'Connecticut Docs Sue Patients Over Medical Bills More Than Hospitals: KFF'

 Many hospital systems in Connecticut have stopped suing their patients over unpaid bills, stung by criticism about the harm caused by aggressive collection tactics.

But physicians, dentists, ambulance companies, and other healthcare providers are still taking their patients to court, a Connecticut Mirror-KFF Health News investigation of state legal records shows.

Lawsuits by doctors and other non-hospital providers now dominate healthcare collections in Connecticut, the records show, accounting for more than 80% of cases filed against patients and their families in 2024.

That's a major reversal from just 5 years earlier, when hospital system lawsuits made up three-quarters of health-related collection cases in the state's courts.

The shift is moving medical debt collections into a less regulated realm. Most hospitals, because they are tax-exempt nonprofits, must make financial aid available to low-income patients and follow federal regulations that limit aggressive collection activities. Other medical providers, such as private medical groups, are generally exempt from these rules.

The lawsuits are typically over bills of less than $3,000, but the impact on patients can be devastating. Lawsuits are among the most ruinous byproducts of a healthcare debt problem that burdens an estimated 100 million people in the U.S.

Lawsuits can lead to garnished wages, liens on homes, and hundreds of dollars of added debt from interest and court fees. They also pile additional financial strains on struggling families, prevent patients from getting needed care, and sap trust in medical providers.

"It's really messed up," said Allie Cass-Wilson, a licensed practical nurse in Bristol, Connecticut, who was sued over a $1,972 debt by an ob/gyn practice where she'd been a patient years earlier. "How can they do that to people?" She did not contest the lawsuit, court records show.

Cass-Wilson, who is 36 and lives in a small apartment just off an expressway on-ramp, said she learned of the outstanding debt only when she was sued. When she tried making an appointment, she said, she was told her doctor wouldn't see her. "They said I was blacklisted," Cass-Wilson said. "I was so confused. I couldn't believe that my medical provider let my care be interrupted like this."

Cass-Wilson ultimately sought medical care elsewhere.

Radiologists, Dentists, Ambulances

Overall, CT Mirror and KFF Health News identified more than 16,000 healthcare-related debt cases in Connecticut courts from 2019 to 2024. The database was assembled from online court records with the help of January Advisors, a data science consulting firm that helped extract and sort the data.

Over the 6-year period, most of Connecticut's more than 25,000 licensed physicians and dentists did not pursue patients in court for outstanding balances.

But records show that more than 400 medical providers, including several hospital systems, sued their patients. Among those filing lawsuits were radiologists, anesthesiologists, eye doctors, podiatrists, allergists, and pediatricians.

Dentists, periodontists, and other dental providers filed more than 1,000 lawsuits against patients. And ambulance companies sued more than 140 people.

Med-Aid, a company based outside New Haven, Connecticut, that provides orthopedic braces and other medical supplies to patients, sued more than 400 people, the court records show. The company's president, Frank Dilieto, did not respond to repeated interview requests.

Cass-Wilson was sued by Briar Rose Network in Bristol, Connecticut, a member of a large network of ob-gyn practices across Connecticut called Physicians for Women's Health. The network's members sued close to 100 patients in 2024, records show.

Paula Greenberg, BSN, CEO of Women's Health Connecticut, a private equity-backed company affiliated with Physicians for Women's Health that manages business operations for the network, said the lawsuits represent a small fraction of the more than 300,000 patients the network sees every year.

"This is an organization committed to patients," Greenberg said. She noted that the group offers options to help patients pay, including installment plans and financial aid.

Geoffrey Manton, MD, president of Naugatuck Valley Radiological Associates, said his practice also will work with people who say they can't pay. But, he said, patients sometimes stop responding to their bills.

"Hiding from your problems isn't going to solve them," Manton said. "If we didn't take any action, there could be that person that is in that late-model Mercedes that just chooses not to pay any bills." The group sued more than 125 patients from 2019 to 2024, according to the court records.

Many medical providers say that aggressive collections stem from the growing prevalence of high-deductible health plans that leave patients with thousands of dollars of bills before their coverage kicks in.

Greenberg and Manton said each of their physician groups must collect. "This is a business," Greenberg said. "We have to look at our operating costs."

Critics of medical collection lawsuits note that the patients are typically sued over relatively small debts that are likely to have little impact on multimillion-dollar medical practices.

The average patient debt that members of Physicians for Women's Health sued over in 2024 was less than $1,100, court records show. The physician group's annual revenues are typically in the tens of millions of dollars, according to Greenberg.

Even relatively small debts -- which often include interest -- can place substantial burdens on families struggling to keep up with their bills, especially while dealing with a serious illness, patient advocates say.

"We don't have a realistic choice in using healthcare," said Lisa Freeman, who heads the Connecticut Center for Patient Safety and has advocated for patients struggling with medical bills. "To then get sued for it, when people have less and less funds available for anything extra, that's very disheartening."

A Stroke, Then a Lawsuit

Matthew Millman, 54, lost his job as an IT support worker after having a stroke. Then Meriden Imaging Center sued him over an $1,891 bill.

Millman and his wife said they tried to explain their financial situation to the center, which is affiliated with Midstate Radiology Associates, a large physician group that operates imaging centers and doctors' offices across Connecticut.

"It was very frustrating," said Millman, who lives in an aging apartment owned by his wife's family in New Britain. Millman, his wife, and their teenage daughter are barely getting by on his two part-time jobs -- one bagging groceries, the other helping homebound seniors. Together, the jobs pay about $1,500 a month, he said.

