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Expand chart
Data: JHU; Chart: Will Chase/Axios

More than a quarter of the 100 U.S. hospitals with the highest revenue sued patients over unpaid medical bills between 2018 and mid-2020, according to new research by Johns Hopkins University provided exclusively to Axios.

Why it matters: The report suggests that, rather than being an anomaly, patient lawsuits are relatively common across the country and among the largest providers.

  • “Most hospitals do not engage in this form of predatory billing. But for the ones that are, it threatens the great public trust in the medical profession,” said Marty Makary, a lead researcher of the project.

The big picture: As patients have become increasingly responsible for higher deductibles and other out-of-pocket costs, some hospitals have responded to unpaid bills by taking patients to court.

  • Meanwhile, the cost of hospital care has continued to rise, and is often many times the rate Medicare pays for the same services.
  • Hospitals continued these “predatory billing practices” even amid the pandemic last year, per the JHU researchers, although there were fewer court actions than in the previous two years.
  • It’s unclear how much of the decrease was because of the pandemic and how much was attributable to lasting changes in billing practices.

Details: The study found that 26 of the hospitals filed nearly 39,000 court actions against patients. This is likely an undercount, as some court records were inaccessible.

  • These court actions took the form of lawsuits, wage garnishments and personal property liens. Wage garnishments are court orders allowing hospitals to take part of a defendant’s paycheck, and a personal property lien is a legal claim that allows the holder to obtain access to an asset if a debt isn’t paid.
  • Even hospitals that didn’t sue their patients often had charges that were several times the cost of care.
Expand chart
Data: JHU; Chart: Will Chase/Axios

By the numbers: 16 hospitals provided complete data on the amount they sued patients for —  $71.8 million altogether. Three hospitals — Westchester Medical Center, VCU Medical Center and Froedtert Hospital — accounted for more than three-quarters of the total amount sought.

  • Among hospitals for which the amounts sought were available, patients were sued for $1,842 on average.
  • The number of court actions decreased over time, with hospitals filing nearly 21,000 in 2018, 16,510 in 2019 and only 1,661 in 2020, although the report only analyzed court records until the end of July.

Between the lines: Nearly two-thirds of the hospitals that sued patients are nonprofits. Eight are government-owned, and only one is for-profit.

  • Nonprofits also comprise around two-thirds of the top 100 hospitals, meaning they aren’t disproportionately likely to sue. But their nonprofit status makes them tax-exempt, in exchange for the provision of free or highly discounted care for patients who couldn’t afford it.
  • When nonprofits sue patients who can't afford to pay, “if it’s not a violation of the letter of the...law, it’s certainly a violation of the spirit of it," Makary said.

The other side: The American Hospital Association called collection actions “a last resort."

  • “Our doors are always open, regardless of a patient’s ability to pay. In total, hospitals of all types have provided more than $702.51 billion in uncompensated care to patients since 2000 for which no payment was received for patients in need,” said an AHA spokesperson in a statement.
  • “The reality, however, is that the health care system must be adequately financed to ensure that hospitals and health systems are able to stay open and be there for their communities in times of need.”

The bottom line: Even some of the hospitals with the highest revenues in the country will take patients to court over bills that are, on average, less than $2,000.

Go deeper: Explore the full Axios-Johns Hopkins analysis

Go deeper

Bryan Walsh, author of Future
Sep 18, 2021 - Politics & Policy

Reported firearm injuries spiked in 2020

Data: Epic Health Research Network (EHRN.org); Chart: Axios Visuals

A new study found health care visits for gun injuries rose sharply last year during the pandemic.

Why it matters: The new data from electronic health records helps confirm media reports and preliminary data suggesting a surge in gun violence in many cities.

Schumer vows to confirm Breyer replacement "with all deliberate speed"

Chuck Schumer. Photo: Alex Wong/Getty Images

Senate Majority Leader Chuck Schumer responded Wednesday to reports that Supreme Court Justice Stephen Breyer will retire, commending his time on the bench and promising to confirm President Biden's nominated replacement "with all deliberate speed."

Why it matters: The opportunity to appoint a new Supreme Court justice will be one of the longest-lasting pieces of Biden's legacy and could energize Democrats ahead of the midterms.

26 mins ago - World

Scoop: Israel's "top priority" mission to discredit UN probe

Israeli Prime Minister Naftali Bennett addresses the UN. Photo: John Minchillo/Pool via Getty

Israel is planning a campaign to discredit a UN commission formed to investigate the violence in Gaza last May and the root causes of the protracted conflict in the occupied West Bank and Gaza, according to an Israeli Foreign Ministry cable seen by Axios.

Why it matters: Israeli officials say they are highly concerned that the commission’s report will refer to Israel as an "Apartheid state" and that its findings could damage Israel's reputation, particularly among progressives in the West. The report is expected in June.