Reporting Highlights
- Suing the Poor: At one neighborhood well being heart in Kansas, many sufferers sued had been uninsured and made so little cash they certified for discounted care.
- Ballooning Prices: A neighborhood well being heart in Virginia filed greater than 7,000 lawsuits. One invoice ballooned 600% resulting from curiosity, courtroom prices and lawyer charges.
- Failing the Mission: Consultants mentioned the lawsuits and wage garnishments violated neighborhood well being facilities’ mission to make preventive well being care accessible.
These highlights had been written by the reporters and editors who labored on this story.
This previous June, Ashley Voss-Barnes acquired a courtroom summons within the mail.
PrairieStar Well being Heart, a nonprofit neighborhood well being heart in south-central Kansas, was suing her for $675 and her spouse for $732 in unpaid medical payments. Voss-Barnes knew the clinic acquired federal funding to make preventive well being care accessible in a area the place many households, together with her personal, wanted monetary assist.
She didn’t perceive what led to the lawsuit. She and her spouse had a blended household of 5 youngsters that price quite a bit to maintain wholesome. In consequence, years in the past, the couple had requested PrairieStar if they may arrange an ongoing cost plan to mechanically take cash from their checking accounts a number of instances a month. Voss-Barnes would later state in a courtroom submitting that PrairieStar by no means knowledgeable her these funds weren’t sufficient to cowl her payments and hold her out of collections.
“If I’ve one thing due, then I’ll attempt to pay it,” she mentioned to ProPublica. “It got here out of nowhere.”
Voss-Barnes, a nurse who feels assured navigating the well being care system, wished to push again. She reached out to a neighborhood lawyer to see if he may characterize them, however he mentioned the debt was too small to be price it. So she represented herself, submitting a letter in courtroom objecting to the lawsuit and asking to proceed the present cost plan.
Finally, Voss-Barnes and her spouse agreed to arrange new cost plans with the collections company for the debt, to keep away from having the cash taken instantly from their paychecks by wage garnishment. To their dismay, they owed tons of extra in curiosity, courtroom prices and lawyer charges on account of PrairieStar’s determination to sue.
They fear about PrairieStar suing them once more. “I do know we’re not the one ones this has occurred to,” Voss-Barnes mentioned.
The lawsuits in opposition to the 2 girls are amongst a minimum of 1,000 that PrairieStar has filed in opposition to sufferers since 2020 for unpaid medical payments, based on a ProPublica evaluation of state courtroom data over that interval. Many sufferers PrairieStar sued had been uninsured and made so little cash they certified for discounted care, a former affected person accounts worker informed ProPublica.
Group well being facilities like PrairieStar Well being, also referred to as federally certified well being facilities, had been created to function medical security nets for individuals who wrestle to afford main care. They had been established in the course of the Civil Rights Motion-era “Warfare on Poverty,” when federal officers realized that low-income People, overwhelmed by lengthy drives and crowded hospitals, had been forgoing medical consideration. The well being facilities obtain federal grants in change for serving sufferers no matter their capacity to pay, growing entry throughout massive swaths of the nation.
However ProPublica discovered that a number of of those well being facilities are suing sufferers and garnishing their paychecks — which consultants say contradicts their mission. We recognized two different facilities in Kansas, plus one in rural Virginia and one in Kalamazoo, Michigan, that constantly filed lawsuits in opposition to sufferers since a minimum of 2020. Our search, which was not exhaustive, targeted on states and counties the place courtroom data are publicly accessible on-line. We additionally reviewed paperwork from a municipality in Alaska and a county in California that run neighborhood well being facilities, which confirmed they use exterior debt collectors to pursue what sufferers owe.
Leaders of 5 neighborhood well being facilities, together with PrairieStar, informed ProPublica they ship sufferers to collections or file lawsuits in opposition to them as a final resort, after sending statements and providing cost plans. Three pointed to the monetary instability that neighborhood well being facilities face as a purpose to pursue affected person debt. All 5 careworn that they didn’t flip away sufferers who couldn’t afford medical care, citing a aim to make well being care accessible.
