Still, Johns Hopkins officials acknowledged in interviews that they generate surpluses from the system. Hopkins, Bayview and the University of Maryland Medical Center showed combined surpluses of at least $130 million in the past five years in the final numbers provided by the commission.
Officials at the University of Maryland, which reported about $55.7 million of that surplus, declined to be interviewed for this article. In an e-mailed statement to The Sun, officials said that the payments even out over time and that any surpluses are reinvested into "patient care activities" at the hospital.
"There are periods when hospitals are not compensated in their rates for the charity care they provide, and there are also periods when the rates bring in more than the charity care provided," the statement said.
Murray said the agency relies on the hospitals to deduct any money they collect from judgments from the numbers they submit for recovery through the rate-setting process. Coyle, the hospital association president, insisted that hospitals do so faithfully.
"Anything we collect from a lawsuit is offset against our payments in the future, so there is no double-dipping here," Coyle said.
Commission officials said that while some hospitals report income from debt collections to them every year voluntarily, others don't.
The commission has never required this information, so officials aren't sure if every hospital is deducting these collections from their claims for unpaid bills.
Murray, a staunch proponent of rate setting, concedes that it might be time for the commission to turn its attention to how patients are faring, especially as the economy worsens and more people struggle to pay their bills.
He acknowledged that the commission's policy of "macro regulation" has left it in the dark about debt collection practices.
"Sometimes we don't see things," Murray said. But he added that the commission has "broad authority to investigate." and collect data. It also has the power to compel hospital officials to appear and explain debt collection and charity care policies in full.
"We can bring people in and say, 'Show us this. This isn't right. We need to change this,' " Murray said.
Commission chairman Donald A. Young said the agency will do a thorough review. "We need to find out exactly what is going on," he said.
what we found
