First: Some hospitals \u2013 definitely not all \u2013 sue a LOT of patients over unpaid bills. Hundreds or even thousands every year.\u00a0<\/p>\n
Second: There\u2019s very little money in it for these hospitals. When reporters and researchers add up the total amounts they\u2019re suing for, it looks tiny compared to, say, their annual surplus. Or what they pay executives. Tiny.<\/p>\n
Third: There\u2019s data showing a LOT of the people being sued are \u2026 pretty hard up already.\u00a0<\/p>\n
That a lot of them would qualify for charity care under the hospitals\u2019 own financial-assistance policies.<\/p>\n
In fact, as we reported last time, a guy named Nick McLaughlin, who spent a decade working for a medical-bill collections agency\u2026 now runs a business telling hospitals they\u2019d be better off \u2013 financially \u2013 writing these bills off through charity care or financial assistance programs.\u00a0<\/p>\n
And I should point out: Nick\u2019s not a do-good crusader. He has started a business, to help hospitals do this. And he\u2019s staked his family\u2019s financial future on it.<\/p>\n
Nick:<\/strong> I had a good but challenging conversation with my wife. And she said, hey, so is the reason we\u2019re not doing this full time because we\u2019re scared the money\u2019s not gonna come in? And I said, well as the sole provider of a family of five that\u2019s kind of a big deal. She said, yeah, I think we should do it.<\/p>\n
Dan:<\/strong> And at the end of our last episode, I asked Nick: So, why would some hospitals make the decision to sue people, if there\u2019s no money in it? What\u2019s behind that decision:<\/p>\n
Nick:<\/strong> It\u2019s really, I would say, philosophically based.<\/p>\n
Dan:<\/strong> So, in this episode, we\u2019ll do two things: One, we\u2019ll try to get a peek at that philosophy \u2013 inside the heads of the people who might hold it.<\/p>\n
And TWO: We\u2019re gonna share some hard data about what\u2019s going on with these lawsuits in three states. We partnered with two awesome news organizations to get this data.\u00a0<\/p>\n
And I\u2019m gonna tell you: we found what really looks like some good news.<\/p>\n
And the whole inquiry really drove home ways we can help ourselves, and each other.\u00a0<\/p>\n
Here we go.<\/p>\n
With Scripps News and the Baltimore Banner, this is An Arm and a Leg \u2013 a show about why health care costs so freaking much, and what we can may be do about it.\u00a0<\/p>\n
I\u2019m Dan Weissmann. I\u2019m a reporter, and I like a challenge. So our job on this show is to take one of the most enraging, terrifying, depressing parts of American life and bring you something entertaining, empowering, and useful.<\/p>\n
So, let\u2019s talk about that philosophy. You could call it a form of\u2026 not thinking too hard. Let\u2019s start with a witness.\u00a0<\/p>\n
These days, Ruth Lande works for a nonprofit you may have heard of \u2013 RIP Medical Debt \u2013 to get hospital bills forgiven.<\/p>\n
But WE talked with her because she spent more than 25 years working in hospital billing, most of it at Memorial Sloan-Kettering Cancer Center. And by the way, she loved it.<\/p>\n
Ruth Land\u00e9:<\/strong> In general, I think it\u2019s good if a job has three things. It\u2019s for a good mission. Two, it should be hard. It should be complicated so it engages your brain every day. And third, it should be with really good colleagues. And I got to tell you, working revenue cycle satisfied all three of those for me.\u00a0<\/p>\n
Dan:<\/strong> And of course, during her quarter-century in the business, the question of whether or not to file lawsuits over hospital bills did come up.\u00a0<\/p>\n
When she got a promotion.\u00a0<\/p>\n
In her earlier role, she\u2019d run one part of the billing department, where they never sued. Now she was taking over another part of the billing department, a bigger one, where sometimes they did.\u00a0<\/p>\n
She says her new colleagues were aware that in her earlier position, she\u2019d taken a no-lawsuits approach.<\/p>\n
Ruth Land\u00e9:<\/strong> There was an assumption, oh yeah, Ruth won\u2019t allow that.\u00a0<\/p>\n
Dan:<\/strong> But, she told me, she didn\u2019t want to be in conflict with her new colleagues from Day One.\u00a0<\/p>\n
Ruth Land\u00e9:<\/strong> And so I said, well, I\u2019m not going to just ban it, but you know, bring me cases. If you believe that we should be suing a person, then just bring me the case so I can review it. And they never brought a case to me ever.\u00a0<\/p>\n
Dan:<\/strong> Never ever. She thinks those colleagues maybe hadn\u2019t stopped to look at who they were suing.<\/p>\n
Ruth Land\u00e9:<\/strong> When you really examine closely you see the harm. I They would have probably imagined that they\u2019re only suing some really rich people sitting up in a mansion somewhere, not bothering to pay their bills.<\/p>\n
