Trends In Hospital Lawsuits Filed Against Patients For Unpaid Bills Following Published Research About This Activity

IMPORTANCE Suing patients and garnishing their wages for unpaid medical bills can be a predatory form of financial activity that may be inconsistent with the mission of a hospital. Many hospitals in the state of Virginia were discovered to be suing patients for unpaid medical bills, as first presented in a 2019 research article that launched 2.5 months of media attention on hospital billing practices and a grassroots public demand for hospitals to stop the practice.OBJECTIVE To evaluate the association of a research publication and subsequent media coverage with the number of hospital lawsuits filed against patients for unpaid medical bills.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of Virginia hospitals that sued patients for unpaid medical bills used an interrupted time series analysis. Data on hospitals suing patients for unpaid medical bills were collected during a preintervention period (June 25, 2018, to June 24, 2019), an intervention period (June 25, 2019, to September 10, 2019), and a postintervention period (September 11, 2019, to September 10, 2020).EXPOSURES Publication of a research article and subsequent media coverage.MAIN OUTCOMES AND MEASURES The total number of warrant in debt and wage garnishment lawsuits filed by Virginia hospitals and the frequency of those lawsuits filed before, during, and after the intervention period on a weekly basis.RESULTS A total of 50 387 lawsuits, filed by 67 Virginia hospitals, were included; 33 204 (65.9%) were warrant in debt lawsuits, and 17 183 (34.1%) were wage garnishment lawsuits. From the preintervention period to the postintervention period, there was a 59% decrease in the number of lawsuits filed (from 30 760 lawsuits to 12 510 lawsuits), a 55% decrease in the number of warrant in debt cases filed (from 19 329 to 8651), a 66% decrease in the number of wage garnishments filed (from 11 431 to 3859), and a 64% decrease in the dollar amount pursued in court (from $38 700 209 to $13 960 300). During the study period, 11 hospitals banned the practice of suing patients for unpaid medical bills. The interrupted time series analysis showed a significant decrease of 5% (incidence rate ratio, 0.95; 95% CI, 0.94-0.96) in the total weekly number of lawsuits in the postintervention period.CONCLUSIONS AND RELEVANCE The findings of this study suggest that research leading to public awareness can shift hospital billing practices.This cross-sectional study evaluates the association of a research publication describing hospital lawsuits filed against patients for unpaid medical bills and the prevalence of this practice among hospitals in Virginia.Question Was the research on and subsequent public awareness of hospitals suing patients for unpaid medical bills in the state of Virginia associated with changes in hospital policies? Findings In this cross-sectional analysis of 50 387 lawsuits filed by 67 Virginia hospitals, Virginia hospitals filed 59% fewer lawsuits in the year after a research article and subsequent media coverage exposed the practice compared with the year before publication. Overall, 11 hospitals banned the practice altogether. Meaning These findings suggest that research and public health initiatives rooted in media exposure can increase public accountability for hospital billing practices and result in meaningful changes that benefit patients.