Lawsuit: Everett hospital hid ‘charitable care’ in fine print

EVERETT — Alexandra Nyfors, 66, was unaware that her kidneys were failing last fall when an ambulance rushed her to Providence Regional Medical Center in Everett.

Nyfors, already a diabetic, spent two weeks in hospital because an infection caused his kidneys to fail. Once released, however, Nyfors faced a new problem. She couldn’t pay the $2,000 bill Providence sent her.

“They said I had two options,” Nyfors said. “Pay the $2,000 directly or pay $162.50 per month. Well, I don’t have $2,000.

Nyfors made monthly payments, which caused her to run out of money for groceries at the end of each month. She was determined not to go into debt, but was unaware that the hospital was obligated to help her financially – if she applied for charity care.

According to a recent lawsuit from the Washington state attorney general’s office, Nyfors’ experience is not an isolated incident. The lawsuit, filed in King County Superior Court, alleges that 14 hospitals misled low-income patients who were eligible for free or reduced-cost hospital care — including Providence in Everett and Swedish Edmonds.

Enacted in 1989, Washington’s Benevolent Care Act requires hospitals to absorb the cost of treating some of the state’s poorest patients, if there is an unpaid bill after insurance. Some patients receiving charitable care have no disbursements. Others get discounts on their hospital bills, depending on their income level. However, patients must apply for charity care to receive it.

“Unfair and Deceptive Practices”

Attorney General’s lawsuit claims hospitals, all owned or affiliated with Providence, violated consumer protection law by failing to tell patients they were eligible for charity care and returning more than 54,000 unpaid bills from patients to collection agencies since 2019. The lawsuit seeks $70 million in debt relief and reimbursements for patients, as well as fines for hospitals.

The attorney general’s office did not respond to a request for comment on Friday.

Beginning in 2018, Providence became more aggressive in collecting payments from patients, including those it knew likely qualified for charitable care, according to the complaint.

“Despite its mission, for years Providence has engaged in unfair and deceptive practices that prevent many of the most vulnerable members of the communities it claims to serve from accessing free and discounted charitable care,” we read in the lawsuit. “…Rather than screening patients for eligibility for charity care, Providence trains and encourages its agents to make it appear that all of its patients are obligated to pay for their care, regardless of income level.”

In a report uploaded last month, Providence expressed disappointment with what it called “inaccurate and unfair charges” regarding its financial aid practices. On Friday, spokesman Casey Calamusa provided the Daily Herald with another statement and declined to comment further.

“Throughout a patient’s care journey with us, we engage with the individual at several stages of the process to inform them of the availability of financial assistance and encourage them to apply,” it reads. partly in the statement. “We work proactively with our patients to understand their unique situation and help them resolve any financial issues.”

In court documents, hospital officials claimed they had sufficiently informed patients about charity care on enrollment forms, on signage throughout the hospital and on billing statements.

But that’s not enough, state prosecutors say. At registration, the only charitable care notice given to patients would be “in broad and dense forms, which…staff members review with patients in a hasty and superficial manner, if at all”.

Similarly, signs about charity care are posted “among a swarm of other notices”.

Additionally, through an analytical tool provided by Experian, Providence is already identifying patients potentially eligible for charity care, state attorneys noted. Yet hospitals knowingly continued collections from these patients anyway. Only after numerous collection attempts fail will hospitals write off those unpaid accounts as alleged charitable care, the lawsuit says — without ever telling the patient they qualified in the first place.

In court documents, Providence says its hospitals generally provide superior charity than its peers, according to state data. The hospital system also says it gives out “several million dollars” in free care, including for patients who don’t submit a claim.

Providence lawyers also argue that hospitals should not be punished for knowingly using “proximate predictive tools to increase the amount of charity given” to patients who did not seek relief.

According to court documents, Providence stopped continuing collections from Medicaid patients in December and those who likely fell below 200% of the federal poverty level as of March 11.

“A Well-Known Secret”

Edgar Hall, general counsel for Washington Debt Law, represents indebted clients and frequently handles charitable care cases involving various Washington hospitals. Hall called charity care a “well-known secret in the trade.”

Most people who contact Hall’s law firm have never heard of charitable care, even though hospitals are supposed to screen patients for eligibility. Hall’s clients often ask for help filing for bankruptcy.

“People come to me in a crisis,” Hall said. “They cry, they don’t know where to go. Half the time my consultations really feel like a therapy consultation, where I’m just trying to say, “Hey, you have options.”

The Northwest Consumer Law Center has seen the same trend.

“I’ve helped hundreds of people with charitable care issues and not a single one has been told they’re eligible,” said chief executive Amanda Martin. “Everyone we speak with is eligible for some level of charity care.”

Hall said hospital staff have tried to block clients from seeking charity care in the past.

“Sometimes when I send people to ask for charity care, they’re told, ‘It’s in collection, we can’t do it,'” Hall said. “…It’s a lie and I’ve heard it more times than I can tell you.”

Hall tells his clients to write down the charitable care laws and show them to the staff. He also advises customers to literally pull out their phone and say they want the staff member to deny their application.

“They always break down and give them the app then,” Hall said.

Providence patient Nyfors has yet to seek charity care. It’s been a tough few months since her hospital stay, and health-wise, she just doesn’t feel up to it.

Nearly half of the money she receives from Social Security is spent on medical expenses, including the Providence hospital bill. His annual income is around $22,000.

Previously, Nyfors worked as a technical writer and wrote software manuals. She became disabled in 2009 and has been living on disability income ever since.

Nyfors didn’t know charity care existed until she read the lawsuit. However, she repeatedly said her problem was with how the hospital handled her bill – not the doctors and nurses who saved her life.

“I think it’s really important to separate the people who are the caregivers from the business that Providence does, where they demand payment,” Nyfors said. “Caregivers are good people, who really care. They took really good care of me. »

The Legislature recently expanded who is eligible for charitable care with Internal Bill 1616.

Legislation requires large hospitals, such as Providence in Everett and Swedish Edmonds, to fully cover out-of-pocket expenses if a patient’s annual income is less than 300% of federal poverty Levelor $83,250 for a household of four.

Large hospitals would also be required to provide at least some financial assistance to patients under 400% of federal poverty Levelor $110,000 for a household of four.

The bill is on the governor’s desk. If Gov. Jay Inslee signs the bill, changes to Washington’s charitable care law would go into effect in July.

Herald writer Zachariah Bryan contributed to this story.

Katie Hayes: [email protected]; Twitter: @misskatiehayes.

Katie Hayes is a member of the Report for America body and writes about issues affecting the working class for the Daily Herald.