The Washington state Attorney general’s office recently filed suit against fourteen Providence Health & Services hospitals across the state for failing to provide charity care and financial assistance to low-income patients. Washington’s charity care law has been in force since 1989. The law requires hospitals to publicly post information about financial assistance, pre-screen patients to determine eligibility for financial assistance, and notify those eligible before attempting to collect debts. Instead, these non-profit hospitals act like collection agencies and push low-income patients further into economic distress.

Providence Health & Services is, notably, a non-profit Catholic health system with 52 hospitals, 900 clinics, and 12,000 care givers. It generated nearly three-quarters of a billion (yes, with a B) dollars in earnings in the first nine months of 2021. Providence also runs two venture capital firms that generate over a billion (that’s a B again) dollars in revenue for the non-profit hospital system every year.

The state attorney general alleges that employees for the Providence hospitals were trained to use tactics and language more closely related to debt collection than properly informing patients up front about charity care options. The suit alleges that Providence trained its employees to push patients to pay their hospital bills before notifying them of the charity care law. The training materials directed staff to try at least three times to collect payment after the “first no” before giving information on charity care. The tactics appear to have contributed to sending some 54,000 accounts to collections, despite knowing that the patients were eligible for obligatory financial assistance. These accounts total $70 million.

Unfortunately, this is only one of several stories from around the country of hospitals coming after their most vulnerable patients. And repeatedly we see that the debt collection practices stop only when they are highlighted via media exposure or lawsuits.