In response to questions from ProPublica, PrairieStar CEO Bryant Anderson mentioned that the well being heart faces “an ideal storm” caring for sufferers whereas additionally coping with greater prices and unstable funding. “With all of the challenges PrairieStar faces to take care of entry to take care of the uninsured and the underinsured, having somebody suggest that we don’t fulfill our mission is definitely rubbing salt within the wounds,” he wrote in an e mail.
Anderson mentioned PrairieStar usually tries six instances to speak with sufferers earlier than sending them to collections. He additionally mentioned each affected person is given the choice to use for sliding-scale reductions based mostly on revenue and a few third select to not present that data.
Different well being heart leaders additionally defined their determination to pursue affected person debt by lawsuits, in response to questions from ProPublica. “We perceive that sending accounts to collections can appear at odds with that mission, and it’s not a choice we take frivolously,” mentioned Renee Hively, the CEO of CareArc, a neighborhood well being heart in Kansas. CareArc has appeared in native information for pursuing one affected person’s medical invoice by a lawsuit and wage garnishments for greater than 12 years, contributing to her being unable to afford fundamental utilities. (CareArc didn’t reply to a request for remark about that exact case.)
A spokesperson for the division that oversees neighborhood well being facilities in Monterey County, California, informed ProPublica that the majority unpaid payments it sends to collections “contain small quantities that don’t justify the price of initiating authorized proceedings.” In consequence, none of its sufferers have been sued since 2019. If the well being facilities ever stopped sending sufferers to collections, the spokesperson mentioned, the monetary impact could be “minimal.”
A lot of the public consideration on medical debt and associated lawsuits has been targeted on hospitals, particularly nonprofit hospitals that obtain tax breaks with a purpose to make care extra reasonably priced. Hospitals should present emergency care no matter whether or not the affected person can afford it however should not required to offer main care like checkups or routine screenings. Nonprofit hospitals are required by federal regulation to examine whether or not sufferers qualify for monetary assist earlier than suing them or garnishing their wages.
Group well being facilities, however, should make “each cheap effort” to gather cash from sufferers earlier than writing it off, based on federal regulation.
Although consultants and leaders of different well being facilities say the facilities have ample freedom to determine what “cheap” means — and whether or not to pursue debt by collections businesses and the courts — Anderson mentioned the way by which PrairieStar collects money owed is remitted by the regulation.
He additionally mentioned that ProPublica could also be attempting to “induce” different well being facilities to violate federal regulation by reporting and scripting this story. “Your messaging would subsequently be harmful and intimate that such well being facilities weren’t required to make ‘each cheap effort to safe funds’ for his or her providers,” he wrote.
However consultants on neighborhood well being heart funds mentioned that federal regulation doesn’t require the facilities to ship sufferers to collections. “There’s no regulation that claims you must garnish wages or that you must go after somebody by collections,” mentioned Ray Jorgensen, a well being care billing marketing consultant who mentioned he has labored with tons of of neighborhood well being facilities over about 30 years. “I might say that’s an anomaly. That’s not the norm.”
Anderson didn’t reply particular questions on PrairieStar’s lawsuits or wage garnishments. He repeatedly mentioned that ProPublica did “not have all of the information” and that the story could be “probably defamatory,” however he didn’t make clear what he felt was lacking or inaccurate. Nor did he reply on to questions on Voss-Barnes’ expertise, although she and her spouse signed privateness waivers permitting him to take action. Voss-Barnes mentioned that he reached out to her instantly, telling her that everybody of their Kansas metropolis would know that she had did not pay her medical payments if she moved ahead with the article. (He didn’t reply when requested about that outreach.) He did inform ProPublica that he personally contacted each a former worker and one other affected person who ProPublica had requested him about. The affected person stopped responding to ProPublica.
