Characteristics of US hospitals using extraordinary collections actions against patients for unpaid medical bills: a cross-sectional study
Objective This study aims to characterise and evaluate the largest 100 hospitals in the USA that have adopted aggressive collection tactics to pursue patients with unpaid medical bills, such as lawsuits, wage garnishments and liens.Design Cross-sectional study.Setting We examined state and county co...
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e060501.full |
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| author | Dominique Vervoort Farah Hashim Sanuri Hennayake Christi M Walsh Chen Dun Joseph Giuseppe Paturzo Indrani G Das Emily A Stewart Jonathan A Teinor Morissa A Schochet Allyson Keslar Ge Bai Martin Makary |
| author_facet | Dominique Vervoort Farah Hashim Sanuri Hennayake Christi M Walsh Chen Dun Joseph Giuseppe Paturzo Indrani G Das Emily A Stewart Jonathan A Teinor Morissa A Schochet Allyson Keslar Ge Bai Martin Makary |
| author_sort | Dominique Vervoort |
| collection | DOAJ |
| description | Objective This study aims to characterise and evaluate the largest 100 hospitals in the USA that have adopted aggressive collection tactics to pursue patients with unpaid medical bills, such as lawsuits, wage garnishments and liens.Design Cross-sectional study.Setting We examined state and county court record systems to measure the magnitude and prevalence of these practices at the largest 100 hospitals in the UA between 1 January 2018 and 31 July 2020.Main outcomes measures The main outcome of this study was the number of lawsuits, wage garnishments and liens. A secondary outcome was the characterisation of a hospital’s safety, charitability, size and financial practices.Results Between 1 January 2018 and 31 July 2020, 26 hospitals filed 38 965 court actions (lawsuits, wage garnishments and liens) against patients for unpaid medical debt. For 16 of 26 hospitals, the dollar amount pursued in the court claim was available for 100% of cases, totalling US$71.8 million. The average aggregate amount sought by hospital lawsuits during the study period was US$4.5 million. Three hospitals filed US$56.2 million in amounts pursued in court, or 78.3% of the total amount pursued by all hospitals in the sample. In the remaining 74 hospitals, the study team did not identify extraordinary collection actions through the court system.Conclusions Standardised medical debt collections best practices and metrics of medical debt collections quality are needed to increase public accountability for hospitals, particularly non-profit hospitals. There is a need to re-evaluate Internal Revenue Service rules pertaining to non-profit hospitals’ tax-exempt status to ensure tax-exempt hospitals provide community benefits commensurate with the value of tax exemption. |
| format | Article |
| id | doaj-art-60eae8160a43433d8f12e8f02bc42894 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-60eae8160a43433d8f12e8f02bc428942025-01-31T16:25:10ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-060501Characteristics of US hospitals using extraordinary collections actions against patients for unpaid medical bills: a cross-sectional studyDominique Vervoort0Farah Hashim1Sanuri Hennayake2Christi M Walsh3Chen Dun4Joseph Giuseppe Paturzo5Indrani G Das6Emily A Stewart7Jonathan A Teinor8Morissa A Schochet9Allyson Keslar10Ge Bai11Martin Makary122 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, CanadaSchool of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USASchool of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USASchool of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USASchool of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USASchool of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USAJoan and Sanford I Weill Medical College, Cornell University, New York, New York, USAWashington University in St Louis, St Louis, Missouri, USASchool of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USAMailman School of Public Health, Columbia University, New York, New York, USASchool of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USABloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USASchool of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USAObjective This study aims to characterise and evaluate the largest 100 hospitals in the USA that have adopted aggressive collection tactics to pursue patients with unpaid medical bills, such as lawsuits, wage garnishments and liens.Design Cross-sectional study.Setting We examined state and county court record systems to measure the magnitude and prevalence of these practices at the largest 100 hospitals in the UA between 1 January 2018 and 31 July 2020.Main outcomes measures The main outcome of this study was the number of lawsuits, wage garnishments and liens. A secondary outcome was the characterisation of a hospital’s safety, charitability, size and financial practices.Results Between 1 January 2018 and 31 July 2020, 26 hospitals filed 38 965 court actions (lawsuits, wage garnishments and liens) against patients for unpaid medical debt. For 16 of 26 hospitals, the dollar amount pursued in the court claim was available for 100% of cases, totalling US$71.8 million. The average aggregate amount sought by hospital lawsuits during the study period was US$4.5 million. Three hospitals filed US$56.2 million in amounts pursued in court, or 78.3% of the total amount pursued by all hospitals in the sample. In the remaining 74 hospitals, the study team did not identify extraordinary collection actions through the court system.Conclusions Standardised medical debt collections best practices and metrics of medical debt collections quality are needed to increase public accountability for hospitals, particularly non-profit hospitals. There is a need to re-evaluate Internal Revenue Service rules pertaining to non-profit hospitals’ tax-exempt status to ensure tax-exempt hospitals provide community benefits commensurate with the value of tax exemption.https://bmjopen.bmj.com/content/12/7/e060501.full |
| spellingShingle | Dominique Vervoort Farah Hashim Sanuri Hennayake Christi M Walsh Chen Dun Joseph Giuseppe Paturzo Indrani G Das Emily A Stewart Jonathan A Teinor Morissa A Schochet Allyson Keslar Ge Bai Martin Makary Characteristics of US hospitals using extraordinary collections actions against patients for unpaid medical bills: a cross-sectional study BMJ Open |
| title | Characteristics of US hospitals using extraordinary collections actions against patients for unpaid medical bills: a cross-sectional study |
| title_full | Characteristics of US hospitals using extraordinary collections actions against patients for unpaid medical bills: a cross-sectional study |
| title_fullStr | Characteristics of US hospitals using extraordinary collections actions against patients for unpaid medical bills: a cross-sectional study |
| title_full_unstemmed | Characteristics of US hospitals using extraordinary collections actions against patients for unpaid medical bills: a cross-sectional study |
| title_short | Characteristics of US hospitals using extraordinary collections actions against patients for unpaid medical bills: a cross-sectional study |
| title_sort | characteristics of us hospitals using extraordinary collections actions against patients for unpaid medical bills a cross sectional study |
| url | https://bmjopen.bmj.com/content/12/7/e060501.full |
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