Ten nonprofit hospital organizations told the IRS they went after patients before checking whether those patients qualified for free care.

Not an allegation. Not an investigation. These hospitals checked the box themselves on their federal tax filing. Read the question carefully, because it is narrower and sharper than it first appears: Schedule H asks what a hospital did before making reasonable efforts to determine whether the patient qualified for financial assistance. Federal law — 26 U.S.C. §501(r)(6) — prohibits exactly that. These ten reported doing it anyway.

Two things this does not mean. It does not mean the other 1,703 filers never sue patients — the form does not ask that, and a hospital may sue after screening someone and still correctly answer “none.” And because the form groups lawsuits, liens and wage garnishment together, a hospital that places liens but never sues answers the same way as one that sues.

Source: IRS Form 990, Schedule H, Part V, Section B, line 19 — actions taken before making reasonable efforts to determine FAP eligibility · latest filing available for each · every row links to the filing.

What they have in common

The filers that checked this box report less free care than the ones that didn’t.

Filers that checked the box

0.40%

median charity care, share of expenses (n=10 filers)

Filers attesting none

1.06%

median charity care, share of expenses (n=1,703 filers)

Both measures point the same way, and both rest on ten filers. Whether that is a pattern or a coincidence of a small group is a fair question this page cannot settle. Bad-debt denominators differ slightly: 80 of the 1,703 do not report it, and none of the ten.

About 40% as much free care — while their bad debt runs higher (median 4.3% of expenses vs 2.5%). Bad debt is unpaid patient bills; charity care is bills forgiven. Both figures point the same way, on ten filers. Whether that is a pattern or a coincidence of a small group is a fair question, and one this page cannot settle. Bad-debt medians rest on slightly different denominators: bad debt is not reported by 80 of the 1,703 filers attesting none, and by none of the ten.

They are also small: about $82M in average annual expenses against $620M for hospitals attesting to no collection actions. Rural and small-town, mostly — places where the hospital is the only one for an hour in any direction, and where the person being sued has nowhere else to go next time.

Ten hospitals is a small group, and small groups move on little — the same comparison on means rather than medians gives a different multiple, which is why we state the method. An attestation is also not a finding of conduct: it is what the hospital told the IRS. Read this as a pattern worth asking about, not a law of nature — and see what the percentage can and can’t tell you.

The ten

Latest filing for each. Percentage is charity care as a share of total expenses — the published Bai et al. benchmark, which draws partly on Medicare cost-report data, is 2.3%.

Ten more admitted it in an earlier year — then stopped saying so

These checked the legal-action box in a prior filing but not in their most recent one. Either the practice ended, or the answer changed. The filings alone can’t tell you which.

And the harder question: who says they don’t — but does?

1,759 hospitals checked “no collection actions.” We cannot yet tell you which of them are telling the truth, and we will not pretend otherwise.

court records checked so far

Here is the loophole, plainly: the hospital is usually not the plaintiff. The debt is sold or assigned to a collection agency, and the agency’s name goes on the lawsuit. A hospital can check “none” on its federal filing while hundreds of suits over its bills move through the county courthouse. Nobody — not the IRS, not any regulator — routinely checks the box against the docket.

This section remains incomplete until court records can be checked jurisdiction by jurisdiction. Here is what it takes:

Step 1 · Where the cases liveMedical-debt suits are filed in state and local courts. Court access is fragmented across county and municipal systems, with different portals, rules, and coverage.

Step 2 · Follow the assignmentHarvest by plaintiff name, then hand-read a sample of complaints. The complaint names the original creditor even when the docket line doesn’t — that’s how an agency’s suits get traced back to a hospital.

Step 3 · Count, then compareSuits per hospital per year, set beside what that hospital told the IRS. Three outcomes: attested none and dockets clean (verified), attested actions and suits found (consistent), attested none and suits found (a federal filing contradicted by public court records).

Step 4 · Protect the patientsDefendants are people who got sick and couldn’t pay. We never publish their names — case counts and amount ranges only, identities hashed. We protect the people these hospitals sued.

Until every one of those steps is done for a given hospital, this site says exactly what it knows: they attested to this; nobody has checked. That sentence is the difference between a truth instrument and a weapon.

Auto-generated from IRS e-file XML — every figure links to the filing it came from. Attestations are what a hospital reported to the IRS; they are not court records, and this page makes no claim about conduct beyond what each hospital reported about itself.

Look up any hospital →

About this data

Where it comes from. Every figure is taken from a hospital’s own IRS Form 990, Schedule H, and links to the filing it came from. We report what hospitals reported. Where a hospital reported nothing, we say “not reported” — we never estimate, impute, or fill a gap.

What it is not. Where we say a hospital “attests” to something, that describes what it told the IRS. It is not a finding about its actual conduct, and it is not a court record. Figures are as filed for the fiscal year shown and may not reflect current policy or practice.

Draw your own conclusions — from the filings. This site exists so you can read the record yourself. It is published for general information only. It is not legal, medical, tax, or financial advice, it is not a recommendation about where to seek care, and it should not be relied on for any decision without confirming the underlying filing and checking with the hospital directly.

Corrections. If a figure here does not match the filing it links to, we want to know and we will correct it. cashpaymed.org