"Medical Debt Lawsuits: A Catalyst Project"

INVESTIGATIVE CATEGORY

KXAN-TV
09/12/2022

KXAN’s investigation into medical debt lawsuits began when an email landed in our inbox. Little did we suspect the depth of human suffering we would learn about as we worked on this project. The tip referenced a Central Texas civil court with a large number of lawsuits aiming to collect unpaid medical bills, as many patients dealt with extreme health and financial challenges during the COVID-19 pandemic. The tip led us to discover a hospital – and its law firm – behind more than 1,200 of these suits over just three years.

The stories we gathered were heartbreaking. A woman who battled cancer while raising two little girls and a hospital that refused to give her information to aid in getting reimbursement. A mother who received a $1,000 notice of legal action but couldn’t get the hospital to tell her what it was for. A state attorney general’s office that received 4,300 complaints but took action only once.

To tell those stories, KXAN collaborated with the journalism company, ClearHealthCosts, launching a series of reports exposing this issue, an interactive digital project walking users through the data we analyzed, a podcast and resource page offering tips on navigating such legal troubles and statewide video crowdsourcing on social media allowing patients to share their own stories to warn others. Our watchdog work also prompted a handful of state lawmakers to begin crafting policy to better protect patients in the 2023 Texas legislative session.

Reaching that impact was challenging. Using online databases over months, we discovered almost all the hospital’s cases were filed in one court – accounting for over 70% of all small claim lawsuits in that court in 2020 alone. Under current law, the hospital is within its right to sue patients for debt but it declined interviews with KXAN, citing medical privacy laws.

To find patients who were sued and hear their experiences, we chose a letter-writing campaign – a more personal, less alarming approach to encourage them to speak with us and fully explain our project. We narrowed the number of recipients to about 200, then handwrote one letter, copied it, printed mailing labels using addresses from court records and stuffed envelopes. Within two weeks, we heard from nearly 20 people sued by the hospital, following up by phone, email and on-camera interviews. We also found several patients across the state through a social media campaign and featured their stories in a special video gallery online.

A common patient complaint was being unable to obtain an itemized invoice from the hospital to understand why they were being charged specific amounts. After our initial reports, State Sen. Paul Bettencourt vowed to revive a failed bill from the last legislative session to require providers to give patients an itemization with their bill.

To understand if suing patients for medical debt is common among other hospitals, we scoured court records in the post populous counties surrounding Austin – which have comprehensive and searchable online court databases. We used the American Hospital Directory to find all hospitals in those counties then search for lawsuits. Beyond that first hospital, our search turned up few other lawsuits filed by hospitals against patients for medical debt in the same timeframe.

Our collaborator ClearHealthCosts – which partners with news organizations to improve health care reporting – assisted by diving into Texas’ medical debt landscape, discovering it may be nearly impossible to accurately count every lawsuit. Once a third-party debt collector buys medical debt, it may file a lawsuit to collect under its own name. A researcher would have to obtain the original petition in every case to see if the original creditor is named. For perspective, nearly 2,400 companies are registered with the Texas Secretary of State to collect debt.

We also spoke with medical billing experts who said the government does little to nothing about concerns over medical debt collection – specifically, complaints made under the Texas Debt Collection Act enforceable by Texas Attorney General Ken Paxton. We requested every debt collection complaint submitted to Paxton’s office and any resulting enforcement action over three years. His office provided 156 individual spreadsheets, each with an average of 30 complaints. Many spreadsheets were not uniform, so we had to individually load each one into a master sheet to build a database of more than 4,300 complaints to analyze using the database management language SQL. Our analysis found 410 related to medical debt. In our requested timeframe, Paxton’s office took just one enforcement action, and it was not related to medical debt. During our investigation, State Rep. Nicole Collier – who has previously worked to improve the Act – asked KXAN to share its data analysis with her office, as she looks into whether the state’s system adequately protects people involved in medical debt lawsuits.

Links to Content Online
Main Story / Docuseries / Interactives
Tips & Resources / Video Crowdsourcing Gallery
Inside the Investigation
Podcast / Expert Analysis
Project Update
Livestream Discussion

Other Project Elements
KXAN’s Handwritten Letter to Patients
KXAN’s Emails to Hospital & Corporate Owner
KXAN’s Video Crowdsourcing Form
Crowdsourcing Campaign Social Teaser
Crowdsourced Stories Video Montage
Digital Project Overview
Hospital Lawsuits Interactive Animation
KXAN/ClearHealthCosts Partnership
KXAN’s “Digging Deep” Investigative Newsletter Feature

Reviews & Reaction
ClearHealthCosts Tweet
Texas 2036 Healthcare Policy Advisor Tweet
Medical Claims Expert Post
Healthcare Strategist Post
Health Benefits Advisor Post

Submitted by Josh Hinkle.