Medical debt consultants mentioned they had been stunned and horrified to listen to that neighborhood well being facilities had been utilizing lawsuits and third-party debt collectors to get better cash from sufferers, given their supposed function of offering care to individuals who haven’t any different choices. Below federal regulation, neighborhood well being facilities should present discounted care on a sliding scale for sufferers who make at or under 200% of the federal poverty guideline, an quantity that varies based mostly on household measurement and family revenue. A household of 4 should make below $64,300 to obtain a reduction. Medical debt disproportionately burdens Black, Hispanic, low-income and uninsured sufferers — teams extra possible to make use of neighborhood well being facilities for reasonably priced care.
“Sufferers who’ve been sued due to medical debt are prone to keep away from care sooner or later,” mentioned Miriam Straus, coverage adviser for Group Catalyst, a well being advocacy group. “These assortment actions appear to violate a minimum of the spirit of the requirement to offer well being providers obtainable to all.”
On Virginia’s Jap Shore, a slim peninsula bordered by the Atlantic and the Chesapeake Bay, getting sued by the neighborhood well being care heart is an everyday prevalence. During the last decade, Jap Shore Rural Well being filed greater than 7,000 lawsuits for unpaid medical payments in two counties the place 45,000 folks dwell.
It sued one couple for $59 in January 2024, an quantity that ballooned by greater than 600% inside months resulting from curiosity, courtroom prices and lawyer charges. Courtroom data present cash repeatedly garnished from folks working within the low-wage industries that abound on the Jap Shore, together with poultry processing and retail.
On an August morning in Accomack County’s civil courtroom, Jap Shore Rural Well being accounted for many of the circumstances on the choose’s docket. One man who confirmed as much as courtroom informed ProPublica that the go to probably price him tons of of {dollars} as a result of he missed out on profitable hours harvesting oysters and clams. He solely spoke Spanish and the courtroom didn’t make a translator obtainable; the choose informed him to return for one more listening to within the fall. Most individuals didn’t present as much as courtroom in any respect, which means the well being heart gained by default.
ProPublica didn’t discover some other neighborhood well being facilities in Virginia constantly suing sufferers for unpaid payments within the courtroom data.
Jap Shore Rural Well being started utilizing lawsuits to gather medical debt about 20 years in the past after conversations about “maximizing our income,” based on Kandy Bruno, the group’s chief monetary officer. An area firm referred to as Bay Space Receivables handles its collections and takes 30% to 40% of what it recovers from sufferers by the courtroom. The minimal quantity that Jap Shore sends to collections is $25, Bruno mentioned.
Bruno mentioned Jap Shore sends sufferers to collections when it has exhausted different choices, together with sending out letters, providing interest-fee cost plans and serving to fill out Medicaid functions. “We must always by no means need to ship anybody to collections,” she mentioned. “It needs to be 100% avoidable.” She additionally mentioned the variety of lawsuits the corporate had filed in a decade was not very excessive in comparison with the 32,400 sufferers seen there final yr.
Sufferers are by no means refused well being care, irrespective of how a lot they owe, she mentioned.
Virginia lately handed a regulation that consultants say would cease a minimum of a few of Jap Shore Rural Well being’s debt assortment practices beginning subsequent summer season. The regulation prohibits massive medical suppliers from garnishing wages of sufferers who qualify for monetary help.
Bruno mentioned she hasn’t but appeared into how the Virginia regulation would have an effect on the well being heart or its sufferers on the sliding scale. “We are going to completely adjust to and make changes to adjust to the letter of the brand new regulation,” she mentioned.
The well being heart is the principle choice for preventive care on the peninsula; in any other case, folks need to make the lengthy drive as much as Maryland or pay tolls, usually totaling greater than $20, to cross the bridge over the Chesapeake Bay. Greater than 70% of people that dwell on the Jap Shore see medical doctors on the well being heart, together with higher-income folks with non-public insurance coverage by their jobs, Bruno mentioned.
