The Lead Brief

A new report alleges that medical debt isn’t just a by-product of high health care costs, but also the result of a system that can frequently turn unclear prices into enforceable payment obligations.

SOME OF THE REPORT’S FINDINGS:

• Nonprofit hospitals are most litigious: Nearly 53 percent of the lawsuits were filed by nonprofit hospitals. The report found that, of the nonprofit hospital systems suing more than 1,000 patients each year, about 44 percent spent less than 3 percent on charity care from 2011 to 2023.

Barak Richman, one of the report’s authors and the co-director of the Health Law Program at George Washington University Law School, describes the systemic problem as “an economic vortex.”

Providers in Virginia filed more than 1 million lawsuits to collect $1.4 billion from patients between from 2010 to 2024, accounting for more than a quarter of all debt collection cases in the state during that period.

How hospitals tap bank accounts, paychecks over unpaid medical bills

Virginia hospitals, led by nonprofit Sentara Health, have filed over a million lawsuits to collect medical debt from patients—including many with insurance—highlighting aggressive billing practices and a growing affordability crisis.

Key points:

Sentara Health initiated more than 96,000 medical‑debt lawsuits in Virginia from 2010 through 2024, the most of any provider in the state.

Virginia hospitals, doctors and medical providers filed a total of 1.15 million lawsuits to collect about $1.4 billion in medical debt between 2010 and 2024.

In addition to lawsuits, there were over 403,000 wage‑garnishment or bank‑account seizure filings and more than 5,500 lien or judgment extensions up to 20 years.

Nonprofit hospitals and hospital‑owned practices filed more than 802,000 lawsuits or garnishments in Virginia courts during the 15‑year period.

The average health‑insurance deductible for workers in 2025 was $1,886, according to the Kaiser Family Foundation’s employer benefits survey.

Arnold Milstein, a Stanford professor of medicine and a co-author of PRA's report, said the research team's analysis identified companies who were under court order to garnish wages of workers to collect debt. The report said workers in retail, manufacturing, grocery stores, gas stations and food service were more likely to have their wages garnished. Among employers, Walmart had the most wage garnishments of its workers in Virginia, the report said.

such garnishments are an indicator of how well employers' health insurance plans protect workers from medical debt.

Milstein said such garnishments are an indicator of how well employers' health insurance plans protect workers from medical debt. An employee with robust health insurance might be better protected. But an insurance plan with a high deductible or other cost sharing could leave workers vulnerable to big medical bills. The report described employers as the "final boundary of the medical debt ecosystem."

Researchers also took aim at Virginia hospitals record on properly disclosing all prices to patients under federal price transparency laws. Even consumers with negotiated discounts from health insurance plans often were clueless to what their final charges would be.