"While hospitals report that they rarely execute legal action, such steps may include garnishment of wages, putting a lien on a patient's home, and/or a claim on an estate. Hospitals report pursuing legal judgments so that their interests are protected at the time a house is sold or when a patient and his/her spouse is deceased," the report said.
The report also stated that hospital debt collection policies varied widely. Some hospitals said they didn't sue at all. Carroll Hospital Center said it considered the existence of a mortgage "an indicator for suit." Garrett County Memorial Hospital said it might sue if it found that a patient owned two cell phones or was saving to buy a lawn tractor.
Murray said if Maryland has not kept pace with other states on consumer protections, "it's a shame."
"We would not want to fall behind if hospitals in this state are becoming too aggressive with regard to debt collection," he said.
The state's chief health regulator said he was "very disturbed" by The Sun's findings.
"We wanted to create a balance of making sure the hospitals had sufficient funds to cover the uninsured but that they did a reasonable job of collection," said John M. Colmers, secretary of the Department of Health and Mental Hygiene. "The question here is, 'what is a reasonable job of collection?' That is something the commission has a right, and if they believe there is a problem, an obligation to look at."
Colmers, who was executive director of the rate-setting agency from 1987 to 1993, said he would prefer the commission to take action, but he would not rule out moving to change state law.
Donald A. Young, the commission's chairman, said the panel needs to examine its system for compensating hospitals for free and reduced-price care and unpaid bills.
Some legislators, citing action in other states, are questioning why the hospital association has opposed state-imposed minimum standards for free and reduced-price care and debt collection.
"The hospitals can't turn anybody away because they don't have insurance. And you think, that is a great system. But then there is this other side of the story. They go after them with these lawsuits. It's the untold story of little people being shuffled around by people much more powerful than they are," Della added.
Reached for comment by The Sun, Mikulski said in a recent letter to Young that she had championed the rate-setting system to "ensure that Marylanders have access to hospital care regardless of insurance status while at the same time controlling health care costs."
"If the Commission finds that some institutions are taking advantage of the letter or spirit of this system at the expense of the uninsured, I expect you to determine the best policy for Maryland following current guidelines and to develop any necessary new policies to stop inappropriate and overly aggressive collections," Mikulski wrote.
To examine debt collection practices by Maryland hospitals, The Baltimore Sun compiled a database of 132,000 collection lawsuits filed by hospitals across the state from January 2003 through June 30 of this year. The Sun also compiled a partial database of judgments after state officials didn't respond to repeated requests for a complete file. The incomplete database contained $101 million in such judgments without counting most judgments of less than $2,000. Reporters reviewed samplings of court files in several busy court districts, observed the collection process play out in the busiest of these courts in Baltimore City, and interviewed lawyers and patients involved in those proceedings. The Sun also obtained five years of financial records and other documents from the Maryland Health Services Cost Review Commission, which over a period of several months provided the newspaper with four different sets of data, each time contending that the previous version contained inaccuracies.
Find videos, a database of judgments, photo galleries, the hospitals' reaction to the series, and previous installments at baltimoresun.com/hospitaldebt
California: Passed law to standardize eligibility criteria for free hospital care; prohibited hospitals from garnishing wages or placing liens on primary residences of patients who are eligible for free care.
Connecticut: Passed law requiring hospitals and bill collectors to include information about free care in all collection notices sent to patients. Hospitals must determine if patients are eligible for free care before they can sue to collect an unpaid bill, and hearings are required before wages are garnished.
Minnesota: Fifty hospitals signed agreement with the state attorney general not to sue or garnish wages until they have verified that the patient owes a bill, confirmed that insurers have been billed, offered the patient a payment plan, and reduced the bill if the patient is eligible for financial assistance.