Which means a number of the sufferers, she mentioned, make sufficient to “take duty for his or her care.” However the well being heart doesn’t monitor what proportion of sufferers despatched to collections obtain monetary help or make so little that their checks legally can’t be garnished.
Brittney Shea, a single mother with two youngsters, has been sued 3 times by Jap Shore Rural Well being since 2021. She and each of her kids have persistent well being situations that require them to see medical doctors and specialists steadily, and the $25 co-payments add up rapidly, she mentioned.
Most lately, the well being heart sued her final October for about $2,000 in medical payments and an extra $760 in lawyer charges and courtroom prices, data present. The cash was garnished from a number of paychecks from her Walmart job.
Shea is conscious that she finally ends up paying extra by garnishments than she would if she paid her medical payments on time. However she mentioned the cash simply isn’t there on the entrance finish, particularly when she has been out of labor resulting from well being emergencies. Typically she avoids seeing medical doctors when she is feeling sick to keep away from owing extra money.
The cycle of lawsuits and garnishments has made it tougher to offer for her kids, she mentioned. “You count on this cash, however then they’re garnishing you,” she mentioned. “Now you bought to determine the way you’re going to feed them, the way you’re going to place gasoline in your automobile to shuttle to work, the way you’re going to pay your lease.”
Many areas served by neighborhood well being facilities lack main care choices and have
an actual want for them. That was the case in Hutchinson, Kansas, a historic salt mining city northwest of Wichita, within the Nineteen Nineties when the native hospital got here up with the concept to begin PrairieStar Well being.
When Aimee Jones began working at PrairieStar in 2015, she had solely ever been on the affected person facet of debt assortment. After a tough divorce a long time earlier, she’d had bother paying excellent medical payments and filed for chapter to keep away from having her wages garnished.
As a affected person accounts consultant, Jones was liable for handing sufferers’ debt over to an out of doors assortment company as soon as she had exhausted efforts to get them to pay. PrairieStar would ship out three statements and two collections notices and infrequently make an extra cellphone name reminding sufferers of their unpaid balances and inspiring them to arrange a cost plan. The final discover informed them that their invoice could be despatched to collections. (Anderson, the PrairieStar CEO, informed ProPublica the collections company additionally despatched sufferers a number of notices earlier than escalating to lawsuits.)
Jones mentioned she satisfied her bosses to vary some insurance policies in favor of sufferers. The corporate was initially sending payments as little as $30 to collections, which Jones felt was pointless as a result of the surface company took a 3rd of the cash. She pushed PrairieStar to boost the edge to $200 in excellent debt. In newer years, that quantity elevated to $500, she mentioned.
In Kansas, in contrast to Virginia, lawmakers haven’t considerably restricted how well being care suppliers can get better medical debt. Kansas can be one among 10 states that has chosen to not increase Medicaid, leaving 1000’s of individuals unable to get medical health insurance — and probably extra reliant on neighborhood well being facilities.
Lots of the sufferers who certified for discounted care based mostly on their revenue had no insurance coverage, Jones mentioned. And even with decrease charges, some struggled to afford medical care at PrairieStar. “You don’t keep on high of it otherwise you are available in quite a bit, it’s going to build up fairly quick,” Jones mentioned. In response to the well being heart’s monetary help coverage, not all providers qualify for reductions.
Jones tried arduous to persuade sufferers to pay even a couple of {dollars} every month so they may keep out of collections. Typically, it labored. She was conscious that some folks, particularly these on fastened incomes, had nearly nothing to spare. In the event that they didn’t pay their payments or join a cost plan inside about six months, she handed their names over to the gathering company.
Jones may request permission to jot down off some payments for individuals who had endured excessive hardship, like a girl whose child died in a home hearth or one other whose boyfriend and son died in a automobile accident. However she couldn’t assist everybody.