You might imagine: It would be interesting to talk with someone who thinks this way \u2013 really talk with them, push them on their point of view.<\/p>\n
And that did happen. Kind of.\u00a0<\/p>\n
It was honestly one of the most confusing conversations I\u2019ve ever had. It was with this guy.\u00a0<\/p>\n
Scott Purcell:<\/strong> My name is Scott Purcell. I\u2019m the CEO of ACA International.<\/p>\n
Dan:<\/strong> That\u2019s the industry association for folks in the bill-collection business. Scott was super-accommodating \u2013 got on Zoom with me within a day of my first email to him. So quickly that it wasn\u2019t till we got on that I realized we hadn\u2019t set a length.\u00a0<\/p>\n
Dan:<\/strong> How long do I actually have you for?<\/p>\n
Scott Purcell:<\/strong> How long do you need us for?<\/p>\n
Dan:<\/strong> Uh, I like to talk to people for a long time, but we start with a half an hour and maybe\u2026<\/p>\n
Scott Purcell:<\/strong> um, bum bum bum. I just need to change one meeting.\u00a0<\/p>\n
Dan:<\/strong> We talked for more than an hour.\u00a0<\/p>\n
The first half-hour was one kind of frustrating.\u00a0<\/p>\n
I\u2019d describe our findings and findings from other people\u2019s reports \u2014 for instance, how little money hospitals seem to gain from these lawsuits \u2014 and ask if he had data to help understand what we\u2019re seeing, and he kept saying, effectively:\u00a0<\/p>\n
Hey, let\u2019s not jump to policy conclusions. How would a new policy on debt collection affect a medical office with just three doctors?\u00a0<\/p>\n
Scott Purcell:<\/strong> And I would say that three person doctor office is different from one of the top 10 nonprofit health care system. Their economics are completely different. And yet we\u2019re talking about policy positions. that impact both<\/p>\n
Dan:<\/strong> And then, in retrospect I\u2019ve figured out a spot where we really, really lost each other. I was talking about one observer\u2019s take on why these lawsuits don\u2019t bring in much money:<\/p>\n
Dan:<\/strong> A lot of the people that end up as your defendants are effectively indigent. Um, you know, they don\u2019t have a lot of income. They may not have W2 employment that you could garnish. They don\u2019t have other assets you can take. So, the amount that you get is not, not what you might expect from looking at the number of cases and the number of judgments. So that was another\u2026<\/p>\n
Scott Purcell:<\/strong> If I could stop you there, I\u2019d love to see that data. Do you know that it takes a lot of money to file a lawsuit? I can\u2019t think. And so my lived experience, I cannot think of one instance where either the hospital or the collection agency or the attorney would choose to sue an indigent person because if they are going to have a low probability of being able to repay that that over time, why would you invest?\u00a0<\/p>\n
Dan:<\/strong> What I didn\u2019t realize then, was: when I said some people were \u201ceffectively indigent,\u201d Scott Purcell had latched onto the word \u201cindigent\u201d and had a very specific image in his mind, of absolute destitution. From that point forward, anything I would say about people being sued who were hard up, who qualified for charity care, who really couldn\u2019t pay \u2013 was gonna run through this filter.\u00a0<\/p>\n
And: Any example I\u2019d bring up of someone being sued who got put in an extremely tough position\u2026 was just gonna sound to him like a novel anecdote.<\/p>\n
A half-hour in, I got pretty direct with Scott, so I asked:<\/p>\n
Dan:<\/strong> How did this happen? How did it happen that we, like, got to the point where so many people are being sued over debts they can\u2019t pay? What do you know about that?<\/p>\n
And this is where things got really confusing to me. Because here\u2019s how Scott responded:<\/p>\n
Scott Purcell:<\/strong> Well, if you just sued somebody who can\u2019t pay, they\u2019re not going to pay you. So, they\u2019re not out any money. So you made a bad business decision, but truly Dan, what is the harm they\u2019re experiencing? The fact that they got sued and they can\u2019t pay?<\/p>\n
Dan:<\/strong> I didn\u2019t see that coming \u2013 the idea that being sued could be \u201charmless\u201d?. Here\u2019s what I said:<\/p>\n
My gosh. Well, I can tell you that, you know, people, by the time they\u2019ve been sued, they\u2019ve been getting tons of collections calls, their credit may have suffered, and they have a judgment against them that says like any money that shows up in their bank account can be seized or that, you know, the next time they get a job, their wages can be garnished. That\u2019s pretty significant harm.\u00a0<\/p>\n
