* In some cases they added annual interest at twice the rate allowed for other types of debts. And despite national hospital industry guidelines that caution against routinely placing liens on houses, Maryland hospitals placed at least 8,000 liens in the past five years.
* Maryland, unlike some other states, lacks uniform standards and practices to determine who is eligible for free or reduced-price care at hospitals. Some people wind up facing lawsuits even though they have little means to pay their bills.
* State officials have never resolved critical gaps in the system. For instance, they don't monitor debt collection practices to ensure that patients are being treated fairly, and they cannot be sure hospitals aren't getting paid twice for some of the same bills. Hospitals deny they collect bills twice.
* A majority of Maryland's hospitals have received surpluses from free and unpaid care in recent years, even though the system is supposed to ensure that they merely break even over time, according to state figures.
Gov. Martin O'Malley, responding to The Sun's findings, ordered an "immediate and thorough review" of hospital debt collection practices and said he wants it completed by early February.
"Assuring the public that all hospitals are pursuing reasonable collection practices consistent with their missions and are not unduly profiting from the system is an essential step to continuing the system well into the future," O'Malley wrote earlier this month to the Health Services Cost Review Commission, the panel that oversees rate setting.
Carmela Coyle, president of the Maryland Hospital Association, said in an interview that hospitals typically sue only patients who can afford to pay and who ignore numerous efforts to make payment arrangements. She noted that hospitals statewide sue only about 0.5 percent of the patients they treat. "Nobody would pay their bills" if hospitals didn't sue to enforce collection, she said.
"The shame about this is ultimately what is happening in the courtroom is what hospitals want to happen in the billing office," Coyle said. "Sometimes, it is the weight of the law that brings people to that conversation."
Hospital administrators said they need to pursue unpaid bills because all patients cover the costs of those bills under Maryland's rate-setting system. Hospitals also argue that they must balance their charitable missions against the need to be paid for services.