As soon as the gathering company referred a case for a lawsuit, it was largely out of Jones’ arms, she mentioned. PrairieStar employed an organization that handles collections for hospitals in lots of Kansas counties — Account Restoration Specialists Inc., which has a documented historical past of requesting arrest warrants for sufferers who don’t present as much as courtroom. (The collections company informed ProPublica that the warrants had been ordered by a choose and that it couldn’t talk about its contract with PrairieStar. It has beforehand denied utilizing the specter of jail to get folks to pay.) Every summer season, the company would ship PrairieStar a protracted listing of affected person accounts deemed “uncollectible” as a result of they’d no revenue or property, Jones mentioned.
Jones, who retired final yr, seems to be again on almost a decade of labor with a mix of delight and unhappiness. She wonders if PrairieStar may have satisfied extra folks to comply with cost plans if it hadn’t contracted with an out of doors company. The well being heart’s sufferers would have benefited from a regulation like Virginia’s, she mentioned, which prevents suppliers from garnishing wages of sufferers receiving monetary help.
“We serve the poorest of the poor. These folks don’t have any cash,” Jones mentioned.
Pursuing debt in courtroom is a alternative, and a few neighborhood well being heart leaders have opted out.
A number of years earlier than Krista Postai based the Group Well being Heart of Southeast Kansas within the state’s poorest area, she labored at a hospital that took excessive measures to gather medical debt. As a part of her job, she fielded calls from sufferers sad with the billing course of. At instances, she mentioned, sufferers reported receiving warnings that they’d be despatched to collections, although they hadn’t acquired a invoice.
When she started making use of for grants to begin her personal clinic in 2002, she knew there needed to be one other means. “In case your aim is de facto preserving folks more healthy, it makes extra sense to ship care on the lowest price attainable and never drive them into ERs and hospitals,” she mentioned.
Hospitals don’t make a lot from suing their sufferers, based on analysis in a number of states. (Consultants didn’t know of comparable research on neighborhood well being facilities.) One research of Virginia hospitals discovered that wage garnishment introduced in only a fraction of a % of their whole income, on common. However sufferers can see their funds devastated by these lawsuits, particularly with the added curiosity fees, lawyer charges and courtroom prices.
The Nationwide Shopper Regulation Heart, a nonprofit that focuses on client safety, urges states to set limits on well being care suppliers gathering medical debt. Their suggestions embrace capping rates of interest for debt at 2% a yr — a lot decrease than Kansas’s 10% most — and prohibiting lawsuits for sufferers who qualify for monetary assist. It recommends banning wage garnishment for all sufferers.
Group well being facilities needs to be held to the identical necessities when attainable, mentioned Berneta Haynes, coverage adviser for the middle. “The concept right here is that sure kinds of egregious and aggressive debt collections actually ought to simply be banned,” she mentioned.
Group Well being Heart of Southeast Kansas, based mostly in a county with a poverty charge nearly twice that of the state as a complete, offers care to many individuals who can’t afford to instantly pay their payments. Postai mentioned the well being heart makes “each cheap effort” to gather cash from sufferers, as required by federal regulation. However she is decided to by no means outsource that work to a collections company, regardless of the weekly calls she will get from corporations hoping to buy the well being heart’s debt.
The middle’s inner coverage says it is not going to ship sufferers to collections “to make sure that affected person dignity is maintained.” Its friends, she mentioned, ought to do the identical.
“Most individuals attempt to pay,” she mentioned. “It is unnecessary to take an already careworn inhabitants and stress them additional.”
As an alternative, the well being heart finds artistic methods to tug in additional sufferers — utilizing federal grants to open low cost pharmacies, serving sufferers at jails and prisons, partnering with different native nonprofits. It has branched out to neighboring counties with no different sources of reasonably priced medical care. Final yr, it wrote off about $5.3 million of unhealthy debt from sufferers who didn’t pay their payments, about 5% of its whole income, federal experiences present.
Postai mentioned the clinic is keen and in a position to maintain the loss, and he or she cringes serious about sufferers at PrairieStar and comparable well being facilities who could keep away from returning there for medical assist.
“That’s a giant gap within the security web,” she mentioned.