I described to Scott the story of Liz Jurado, a woman on Long Island who says she found out, years after the fact, that she had been sued over a bill relating to the birth of one of her kids. A bill she says she thought insurance had paid. Her husband was the main breadwinner, until he got laid off. Liz took a job working for DoorDash to support the family \u2013 her first W2 paycheck \u2013 and she says that\u2019s how she found out about the lawsuit. Because once she starts the job, she starts getting letters, saying her wages are going to be garnished. And she\u2019s like:<\/p>\n
Liz Jurado:<\/strong> What is this? Where did it come from? How could they not tell me about it until now?\u00a0 I get a job and three months later, you\u2019re coming after me. I mean, this is my family\u2019s bread and butter.\u00a0 This is horrible.<\/p>\n
Dan: <\/strong>I said to Scott: That seems bad, right?<\/p>\n
Dan:<\/strong> So I\u2019m, I\u2019m, I\u2019m trying to give you the opportunity to respond to that point that lots of people make that. If you get sued over a debt you can\u2019t pay, there\u2019s harm. That\u2019s, that\u2019s a lot of people\u2019s positions, and I find it fairly persuasive. How do you respond to that?\u00a0<\/p>\n
Scott Purcell:<\/strong> You and I were using a hypothetical. You said somebody got sued who\u2019s indigent. Has no money.<\/p>\n
Dan:<\/strong> Do you think that doesn\u2019t happen?<\/p>\n
Scott Purcell:<\/strong> I don\u2019t understand the business case as to why that would.\u00a0<\/p>\n
Dan:<\/strong> But, like, do you think it doesn\u2019t happen because, like, do you think the reports that show that it happens a lot are wrong? I mean, I talked to a couple, a couple months ago who got sued over a debt. I mean, their story was like, they got hit with a bunch of medical problems.<\/p>\n
I described to him the story of Casey and Ron Gasior, who we met in our last episode. The bills for those medical adventures threw their finances completely out of whack.<\/p>\n
Casey:<\/strong> We would dig little bit out of our hole, and then we\u2019d go right back down.\u00a0<\/p>\n
Dan:<\/strong> \u2026 until they were in danger of losing their house. They filed for chapter 13 bankruptcy \u2013 wrapping everything they owed into a five year payment plan. They\u2019d just about made it through, when they got a letter from a law firm earlier this year: They were being sued over a medical bill, that had arrived just after their bankruptcy started. I was getting a little worked up.\u00a0<\/p>\n
Dan:<\/strong> So, these are not hypothetical, and these are not, like, you know, these stories are just entirely consistent with the data that, that gets collected. So, when you ask me, like, what\u2019s the harm? I want to give you this opportunity to say, like, you sure that\u2019s your position?<\/p>\n
Scott Purcell:<\/strong> So, first of all, that was on a different, that was a different question. I made an assumption of that story that they were indigent now and would be indigent \u2013 I was saying, I don\u2019t know why that decision got made if indeed that person, um, is indigent, why a particular, um, provider has whatever parameters they\u2019ve set for their lawsuit program. I can\u2019t speak to the business decisions they\u2019re making. I can speak to, societally, what do we expect people to pay and not pay?\u00a0<\/p>\n
Dan:<\/strong> With the case of the couple in Wisconsin, if they couldn\u2019t pay ever, if their chapter 13 hadn\u2019t worked out, and they\u2019d lost their house, and they\u2019d lost their jobs, and they couldn\u2019t pay ever, are you saying they wouldn\u2019t be harmed?<\/p>\n
Scott Purcell:<\/strong> I\u2019m saying the answer lies in taking those stories to the table. And let\u2019s take a look at what are the other policy changes that should be made in order to get better outcomes. So, in the situation you did outline, I am sure that individual actually went through emotional stress. But there\u2019re safeguards throughout.\u00a0<\/p>\n
Dan:<\/strong> So you\u2019re saying you view this as a kind of exceptional case and that generally there are, from what you know, guidelines and guardrails, as you say, to prevent this sort of thing from happening.<\/p>\n
Scott Purcell:<\/strong> It\u2019s the thing I don\u2019t have data to answer it.\u00a0<\/p>\n
Dan:<\/strong> Yeah, it\u2019s \u2014 I mean, I just need to say: It\u2019s striking, um, that you asked \u2014 you\u2019re, yeah, like: Where\u2019s, where\u2019s the harm?<\/p>\n
Scott Purcell:<\/strong> I made an assumption of that story that they were indigent now and would be indigent\u2013<\/p>\n
Dan:<\/strong> Well, I guess I just don\u2019t understand, I, I don\u2019t really quite understand the difference. Can you explain the distinction between someone being indigent right now, being indigent forever, I don\u2019t really get the distinction at all. And I don\u2019t know in which case, in which case there is harm, in which case there isn\u2019t in your view.<\/p>\n
