First appeared in NY Times
For most of her life, Hope Rubel was a healthy woman with good medical insurance, an unblemished credit history and a solid career in graphic design. But on the day an ambulance rushed her to a Manhattan hospital emergency room shortly after her 48th birthday, she was jobless, uninsured and having a stroke.
Ms. Rubel’s medical problem was rare, a result of a benign tumor on her adrenal gland, but the financial consequences were not unusual. She depleted her savings to pay $17,000 for surgery to remove the tumor, and then watched, “emotionally paralyzed,” she said, as $88,000 in additional hospital bills poured in. Eventually the hospital sued her for the money. An Omaha Hospital Lawyer is interested in these cases.
Yet that year the hospital, NewYork-Presbyterian/Weill Cornell, had already collected $50.2 million from the state’s so-called Indigent Care Pool to help care for people like Ms. Rubel who have no insurance and cannot pay their bills.
New York’s charity care system, partly financed by an 8.95 percent surcharge on hospital bills, is one of the most complicated in the nation, but many states have wrestled with aggressive debt collection by hospitals in recent years. Like New York, several passed laws curbing hospitals’ pursuit of unpaid bills, including Illinois, California and Minnesota.
But a new study of New York hospitals’ practices and state records finds that most medical centers are violating the rules without consequences, even as the state government ignores glaring problems in the hospitals’ own reports. An Oklahoma City Hospital Malpractice Lawyer is interested in defending the health care system in these situations.
“The entire system is corrupted, and it isn’t working for patients,” said Elisabeth R. Benjamin, vice president of health initiatives at the Community Service Society of New York, a nonprofit antipoverty group, which is releasing the two-year study on Monday.
The state’s Department of Health acknowledges systemic problems, including the need for better reporting and enforcement, a spokesman, Michael Moran, said. A group of patient advocates and hospital administrators is being convened to develop a better system, he said, and the department is engaged in “a comprehensive data integrity project that will include the retention of an outside auditor.”
The study found that some hospitals did not provide financial aid applications at all, and that many made impermissible demands for irrelevant documents or failed to supply key information, like eligibility rules for big discounts required by state law in 2007. Data reported to the state was obviously faulty, it found.
Yet even hospitals that reported they had spent nothing on financial aid, or had filed hundreds of liens against patients’ homes, were allowed to collect without questions from the charity care pool, which distributes more than $1 billion a year.
Hospitals are not legally barred from seeking judgments or liens, but must first offer an aid application, help the patient complete it, and wait while it is pending. Instead, many hospitals turn to collection agencies, and sue when that fails. The unpaid bills — typically reflecting much higher rates than what insurers pay — are then treated as the equivalent of charity care.
Change is now urgent, health care experts agree, because the state pool stands to lose hundreds of millions of federal dollars in 2014, when provisions of the health care overhaul will no longer treat so-called bad debt, based on uncollected bills, as if it were charity care.
“There’s a law in place, and obviously it should be complied with,” said David Rich, an executive with the Greater New York Hospital Association, a trade group. But, he added, “hospitals are providing a lot of charity care at a loss.”
He said hospitals were improving their compliance with the law, which requires aid to patients with income up to 300 percent of the poverty line, or up to $33,000 for a single person. But, often stymied by patients who fail to complete applications for aid, he said, many hospitals have moved to simply deeming some patients eligible without an application, using what he called “a soft credit check” at registration to gauge income and assets.
Myrna Manners, a spokeswoman for NewYork-Presbyterian Hospital, said that it would be inappropriate to discuss specific cases, but that the hospital “proactively helps patients at every step” of the financial aid process. It approved 25,861 applications in 2010, the most recent annual data.
“Where there has been a determination that there is an ability to pay, we still go to all lengths to ensure that we resolve the matter before it becomes a legal action,” she said.
Court records abound in judgments against patients who say they had little or no chance to apply for help. A couple fighting foreclosure in Elmont, Nassau County, has a $41,000 default judgment from NYU Langone Medical Center for emergency surgery on their disabled adult son in 2007, when their insurance unexpectedly dropped him. He was eventually approved for Medicaid, but it would not pay for the surgery retroactively.
The mother, Myrlene Stimphil, 55, a nurse at a city hospital, said she had sought a reduced payment plan from NYU Langone, but was told only that the hospital would get back to her. Instead, she said, collectors were calling her son, now 24, who suffered brain damage at his premature birth.
“We don’t want to be a burden,” she said, as her husband, Antenor Francois, 56, a former cabdriver, looked through old bills. One announced, “Welcome to Portfolio Recovery Associates!” and added that the collection agency “purchased your account from NYU Hospitals Center.”
Lisa Greiner, a spokeswoman for the hospital, which collected $10.7 million from the charity care pool in 2010, said she could not comment on the case under privacy laws. But the hospital no longer uses that collection agency, and under new leadership in the last three years, its reported financial aid approvals soared to 36,000 in 2010, from 256 in 2008.
Christopher Ward, 49, living in his father’s house in White Plains on a $200-a-week disability payment from a workplace spinal injury, recalled stopping at an A.T.M. — “just to have something in my pocket to buy food” — and discovering that his accounts, totaling less than $4,000, had been seized.
“I tore my hair out for a long time not understanding why all this was happening to me,” Mr. Ward said, admitting to memory lapses.
Court records show that NewYork-Presbyterian obtained a $102,636 judgment against him in 2007, including 9 percent interest back to 2004, when, uninsured, he underwent emergency surgery for a brain aneurysm. Now his ailing, widowed father, 75, a teacher at Mercy College, worries that anything he leaves for Christopher could be seized.
State hospitals seem to be especially aggressive collectors. State University of New York Downstate Medical Center, in Brooklyn, secures hundreds of judgments annually through the attorney general’s office, which says such suits protect the state’s interest in case a former patient comes into money. A Clarksdale Hospital Lawyer is watching these cases closely.
One picked at random: a $12,000 judgment in 2008 against Cherrilyn McFarlane, a single mother on public assistance, for one day’s care for her newborn five years ago, when her Medicaid coverage had briefly lapsed. Ms. McFarlane said the judgment could hurt her plans to seek a student loan for nursing school. “I want to get it cleared,” she said.
To Hope Rubel, the greatest fear was that the suit itself would deter employers from hiring her and leave her destitute, she wrote the judge. Finally, she said, a law clerk directed her to the hospital’s financial aid department. It said more documents were needed to decide her eligibility.
“I had given them everything,” she said. In despair after a year of courthouse meetings, she said, she offered $100 a month, and at the court’s urging, the hospital’s lawyers accepted. “I’ll be paying for the rest of my life,” she said.