Medicare covered man’s healthcare. Mississippi hospital charged him anyway and their collection agency sued to collect.
Published 9:16 am Monday, January 17, 2022
By Jerry Mitchell
Mississippi Center for Investigative Reporting
Matthew Daniel Hall had been treated for years at St. Dominic Memorial Hospital, but when his mother tried to get her disabled son into a home of his own, that proved impossible because his credit score had plummeted.
When she looked closer at the score, she found out that St. Dominic, through its debt collector, Smith, Rouchon & Associates, claimed he owed $4,800 in hospital bills that he hadn’t paid.
That shocked her because hospitals are barred from collecting money directly from Medicaid patients like her son. “This was totally illegal,” said Hall’s mother, Judy. “We have turned this over to the Consumer Finance Protection Bureau.”
Franciscan Missionaries of Our Lady, the Louisiana-based health system that owns St. Dominic, did not respond to MCIR’s requests for comment, but has previously said the hospital no longer directly sues patients — a policy that took place in July.
But St. Dominic rarely sued patients directly, instead relying on two local collection agencies to handle the vast majority of medical debt collection suits. The hospital still allows its debt collectors to sue patients, garnish their wages, damage their credit and drive them into bankruptcy.
Our investigation found that St. Dominic and its debt collectors:
- Sued thousands of patients, many of whom were working in low-wage industries like fast food and retail, garnished wages, and seized money from patients’ bank accounts.
- Sued more than a hundred of its own employees over medical debt.
- Inflated patients’ bills by a third or more with attorney’s fees, court costs and 8% interest rates.
- Billed thousands of Mississippians when those patients should have qualified for free or reduced medical care.
- Continued suing patients and garnishing their wages throughout the COVID-19 pandemic, while the federal government gave the hospital millions of dollars in pandemic relief funds.
Judy Hall and her husband adopted Daniel when he was 1, and he lived “a charmed life,” she said.
That all changed in 2007 when a car accident left him with a traumatic brain injury and a severed femoral artery, leading to recurring blood clots.
Six weeks after the wreck, he began to have seizures. Testing revealed that he had epilepsy.
His mental state deteriorated, and doctors soon diagnosed him with schizophrenia
Earlier this month, Hall’s mother, now 65, said she and her husband, now 72, were helping their son find a modest place to live.
Since the Federal Housing Administration can finance loans for those who suffer from disabilities, she reached out to the agency, only to discover her son had $4,800 in debt from a collection agency hired by St. Dominic. The debt dated back to April 2019, about five years after Medicaid began to cover his care.
“It is not legal,” Judy Hall said, “to charge the patient for Medicaid coverage.”
In January 2019, Dr. Andrew Bishop, a Jackson psychiatrist affiliated with St. Dominic, began treating her son for “intermittent explosive disorder and psychosis.”
Nine months later, Bishop dropped her son as a patient because of an “abundance of late cancellations and-or missed appointments” and “markedly disruptive, verbally abusive, disrespectful behavior by your relatives.”
Judy Hall said she became upset after the Infusion Center would not give her son the injection he needed. She said she was “never impolite” to his staff, “although I was tempted.”
“It was a battle between accounts payable, the pharmacy, the doctor and the Infusion center at St. Dominic. Daniel was the victim.”
Bishop’s office staff wrote in an email that it could not confirm or deny that Daniel Hall was a patient, but “I can tell you that it is a patient’s responsibility to know what is covered under their insurance drug formulary.”
His office recommended talking to the Infusion Center, which would not comment on the matter.
As a result of this dispute, Daniel Hall went 90 days without his medication, which costs about $5,000 a month without Medicaid, his mother said.
“It got so bad he was arrested for aggression (in Rankin County) before I could get his medication back on track,” she wrote. “The charges were dropped. This ordeal was all about the money.”
MCIR found no record of charges at the Rankin County Sheriff’s Department.
Judy Hall said her son has “the mentality of a 15 year old, and he is 33. This is another reason law enforcement reaches out to help. It is frightening to look at the number of mentally ill people in jail.”
After this, she began to seek treatment for her son at Region 8 Mental Health Services, where “all his medications were covered by Medicaid now as they were then,” she wrote. “We were told that this would be corrected, but it never was.”
She believes the hospital failed to get pre-approval from Medicaid to cover the medicine, discovering the problem after the fact, she said. “In turn, they billed Daniel.”
Despite being her son’s power of attorney, she never received any correspondence from this collection agency, she wrote. “No one should have been billed that was on Medicaid, per Medicaid.”
Daniel Hall said the $4,800 bill shocked him. “After all I have been through with my health, it just didn’t seem fair,” he said. “I had insurance, so how could this happen?”
Jennifer Coney of Flowood, a licensed insurance agent and paralegal who works with law firms, said that since 2017, she has been contacted by about 50 Mississippians who receive medical care through Medicaid but were still billed by hospitals.
Such “balanced billing” is illegal in Mississippi, she said.
Sometimes it’s a lack of communication inside Medicaid, and sometimes the hospital fails to file for reimbursement with Medicaid, she said.
Whatever the reason, she said, patients are being sent “erroneous debt that they don’t owe.”
That’s a serious problem, she said, because those covered by Medicaid lack the resources to fight in court.
Matt Westerfield, a spokesman for Mississippi Medicaid, said the agency hasn’t received complaints on this matter lately.
“When we have received questions or concerns,” he said, “it’s more often a case where a beneficiary receives a bill because the provider didn’t follow billing instructions or didn’t check the beneficiary’s coverage or some other mix-up.”
To make clear what’s right, the agency holds workshops to help both providers and patients, he said.
On Dec. 2, Judy Hall sent a complaint to the Consumer Financial Protection Bureau. Two weeks later, the bureau referred the complaint to the Federal Trade Commission.
Days ago, she learned that the collection agency had dropped its demand for payment.
“That must mean it shouldn’t have been there to start with,” she said. “There are other people out there in the same situation, and they don’t know what to do about it. I hope this will give them some help, because something like this to your credit is devastating.”
She has started to look again for a home for her son so that he can gain independence. “He is still eligible for housing,” she said. “That’s very important. He doesn’t want to live with his mother forever.”
Daniel Hall told MCIR that a new home is “a dream come true for me. I never thought this could be a reality, and now it will be.”
You can follow him on Facebook, Twitter or Instagram.
This story was produced by the Mississippi Center for Investigative Reporting, a nonprofit news organization that is exposing wrongdoing, educating and empowering Mississippians, and raising up the next generation of investigative reporters. Sign up for our newsletter.