Scott Purcell:<\/strong> So, um, I wasn\u2019t being flippant. I was taking a very extreme\u2026 um, I\u2019m in D.C. I see homeless people now. So when I heard you say indigent, I\u2019m thinking somebody who\u2019s living under a bridge. They deserve to be treated with dignity and respect. I was thinking that level of indigency. You\u2019re talking about, I think, the, the working class, and people beyond that. And up to the higher end scale is your question. And for that, my question or my answer is back to there are safeguards that should be occurring. And if those safeguards don\u2019t occur, harm does happen. And we collectively need to look at why there are gaps in those safeguards.<\/p>\n
Dan:<\/strong> So in retrospect \u2013 knowing how Scott Purcell took that word indigent \u2013 I\u2019m a little less mystified. But the conversation still seems really\u2026 striking to me.<\/p>\n
For one thing, there\u2019s the idea \u2014 even if it\u2019s not a conscious philosophy\u00a0 \u2014 that some people are beyond hope, so they\u2019re beyond harm. So morally, it wouldn\u2019t matter if, say, you sued them.<\/p>\n
But the other thing that strikes me is the difficulty Scott Purcell had understanding \u2013 believing \u2013 that people being really harmed is something that happens at scale. That last thing he said: \u201cThere are safeguards that should be occurring, and IF those safeguards don\u2019t occur, harm does happen.\u201d<\/p>\n
That word \u201cIF\u201d seems to be doing a lot of work there.\u00a0<\/p>\n
Beyond the mountains of data that folks have compiled \u2013 showing that people get sued who qualify for charity care, and that people who get sued over medical bills tend to live in neighborhoods where poverty is high \u2013 there\u2019s the finding that\u2019s practically a cliche:\u00a0<\/p>\n
About four out of ten Americans don\u2019t have enough money on hand to cover a 400 hundred dollar emergency expense. Maybe I should have explained that to Scott Purcell.\u00a0<\/p>\n
But I just didn\u2019t think I\u2019d need to. He\u2019s sitting atop a whole industry that NEEDS to know, basically, how much money people have. Since we talked, I\u2019ve seen a report for folks in his industry \u2013 third-party collections \u2013 that goes into a lot of detail on that topic.\u00a0<\/p>\n
Of course, third-party collections agencies are for-profit businesses. And at least for some of them, lawsuits like these are part of the business.\u00a0<\/p>\n
So, I guess I\u2019m starting to understand \u2013 maybe belatedly \u2013 how hard it is to get some people to reconsider business as usual. Is business as usual a philosophy?<\/p>\n
But sometimes business as usual does change. In fact, I\u2019m about to share some much more cheerful news with you. It\u2019s what our partners found when we went looking for details on these hospital bill lawsuits in three states.\u00a0<\/p>\n
Because the big surprise was in what we DIDN\u2019T find.<\/p>\n
That\u2019s coming right up.\u00a0<\/p>\n
This episode is produced in partnership with KFF Health News. That\u2019s a nonprofit newsroom covering health care in America. Their incredible journalists win all kinds of awards every year. I\u2019m so glad to get to work with them.\u00a0<\/p>\n
This investigation builds directly on reporting by KFF reporters like Jay Hancock, Noam Levey and Jordan Rau. Respect.\u00a0<\/p>\n
OK, so this whole inquiry \u2014 into why some hospitals sue so many patients who could just get charity care \u2014 started a couple of years ago.\u00a0<\/p>\n
That\u2019s when I spotted what looked like a clue \u2013 in a big report done by National Nurses United. It looked at 145 thousand hospital lawsuits against patients in Maryland over a ten-year period.<\/p>\n
And in addition to documenting how little money hospitals were getting from these suits \u2014 compared to the million-dollar salaries they paid a lot of executives \u2014\u00a0<\/p>\n
This report also noted\u2013 just kind of by-the-way, on page 18 of a 68-page report \u2013 that a relatively small number of attorneys were filing most of these lawsuits.<\/p>\n
Just five attorneys filed almost two-thirds of the cases.<\/p>\n
And just one attorney filed more than 40,000 cases.\u00a0<\/p>\n
I was like, huh! Maybe that\u2019s a clue.\u00a0<\/p>\n
It seems like hospitals don\u2019t get a lot of benefit from these lawsuits. But maybe we\u2019re looking at someone who does. We should find out more.\u00a0<\/p>\n
Starting with the names of those lawyers, which weren\u2019t in the report.<\/p>\n
And I was gonna want a big update on Maryland.<\/p>\n
That report was part of a big advocacy campaign \u2013 which really worked.\u00a0<\/p>\n
In 2021, Maryland enacted a new law saying hospitals couldn\u2019t sue anybody without checking to see if they qualified for free care.<\/p>\n
Which in retrospect, may seem like an obvious requirement. Here\u2019s Malcolm Heflin, one of the organizers who worked on the campaign.<\/p>\n
