Virginia medical debt report ranks pre-merger Ballad Health among most litigious

A new report ranks Ballad Health in the top 10 most litigious health systems in Virginia, with the bulk of its lawsuits likely happening before the merger that created the organization. The publication — a product of Stanford Medicine, George Washington University Law School and nonprofit PatientRightsAdvocate.org — found that the health system has sued more than 26,000 patients from 2010-2024. More than 25,000 of those lawsuits happened before 2019, including those under Mountain States Health Alliance and Wellmont Health Systems. The two merged in early 2018 to create Ballad Health. Alan Levine, Ballad's chief executive officer and chairman, said the data related to policies that no longer exist with Ballad. "When we merged, we substantially changed our policies related to people without insurance and low income patients," he said in an email. Ballad offers free care for people below 225% of the federal poverty level, as well as tiered discounted prices for those between that and 450%, under its financial assistance policy. It sometimes activates those benefits automatically through a "presumptive eligibility" provision, meaning patients don't have to apply for charity care. Levine pointed to Virginia reports that call the charity care policy "generous" compared to other nonprofit hospitals and systems. He also emphasized that the health system has taken other measures to alleviate debt, such as partnering with nonprofit Undue Medical Debt in 2021 to eliminate more than $277 million in debt for patients. The health system also recently received an innovation award from Modern Healthcare for its work connecting uninsured patients to health care. "Generally, the only people we pursue when they don't pay their bills are those who have the means, but fail to respond to numerous efforts to make contact," Levine said in an email. "It isn't fair to all the patients who pay their bills...what do you say to those people when someone with substantially higher income just refuses to even respond?" Overall, the report found that Virginia hospitals and medical providers sought $1.4 billion in medical debt collections through 1.15 million lawsuits against patients from 2010-2024. It alleges that many of those suits followed hidden prices, predatory contracts and opaque billing. Ilaria Santangelo, PatientRightsAdvocate.org director of research, said while the report focuses on Virginia alone, the problem is nationwide. "Medical debt is the leading cause of bankruptcy in our country," she said. "We have over one-third of Americans delaying the care that they need because they don't know the cost up front." Santangelo added that no matter where patients are from, they can't do much if they have little recourse — and that a majority of Americans want to know health care prices so they can get the best quality at an affordable cost. "Without price transparency, patients are left powerless to fight back on devastating medical debt lawsuits for bills that are known to commonly contain errors," she said. "A visit to the hospital should never end in the courtroom."