The imaging center, after winning the collection case against Millman, tried to garnish his wages, though that was unsuccessful because Millman had lost his IT job.

"It's all about money," Millman said, shaking his head. "If you are trained in helping somebody with their health, it shouldn't be about the money first. It should be about their health."

Court records show that Midstate Radiology, Meriden Imaging Center, and affiliates filed more than 1,000 collection lawsuits against patients from 2019 to 2024, making them the most litigious non-hospital providers in the state. As is common in medical debt lawsuits, the plaintiffs prevailed in most cases, records show.

Midstate president Gary Dee, MD, a radiologist, didn't respond to emails and messages left at his West Hartford office.

Across town from Millman's apartment in New Britain, Joseph Lentz lives in a cramped apartment with his wife and daughter. He used to oversee operations at a Boy Scout camp but is now unemployed. Lentz lost his job during the pandemic. The family home went into foreclosure, he said.

In 2023, Orthopedic Associates of Hartford sued Lentz over a $3,644 bill the practice said he owed after having shoulder surgery in 2018.

"I'd pay it if I could, I guess," said Lentz, 59. "But I don't even know where next month's rent is coming from. I'm trying to climb out as best I can. I guess this is just one more thing to shovel in."

The orthopedic group filed more than 580 lawsuits against patients from 2019 to 2024, prevailing in most, records show.

The medical group declined interview requests. But chief executive David Mudano said in a statement: "As an independent physician practice, we strive to balance compassion for patients with the financial responsibility required to sustain our practice."

Old Debts and Disputed Claims

Lentz, who did not contest the lawsuit, said he has no reason to doubt he owes the debt. But in many cases reviewed by CT Mirror and KFF Health News and in interviews, patients being sued questioned the accuracy of their medical bills, citing care they thought health insurance should have covered or, in some cases, bills for services they never received.

This reflects broader problems with aggressive collection tactics like lawsuits when disputes over the accuracy of medical bills and delayed or denied insurance claims are so widespread in American healthcare.

A 2022 report by the federal Consumer Financial Protection Bureau found that nearly half of the medical debt complaints fielded by the agency involved bills that consumers said were erroneous in some way or that consumers said they'd already paid.

"We know people are billed incorrectly," said Lester Bird, who studies debt collection lawsuits at the nonprofit Pew Charitable Trusts. Bird noted that courts are ill equipped to sort through disputed medical charges or insurance claims, especially when there is little documentation in most debt collection lawsuits.

"It's complicated before it gets to the courts," Bird said, "and it's very complicated when it gets into the courts."

This can create headaches for physicians and other providers. But billing problems ultimately affect patients and their families most, said Connecticut state Sen. Saud Anwar, MD, a Democrat. "Patients are left to deal with it."

Andrew Skolnick, an attorney in Milford, outside New Haven, was sued in 2023 by an imaging center where his wife had received services in 2020.

Skolnick said that when the couple, who were covered through his job-based insurance, originally received the bill from Diagnostic Imaging of Milford, he tried to tell the imaging center it had submitted the claim to the wrong insurance plan, but he said they wouldn't speak with him.

The center later filed the lawsuit, alleging he owed more than $2,000, plus almost $300 in interest.

Despite interview requests, officials at Diagnostic Imaging of Milford did not comment for this article.

Unlike most patients who are sued, Skolnick had the resources and expertise to contest the suit. He said he offered to pay what would have been his responsibility under the plan if the imaging center had filed his claim correctly. He ultimately settled for $1,700, court records show.

"It wasn't a tremendous amount, but I knew that they had made a mistake," Skolnick said. "The system is not working."

More Protections?

Anwar, the state lawmaker and physician, expressed concern that lawsuits undermine patients' faith in their doctors.

"It's a sacred relationship," he said. "If your physician, who is taking care of you, is suing you for money, that's a problem."

Many hospitals, facing bad publicity from suing patients, have stopped taking patients to court over unpaid bills. Hospital collection lawsuits identified by CT Mirror and KFF Health News in Connecticut court records plunged from more than 4,900 in 2019 to fewer than 300 in 2024.

Also, in recent years, several states, including Connecticut, have expanded protections for patients with bills they can't pay.

Connecticut now bars medical debt from consumer credit reports, and legislators are pushing to get hospitals to provide more financial aid to patients. Other states have restricted the use of wage garnishment and property liens to collect medical debt.

The Trump administration last year issued new guidance that threatens ongoing state efforts to keep medical debt off consumers' credit reports.

But state efforts to rein in aggressive medical debt collections have mostly focused on hospitals. That may need to change, said Connecticut state Sen. Matt Lesser (D), who co-chairs the legislature's Human Services Committee.

He is a key backer of a bill introduced this year that would bar hospitals from billing patients who receive public benefits like food assistance or who make less than twice the federal poverty level, about $32,000 for an individual.

The restriction would not apply to bills from physicians and other non-hospital providers, however. "We may have to go bigger if that's where the heart of the matter is," Lesser said.

Connecticut Gov. Ned Lamont (D), who spearheaded an initiative to cancel medical debt for more than 150,000 state residents, also expressed concern about physicians suing the people in their care.

"Everyone should do the right thing by patients," he said.

This article was produced in partnership with The Connecticut Mirror, a statewide nonprofit newsroom that covers public policy and politics.

https://www.medpagetoday.com/practicemanagement/medicolegal/120855