Malcolm Heflin<\/strong>: It\u2019s like reading the postscript in a Dickens novel almost. It\u2019d be like, \u201cOh yeah. Hey, look, now we can\u2019t chain children to factory machines.\u201d Like what? Wait, what? That was legal before?\u00a0<\/p>\n
Dan:<\/strong> Anyway, if that report was the \u201cbefore\u201d picture, what would \u201cafter\u201d look like? I was gonna need help. And I got some.<\/p>\n
Ryan Little:<\/strong> my name is Ryan Little and I am the data editor at the Baltimore Banner.<\/p>\n
Dan:<\/strong> The Banner is a new nonprofit daily newspaper \u2013 without the paper. Data reporting is a big specialty, and Ryan is the big specialist. Pulling a LOT of Maryland courts data was already on his to-do list.<\/p>\n
Ryan Little:<\/strong> And so I said, maybe there\u2019s a way that we can make a partnership happen. And then many months later, you\u2019ve probably regretted that, but we\u2019ve had a good time doing it. Anyways\u2026<\/p>\n
Dan:<\/strong> No way. Are you kidding me?<\/p>\n
Ryan\u2019s amazing. I am so lucky to get to work with him.\u00a0<\/p>\n
But I wanted to know about more than just Maryland. And I got lucky there too.\u00a0<\/p>\n
Maryland\u2019s not the only state where advocates compiled a bunch of court data to push for change. You might remember Elisabeth Benjamin in New York from our last episode.\u00a0<\/p>\n
She\u2019s the one who pointed out how little money is involved in these suits \u2013 for hospitals she has looked at.<\/p>\n
Elisabeth Benjamin<\/strong>: They\u2019re suing people for pennies. right. The average law suits maybe 1900 bucks. So they\u2019re suing them for chump change, but that $1,900 is like life ruining for the patient.<\/p>\n
Dan:<\/strong> She knew that because she had pulled more than 50 thousand hospital-bill lawsuits from across the state. She used that data in a series of reports that got new laws passed \u2013 like one banning wage garnishment to pay medical debts.\u00a0<\/p>\n
And she shared a giant spreadsheet with me, which included the names of attorneys in 40 thousand cases.<\/p>\n
And guess what? Just three law firms handled the majority of those cases. So now we knew: This wasn\u2019t just a Maryland thing.<\/p>\n
But we were gonna want to look somewhere else too. Someplace where no new laws had been passed. Someplace that was still a \u201cbefore\u201d picture. Someplace like Wisconsin.<\/p>\n
I\u2019d been getting reports from a public-interest lawyer there named Bobby Peterson. He\u2019d been publishing some data about lawsuits, but hadn\u2019t gotten laws passed. And he also wasn\u2019t able to share data. I was gonna need MORE help.\u00a0<\/p>\n
Rosie Cima:<\/strong> My name is Rosie Cima and I manage a data reporting team at Scripps News. I also report for them.\u00a0<\/p>\n
Dan:<\/strong> YES! More data help. Scripps News came aboard as a partner, and Rosie started looking for the data we\u2019d need in Wisconsin.<\/p>\n
And at this point, it may be getting clearer why it has taken us more than a year to bring this story to you. Let\u2019s just recap for a second all the moving parts we\u2019ve got in play here:<\/p>\n
We\u2019ve got Ryan, pulling cases in Maryland, Rosie doing the same in Wisconsin, and me with some New York cases.<\/p>\n
We\u2019re looking to see what the \u201cafter\u201d picture looks like in Maryland and New York, and we\u2019re looking at the role of a few lawyers.<\/p>\n
And this is where I admit: that initial hypothesis? That the lawyers were driving these lawsuits, sweet-talking hospitals to drum up business?<\/p>\n
It didn\u2019t really pan out. As far as I can tell, after talking with a bunch of people and looking at a bunch of reports, it doesn\u2019t seem to work that way.\u00a0<\/p>\n
A lot of the time, anyway, it seems like the lawyers are often freelancers. They get hired by the collection agencies.<\/p>\n
Who get their marching orders from the hospital revenue office.<\/p>\n
But I\u2019m so glad we went looking, because of what we did find.\u00a0<\/p>\n
Or, you could say, what we didn\u2019t.<\/p>\n
In Maryland, Ryan spent months and months and months collecting hundreds of thousands of cases, then weeks and weeks crunching the numbers. And then\u2026\u00a0<\/p>\n
Ryan Little:<\/strong> On Wednesday, September 6th, I sent this email. I find this hard to believe. But it may be that there were zero medical debt lawsuits filed by hospitals against individuals in 2022 and 2023.\u00a0<\/p>\n
Dan:<\/strong> He found it hard to believe \u2013 like, it must be wrong \u2013 so he went back to try to find his mistake. That took almost a week.<\/p>\n
Ryan Little: <\/strong>On Monday, September 11th, I emailed, Hey Dan, news that hospital debt collection lawsuits had ended in Maryland was wrong. It looks like the Maryland Judiciary is somehow suppressing them in case search. Either intentionally or not, I\u2019m rewriting the code to account for this.<\/p>\n
