PROUT Editor's note: The USA is not the ideal place to live. The USA does not even provide health care to its citizens. Only the employed receive health insurance, and even many of the employed are not provided health insurance coverage by their employers. Yet, just to the north, in Canada, every single citizen is taken care of. Any Canadian citizen can walk into any hospital and be cared for. So why are Americans under some absurd illusion that the USA is the greatest place to be? The American Medical Association (AMA) has more than 1000 lobbyists who make sure that Americans are brainwashed into believing that Canada is a socialist country with socialized medicine. The AMA makes sure that American citizens never demand universal health care. American health care is no longer in the public sector. It has been 100 percent taken over by private corporations. Corporate executives rather than doctors decide on many medical cases, because the bottom line is the cost, not the patient's welfare. Eighteen thousands Americans die prematurely every year because of no health insurance and hence not going for necessary treatment.
Failing to provide health care is failing to provide basic human rights. It can also be called crimes against humanity on the part of the political leaders. Failing to provide health care is against the Universal Declaration of Human Rights. Any American president who fails to provide health care to all citizens should be tried for crimes against humanity at the International Court of Justice (ICJ) and locked up for life.
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by Kevin Dobbs
published: 10/19/2004
Patients Claim Intimidation
As part of a nationwide string of hotly contested lawsuits against nonprofit hospitals, South Dakota's major health systems are being accused of overbilling uninsured patients and profiting from abusive debt-collection tactics.
In federal lawsuits filed this month, separate patients allege that Rapid City Regional Hospital and Sioux Falls-based Avera Health and Sioux Valley Hospitals and Health System violated their mission as nonprofits to provide charity care in exchange for tax exemptions.
The complaints say the health systems stick uninsured patients with artificially inflated bills and then later intimidate those unable to pay by threatening lawsuits, property liens and wage garnishments.
The lead lawyers in all three South Dakota cases, Stan Siegel and Phil Pfaffly of Minneapolis, are pursuing class-action status to allow other patients allegedly wronged by the health systems to join in on the lawsuits.
"These hospitals are not providing the care that they are supposed to provide to the poor," Pfaffly said.
Each health system called the lawsuits meritless, saying they bill fairly, treat all patients regardless of their ability to pay, and work closely with the uninsured to find reasonable steps for them to settle outstanding charges. That often includes discounts.
"We are going to vigorously and energetically pursue motions to dismiss, and we are going to prevail," said Matt Michels, general counsel for Avera Health.
The lawsuits seek unspecified monetary damages and orders for the hospitals to change pricing and billing practices.
The lawsuits in South Dakota are part of a larger movement that started several months ago in Mississippi and has now spread to at least 23 states. Federal class-action lawsuits that mirror those in South Dakota have been filed against more than 400 nonprofit health systems.
Of those, only one case in Mississippi has been settled. None have reached trial. Lawyers for the Sioux Falls health systems said this kind of class-action suit is new here and has no precedent in terms of a jury ruling.
Forced into bankruptcy
Specifics of the South Dakota cases:
• Robert Dosch of Webster alleges that Avera St. Luke's Hospital in Aberdeen, a unit of Avera Health, billed him $30,000 after treating him for a broken hip in 1993. He claims that was the full price. Dosch lacked insurance and tried to make $200 monthly payments to the hospital.
But he states in his complaint that the payments were offset by interest charges and that a collection agent for Avera wanted a full payment and suggested that Dosch mortgage his house to pay off the bill, which, after interest and fees, eventually totalled more than $50,000. He says he was forced into bankruptcy.
• Sherry B. Nygaard of Vermillion says in her complaint against Sioux Valley that she had intestinal surgery at the health system's Vermillion medical center in 2003.
She was uninsured at the time, and Sioux Valley billed her the full price of the operation. She does not disclose the amount in court documents, but she said she cannot afford to pay it in full. Sioux Valley, she alleges, has nevertheless aggressively pushed her for a full payment. Nygaard said she's made payments on her balance, but because Sioux Valley continues to charge fees on that balance, the amount she owes "remains substantial."
• Brett and Deborah Burgher of Rapid City, both uninsured, allege that bills from Rapid City Regional Hospital from 1999 to 2003 topped $100,000, including interest. They say the hospital aggressively tried to collect the money through harassing phone calls and letters, threats to seize property and threats of lawsuits.
They said the hospital's tactics forced them to seek bankruptcy protection.
Patients in each of those cases declined to be interviewed.
