- http://www.kaiserhealthnews.org/stories/2012/april/27/charity-care-nonprofit-hospitals-patient-debt.aspx
- http://www.npr.org/blogs/health/2012/04/27/151537743/nonprofit-hospitals-faulted-for-stinginess-with-charity-care
List date(s) this work was published or aired.
4/27/2012
Provide a brief synopsis of the story or stories, including any significant findings.
This story examines the common practice of nonprofit hospitals suing low-income patients who are unable to pay their hospital bills. Mount Carmel, a nonprofit Catholic hospital in Columbus, Ohio, sued nearly 1,600 people in county court between 2009-2011 — far more than the other hospitals in the area. Often, these low-income patients face charges that are much higher than the negotiated rates paid by private insurers. Few of them seek legal assistance and instead end up with ruined credit scores and garnished wages. Lori Duff, a 27-year-old mother of three was sued over an $1,800 bill for prenatal visits, though her family earns less than the federal poverty level and should have qualified for Mount Carmel’s financial assistance policy. She received threatening calls from a debt collector on a daily basis and requests to appear in court. Nonprofit hospitals, including Mount Carmel, pay no federal, state or local taxes, giving them a competitive edge over their for-profit counterparts. In return, they are expected to offer a community benefit, including free and discounted care for low-income patients. Yet many shirk their duties. The federal health law passed in 2010 attempts to address that by mandating how a nonprofit hospital must report charity care and serve poor patients. The new rules have already gone into effect but are not being actively enforced, and not all hospitals are complying with the new rules. This story includes an investigation of Mount Carmel’s billing practices, and an examination of whether nonprofit hospitals tend to provide adequate charity care for their patients. It also discusses what states and the federal government are doing to address the problem. A radio version ran on NPR, and a longer text story was published on Kaiser Health News.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
I requested data from several Columbus hospitals on their charity care policies and reviewed their 990s carefully. Mount Carmel was not forthcoming with their charity care practices, though the ACA requires that it be publicly available. I also requested several sets of documents from the county courts in order to determine the numbers of patients who had been sued by the various hospitals. Legal Aid Columbus was also helpful in sharing with me the details of several court cases against Mount Carmel. In addition, I researched the hearings and policy papers from years of Congressional investigations, CBO and GAO reports on nonprofit hospitals. Lori Duff shared with me extensive legal documents from the suit against her, dozens of letters from Mount Carmel, her charity care application and her financial documents from the last several years. I received similar documentation from several other patients who were being sued by the hospital.
Explain types of human sources used.
Several patients who were being sued by Mount Carmel opened their homes to me and shared their stories and documents. Kate McGarvey, a lawyer at Columbus Legal Aid, was invaluable. After weeks of rejected requests, Mount Carmel finally agreed to let me speak to one of their administrators. I was also fortunate to be able to interview Sen. Chuck Grassley, R-Iowa, who has led the charge on Capitol Hill to hold nonprofits more accountable. I also spoke to more than a dozen experts on hospital finances.
Results:
After the story ran on NPR, we received so many offers to help Lori Duff pay her hospital bill that we had Legal Aid open a special account for her. Since then, Legal Aid has met several times with Mount Carmel. They were able to resolve all of the outstanding cases, including the case against Duff. Kate McGarvey reports that since the story aired, the hospital has been filing fewer suits against patients. Nonetheless, the practice has not stopped entirely.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
We did not have to run any corrections, and no one has come forward to challenge its accuracy.
Advice to other journalists planning a similar story or project.
The most difficult part of this story was finding a patient willing to open up about a suit against them and share their financial information. I found patients in several states who did not want to go on the record. Legal Aid ended up being the key in finding patients willing to share their stories — I recommend approaching Legal Aid and other groups who provide advice to low-income patients if you are trying to find the same. Several states, including Illinois, are taking matters into their own hands. I suggest looking into court records in your county to find out if any hospitals stand out as filing more suits than the rest. Then find out whether they are following the new ACA rules regarding charity care, and whether anyone is attempting to enforce them. There are plenty of bad actors in this arena.