Dan:<\/strong> He thought the Maryland court system was HIDING these cases. Not only did he rewrite the code, he went to the courthouse to go hunt for whatever was missing.\u00a0<\/p>\n
It took him another week. And then I got one more email.<\/p>\n
Ryan Little: <\/strong>So on September 18th, I said, Maryland hospitals are dot, dot, dot. Basically not suing anyone for medical debt anymore.\u00a0<\/p>\n
Dan:<\/strong> Basically not suing anyone for medical debt this year. WOW. I mean, we had expected a significant drop\u2013 if only because Maryland had passed that 2021 law, which required hospitals to see if people were eligible for charity care before suing them.\u00a0<\/p>\n
But zero was a much bigger drop than we\u2019d expected.\u00a0<\/p>\n
Next stop, New York. A few months ago, we looked at those three law firms \u2013 the ones that handled the majority of hospital-bill cases there.\u00a0<\/p>\n
And as far as we could tell, two of them were just not doing any work for hospitals at all anymore.<\/p>\n
But OK, again: We\u2019d expected an \u201cafter\u201d picture in both these states. What about Wisconsin?<\/p>\n
Well, for one thing, it turned out to be TOUGH.\u00a0<\/p>\n
Rosie Cima:<\/strong> When we took this on the first time, it definitely seemed like it\u2019d be a lot easier than it ended up being.\u00a0<\/p>\n
Dan:<\/strong> You can pull some case data from the web, but there\u2019s a problem: Once a case has been dismissed, it gets taken off that website after a few years.\u00a0<\/p>\n
Rosie Cima:<\/strong> So all the data that we had from before 2020 was missing some unknown number of cases<\/p>\n
We can laugh about it now, but that sucked. We did find some guys who had data on older cases socked away. From them, we got the full caseloads for two lawyers we\u2019d heard did a lot of medical-bill lawsuits.<\/p>\n
Rosie Cima:<\/strong> We found more than 8000 cases in one year, um, for two lawyers,\u00a0<\/p>\n
Dan:<\/strong> That was 2019. Pre-pandemic.\u00a0<\/p>\n
Rosie Cima:<\/strong> And in 2022, There were fewer than 1400 for both of them.<\/p>\n
Dan:<\/strong> In other words, these two lawyers were doing less than a quarter as much medical-bill business as they\u2019d been doing three years earlier.<\/p>\n
And Rosie pulled numbers year by year, client by client, which was super-revealing.\u00a0<\/p>\n
Because for both of them, many of their biggest clients \u2013 hospitals and medical practices for whom they had been filing hundreds of cases a year \u2013 weren\u2019t filing any cases.<\/p>\n
Which wasn\u2019t totally conclusive. We knew these lawyers were getting less work\u2026<\/p>\n
Rosie Cima:<\/strong> The thing that we didn\u2019t know was, like, whether, Hospital A had stopped suing, or whether they just stopped hiring this lawyer.<\/p>\n
Dan:<\/strong> Right. So Rosie went back to the public data website to see whether those hospitals A, B, C and so on were suing. And for the most part, they weren\u2019t \u2014 at least not like they used to.\u00a0<\/p>\n
Rosie Cima:<\/strong> Yeah, we now know that those cases weren\u2019t going to a different lawyer. Right? They\u2019re just not, they\u2019re just not being filed.<\/p>\n
Dan:<\/strong> Just not. Being filed. And it wasn\u2019t just the hospitals that had been using these two lawyers that had fallen away. Other hospitals that had been suing tons of patients had cut way back.\u00a0<\/p>\n
From more than a thousand in 2019 to a few dozen, or less than a dozen. Or one. Or zero.\u00a0<\/p>\n
One hospital system sued more than 47 hundred people in 2019. In 2023 so far, they\u2019ve sued one.<\/p>\n
And remember, because older cases get wiped from the web, there\u2019s some unknown number of cases from 2019 we aren\u2019t seeing. The decline is probably bigger than what we see.<\/p>\n
So, one thing to say is: We don\u2019t know WHY this is happening. In any of these states. Our colleagues at the Baltimore Banner called every hospital in Maryland to ask about these changes, and got a bunch of no-comment. We emailed dozens of hospitals in Wisconsin and basically got the same answer.<\/p>\n
So we\u2019re left with some guessing \u2013 and here are some of our best guesses:\u00a0<\/p>\n
Those new laws in New York and Maryland didn\u2019t outlaw lawsuits\u2026 but the Maryland law made them more difficult, and the New York laws made it harder to collect.\u00a0<\/p>\n
And the campaigns that led to those laws brought a LOT of negative attention to hospitals that filed a lot of lawsuits. So one way or another, it seems like a lot of hospitals decided it wasn\u2019t worth it.<\/p>\n
And in Wisconsin? Laws didn\u2019t change, but the reports that the lawyer Bobby Peterson put out there did get some attention locally.\u00a0<\/p>\n
We know in Wisconsin, lawsuits halted altogether for a while when the pandemic started. Maybe hospitals noticed that they weren\u2019t exactly losing a ton of money when that happened?<\/p>\n
