Providence continues to face questions about hospital debt collection



Providence hospitals continue to face criticism over the healthcare system’s debt collection practices, more than six months after they were sued by the state attorney general for allegedly failing to provide millions of dollars free or reduced-cost medical care to low-income patients.

In a Wednesday evening letter that U.S. Senator Patty Murray sent to Rod Hochman, CEO of Providence St. Joseph Health, she asked detailed questions about the number of low-income patients in Providence who have been forced to pay the completeness of their hospital bills, what hospital debt collection policies are and how employees are trained to talk about debt collection, among other issues.

“It is unacceptable to me that anyone in trouble should go to a nonprofit hospital only to be aggressively sued to pay for care that should have been free in the first place,” said Murray, chairman of the US Senate Committee on Health. health and education. , Work and Pensions, said in a statement Thursday morning. “These are patients, not profit opportunities. They must be treated and not exploited.

In the letter, Murray reiterated the state’s Charitable Care Act, which was established in 1989 and requires hospitals to provide free or reduced-cost medical care to those who cannot afford the full amount – this that Providence has been accused of not doing.

Instead, the hospital system allegedly trained its employees to use ‘collection tactics’ that make it seem like all patients have to pay for care, regardless of income level, according to Attorney General Bob’s lawsuit. Ferguson versus Providence.

One tactic gives staff members a script to follow and asks them to “ask every patient every time” to pay their hospital bills, the complaint says, referencing Providence’s training materials. Another training guideline asks staff to try at least three times to collect payment after the “first no” – and only give information about charity care after that.

Providence has denied all allegations. According to a statement Thursday from Providence spokesperson Melissa Tizon, hospital executives had contacted Murray’s office in February, when Ferguson’s office filed the initial complaint, to offer to explain the concerns, but did not receive a response.

The hospital remains “more than happy” to answer Murray’s questions, the statement said. Further, Providence said these particular training materials “weren’t widely used” as far as administrators understand and they “are not used today.”

“The idea that Providence intentionally takes advantage of those who are vulnerable couldn’t be further from the truth about who we are,” the hospital said in a direct response to a New York Times article on the subject this week. . “Providence proactively communicates the availability of financial assistance in many ways and strives to engage with patients early to determine the need for assistance. However, it is not always possible to have these conversations in the instant given the urgency of certain medical situations.

The hospital added that if patients “do not respond to tell us they need financial assistance, we proceed with the normal billing process. … When patients respond, we work with them to get them approved for assistance and adjust their balance accordingly.

In an internal message to Providence employees, CFO Greg Hoffman also wrote, “Allegations [in The New York Times story] were shocking and upsetting. … The crux of the Times’ allegations is that we intentionally changed our policy to send those who were eligible for charity care to the collections. This is categorically false.”

An “unintentional error” occurred when the hospital switched from a manual to an automated process, causing some Medicaid patients to receive collection notices, he said. Further details about the error or the number of people affected were unclear.

Under a previous form of the Charitable Care Act, Washingtonians below 200% of the federal poverty level were eligible for financial assistance, which can reach about $27,200 in annual income for a one-person household. nobody.

The law was updated on July 1, ensuring that all Washingtonians below 300% of the federal poverty level are eligible for charitable care for their full hospital bill, as long as the care is considered “medically necessary.” .

Murray’s letter noted that many of Providence’s alleged practices to pressure low-income patients “began or escalated” in 2018, when the hospital hired consulting firm McKinsey & Company to design and develop Rev-Up, the training program that instructed employees not to take the “First No,” reported The New York Times.

According to the lawsuit, Providence paid McKinsey $45 million in 2019 for its consulting work, which included but was not limited to training materials, the hospital said in the statement.

Prior to the launch of the Rev-Up program, Providence spent 1.24% of its spending on charitable care, below the national average of 2% for nonprofit hospitals, The New York Times reported.

Ferguson also alleged that Providence sent more than 54,000 patient accounts to a third-party debt collection agency, even though the hospital knew the patients were eligible for financial assistance. The accounts totaled more than $70 million.

In August, Ferguson’s office added two debt collection agencies, Optimum Outcomes and Harris & Harris, to the lawsuit. According to the updated complaint, the two agencies “failed to include mandatory written disclosures informing patients of the availability of charity care.”

“Collection agencies cannot mislead Washingtonians about their legal right to access medical financial assistance,” Ferguson said in a statement at the time.

Murray asked Providence to send a response to his office by October 12.

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