The spark
In most of the cases, the American Hospital Association, the trade group for nearly 5,000 hospitals and health systems nationwide, also is named as a co-defendant because it is the national group that guides hospital policy. It's accused of endorsing predatory billing practices.
After a series of 2003 Wall Street Journal articles reported on overly aggressive debt-collection practices at some East Coast hospitals, AHA President Dick Davidson wrote that federal Medicare rules appeared to require hospitals to bill uninsured patients full price - even though hospitals can negotiate discounts with private insurance companies and public health plans.
In a letter to Davidson earlier this year, U.S. Department of Health and Human Services Secretary Tommy Thompson said the association had it wrong. Hospitals can give uninsured patients price breaks, Thompson wrote, saying, "Nothing in the Medicare program rules or regulations prohibits such discounts."
An AHA spokeswoman said the association was merely trying to clarify a gray area for its members and was not advocating that hospitals overcharge patients.
"We felt that (Thompson) really cleared up and cut through the regulatory underbrush, and we are very pleased with the new guidance that he gave us," the AHA's Alicia Mitchell said.
But Thompson's response helped spark what has grown into a series of lawsuits.
Richard Scruggs, the Mississippi lawyer famous for suing tobacco companies, has teamed with other lawyers to sue health systems in Mississippi and several other states. He told Trial magazine that the lawsuits are not about money but about getting health systems to live up to their nonprofit status.
Siegel agreed: "The problem is, the uninsured are the only ones who end up being asked to pay the full prices. ... That needs to change."
All of the South Dakota plaintiffs' complaints use language similar to that used in lawsuits filed by Scruggs and others in several other states, including Minnesota. The lawsuits state that health systems agreed to provide affordable care and charity care to the poor in exchange for tax exemptions, including major property-tax breaks. The lawsuits say nonprofit systems all over the country are not doing that and, in addition, are engaging in abusive collection practices.
Such tactics, Pfaffly says, allow hospitals to "run up huge profits" on the backs of poor patients. IRS records show that each of the South Dakota health systems operates in the black, and each has spent millions of dollars on expansion in recent years.
Allegations denied
The health systems, however, said the accusations are unfounded. They said they could not address specifics of each case, citing patient privacy laws. But they said they consistently provide charity care and absorb bad debt.
"The general response is just frustration," said Mary Masten, lawyer for Rapid City Regional.
Health system officials said all patients are charged the same price, regardless of their insurance plan or lack thereof. Most plans do negotiate reduced rates, but the officials said they also routinely give breaks to uninsured patients.
The lawsuits "simply do not pertain to the way we care for our patients," said Daryl Thuringer, spokesman for Avera Health.
System officials said patients are asked to sign an agreement that says they will take responsibility for bills, but if they simply cannot pay, they are given charity care. For those who can pay, the hospitals say they try to work with patients to arrange payment plans toward settling the debt. A collection agency is a last resort, and all three health systems deny harassing patients or being overly aggressive when trying to collect.
Diane Breck, who's been hospitalized at Sioux Valley Hospital in Sioux Falls several times because of problems caused by multiple sclerosis, said the hospital recognized that she was unable to work and pay her bills and it forgave about $50,000 in debt.
"To me, that's a whole heck of a lot of money," Breck said. "They've helped me out for several years. They've given me no problems."
Sioux Valley and Avera said that 99 percent of patients who request financial assistance get it. Many of the remaining 1 percent would also but they often fail to formally apply for it, said Sioux Valley spokeswoman Cindy Morrison.
"We give our patients ample time and plenty of opportunity to work with us, and we try hard to work with them," she said.
Sioux Valley said that in its most recent fiscal year, it covered $26 million in discounted care and bad debt. Rapid City Regional posted a similar figure. Avera reported nearly $30 million.
Officials for the health systems said the lawsuits against them appear to copy the litigation created by Scruggs in Mississippi, indicating that the lawyers might simply be latching on to what's hoped will be the latest profitable wave in litigation.
"They are baseless claims," said Kim Patrick, lawyer for the Sioux Valley system. "It's an attorney-driven lawsuit."
Siegel called that criticism "little more than a transparent effort to divert attention away from the very serious core issues of the case."
In the end, Thuringer countered, the cases are misguided and will do little to help curtail the cost of health care. "We're just going to end up expending a lot of resources defending ourselves - resources that could be spent on caring for the uninsured," he said.
Reach Kevin Dobbs at 977-3924 or kdobbs@argusleader.com.
Posted by proutist-universal on October 19, 2004 11:28 PM