Here\u2019s one last data point from Rosie. She looked closely at the cases she had for those two lawyers from 2019. The ones where the hospital was awarded a judgment.<\/p>\n
Rosie Cima: <\/strong>We found that the majority of those awards were never fulfilled, like, I, I feel like that\u2019s important, a judge said, yes, you defendant owe this case. company, the plaintiff, this much money and in a lot of cases, the plaintiff hasn\u2019t paid out. And it\u2019s been years.<\/p>\n
Dan:<\/strong> Which I don\u2019t think is evidence that \u201cWow, these folks were really good at dodging payment!\u201d No, because in a lot of these old cases, the judge gave an OK to garnish these folks\u2019 wages: To take money directly from their paycheck.<\/p>\n
So if these debts haven\u2019t been paid, years later \u2013 and remember, these are often amounts of a thousand dollars or less \u2013 it seems like these folks may be earning so little that garnishing their wages for years doesn\u2019t get you much.\u00a0<\/p>\n
So, to start wrapping up: There\u2019s a TON we don\u2019t know. For one thing, there\u2019s 47 other states we haven\u2019t looked at. And we don\u2019t know if hospitals in these three states will start suing again, when they think nobody\u2019s looking.<\/p>\n
But here\u2019s something I do know: A surprising number of those other states have been passing new laws and regulations in the last couple years, to prevent hospitals from filing so many lawsuits against folks who qualify for charity care:\u00a0<\/p>\n
Illinois, Arizona, Colorado, Minnesota, Washington, Oregon. I\u2019m probably missing some.\u00a0<\/p>\n
But here\u2019s the single biggest thing I\u2019m taking away from this whole adventure: A LOT more people qualify for charity care\u2013 free or discounted care from the hospital\u2013 than we think.<\/p>\n
And we can help ourselves and each other, just by spreading the word.<\/p>\n
I called Casey Gasior in Wisconsin a couple weeks ago. It wasn\u2019t a great day for her.<\/p>\n
Casey:<\/strong> Everybody in my house is sick and I just tested positive for covid. And now we\u2019re going to lose work time.<\/p>\n
Dan:<\/strong> Right.<\/p>\n
Casey:<\/strong> I tell you, it never ends.<\/p>\n
Dan:<\/strong> I was calling because I knew: Casey and her husband Ron have had more medical adventures this year. More knee trouble for him, emergency surgery for her, time away from work and lost income for both of them. And thousands of dollars of new medical bills.\u00a0<\/p>\n
I said to her: It seems like maybe you and Ron might qualify to have some of those bills forgiven through charity care.<\/p>\n
Casey:<\/strong> I think my, my husband makes too much.\u00a0<\/p>\n
And I was like, well, maybe. But as we learned from Nick McLaughlin in our last episode, almost 60 percent of Americans qualify for charity care at a bunch of hospitals.\u00a0<\/p>\n
And the nonprofit Dollar For has created a database of the charity care policies of almost every hospital in the country \u2013 and they\u2019ve built it into their website.\u00a0<\/p>\n
So you can type in a few details \u2013 where you were treated, how much you make \u2013 and it\u2019ll tell you whether you\u2019re likely to qualify for help.<\/p>\n
Dan:<\/strong> So, I\u2019m looking at their website right now.<\/p>\n
And would it be okay with you to just kind of walk through kind of what they\u2019re asking you, what they, um\u2026<\/p>\n
Casey:<\/strong> Yeah, sure.<\/p>\n
Dan:<\/strong> Questions included: Where\u2019d you get seen, and when?<\/p>\n
Casey:<\/strong> Um, my surgery was July 24th.<\/p>\n
Dan:<\/strong> Casey and I went line by line, filling out the form. I had her hunting for tax returns, and other documents<\/p>\n
Casey:<\/strong> Hey, Ron. Can you send me a, um, a pay stub? Can you send me a picture of it? Like, now?<\/p>\n
Dan:<\/strong> Okay. Alright, I\u2019m going to add those up. There we go.<\/p>\n
And yeah, so Dollar For thinks that you would qualify,\u00a0<\/p>\n
Casey:<\/strong> Wow. That surprises me.\u00a0<\/p>\n
Dan:<\/strong> This is good.<\/p>\n
Casey:<\/strong> This is really\u2026<\/p>\n
Dan:<\/strong> Yeah. I\u2019m really glad that we took this step.<\/p>\n
Casey:<\/strong> Yeah, me too, because I was kind of, I didn\u2019t know where to go and like, it, it seems so weird asking for charity.<\/p>\n
Dan:<\/strong> But Casey was ready to take the next step.<\/p>\n
Casey:<\/strong> Now this application that I\u2019m filling out now do I have to do one for myself and one for Ron.\u00a0<\/p>\n
Dan:<\/strong> Yes. Yeah.\u00a0<\/p>\n
Casey:<\/strong> Okay, I\u2019m going to work on this<\/p>\n
Dan:<\/strong> Okay. Fantastic.<\/p>\n
And this is a thing that we can do for ourselves, and each other. Spread the word: The majority of people qualify for at least some charity care \u2013 at least partially wiping out your bill \u2013 at a LOT of hospitals.\u00a0<\/p>\n
The Dollar For website is set up to tell you if you\u2019re likely to qualify, and to help you apply. They\u2019ve also got actual human beings on staff to help if you get stuck.<\/p>\n
Their website is Dollar For \u2013 that\u2019s Dollar F-O-R dot org. Dollar F-O-R dot org.\u00a0<\/p>\n
And that is our story. We never got all the way to the bottom of the question of WHY these bulk lawsuits happened \u2013 or why they seem to have stopped in some places \u2013 but we did get a peek into the process.\u00a0<\/p>\n
And we learned some things that are heartening \u2013 a lot fewer lawsuits in these three states!<\/p>\n
I\u2019ve learned a lot more, along the way \u2013 there\u2019ll be follow-ups.\u00a0<\/p>\n
This has been a HUGE project for our little outfit. We got a ton of help from our partners, and we put a TON of resources into it: Travel to Wisconsin and Michigan, MONTHS of phone calls, 1600 bucks to get court records.\u00a0<\/p>\n
We\u2019ve been able to do that because you\u2019ve been supporting us\u2013 giving us the resources to do the job. And this is the absolute best time to pitch in:\u00a0<\/p>\n
Every dollar you give is matched. A few generous Arm and a Leg listeners have put up more than 10 thousand dollars in matching funds ON TOP of what the Institute for Nonprofit News does through their NewsMatch program \u2013 and I want to max it out.\u00a0<\/p>\n
The place to go is Arm and a Leg Show, dot org, slash support. And there\u2019s a link in the show notes \u2013 pretty much anywhere you\u2019re listening to this.\u00a0<\/p>\n
We\u2019ll be back next week with a quick little coda to this story.<\/p>\n
Meanwhile, thank you so much for helping us make this show. I\u2019m gonna give that address one more time: Arm and a Leg show dot com, slash support.\u00a0<\/p>\n
I\u2019ll catch you next week.<\/p>\n
Till then, take care of yourself.<\/p>\n
This episode of An Arm and a Leg was produced by me, Dan Weissmann, with Emily Pisacreta and Bella Czakowski.\u00a0<\/p>\n
In partnership with Scripps News, thanks to Rosie Chima, Amber Strong, Claire Malloy, Jacqueline Baylon and Zach Toombs and the Baltimore Banner, thanks to Ryan Little, Meredith Cohn, Brenna Smith and Kimi Yoshino and the McGraw Center for Business Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York, with thanks to Jane Sasseen.<\/p>\n
Our work on this story is supported by the Fund for Investigative Journalism, and edited by Ellen Weiss.\u00a0<\/p>\n
Big thanks also to Jared Walker, Bobby Peterson, Luke Messac, Jeff Bloom, Emily Stuart, Berneta Hayes, Matt Szaflarski, Amanda Dunkler, and Marceline White! Plus Barry and Jo from Court Data Techologies, in Wisconsin.<\/p>\n
Gabrielle Healy is An Arm and a Leg\u2019s managing editor for audience \u2013 she edits the First Aid Kit newsletter.<\/p>\n
Sarah Ballema is our Operations Manager. Bea Bosco is our Consulting Director of Operations.<\/p>\n
An Arm and a Leg is produced in partnership with KFF Health News.\u00a0<\/p>\n
That\u2019s a national newsroom producing in-depth journalism about health care in America, and a core program at KFF \u2014 an independent source of health policy research, polling, and journalism.\u00a0<\/p>\n
You can learn more about KFF Health News at arm and a leg show dot com, slash KFF.\u00a0<\/p>\n
Zach Dyer is senior audio producer at KFF Health News. He is an editorial liaison to this show.\u00a0<\/p>\n
Thanks to the INSTITUTE FOR NONPROFIT NEWS for serving as our fiscal sponsor, allowing us to accept tax-exempt donations. You can learn more about INN at I-N-N dot org.\u00a0<\/p>\n
And thanks to everybody who supports this show financially.\u00a0<\/p>\n
If you haven\u2019t yet, we\u2019d love for you to pitch in to join us. Again, the place for that is arm and a leg show dot com, slash support.<\/p>\n
And now, time for one of my favorite parts: Shouting out some of the folks who have made donations since our last episode. Thanks this time to\u2026<\/p>\n
[DAN READS NAMES]<\/p>\n
Thank you so much!<\/p>\n
\u201cAn Arm and a Leg\u201d is a co-production of KFF Health News and Public Road Productions.<\/p>\n
This episode was produced in partnership with Scripps News<\/a>, The Baltimore Banner<\/a>, and the McGraw Center for Business Journalism<\/a> at the Craig Newmark Graduate School of Journalism at the City University of New York.<\/p>\n
Work by \u201cAn Arm and a Leg\u201d on this article is supported by the Fund for Investigative Journalism.<\/p>\n
To keep in touch with \u201cAn Arm and a Leg,\u201d\u00a0 subscribe to the newsletter<\/a>. You can also\u00a0follow the show on\u00a0 Facebook<\/a>\u00a0and\u00a0 X, formerly known as Twitter<\/a>. And if you\u2019ve got stories to tell about the health care system, the producers\u00a0 would love to hear from you<\/a>.<\/p>\n
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