Oregon AG seeks Providence Health documents in charity care investigation

Oregon Attorney General Ellen Rosenblum has asked a judge to force Providence Health & Services to turn over documents in an investigation of the health system’s charity care program.

Filings from the state Department of Justice allege Providence enacted policies meant to minimize free medical care to low-income patients, sending some to collections when they couldn’t pay. The department said it’s investigating the practice as a “potential” violation of the state’s Unlawful Trade Practices Act, a consumer protection law, as well as charity care laws that require the nonprofit health system to provide free care to low-income patients in exchange for its various tax exemptions. It has not yet filed a complaint in the case, which it’s pursuing as a civil matter, not a criminal one.

The Justice Department attorneys say Providence has declined to search through and turn over some documents sought by investigators from 10 managers, each of them involved in billing or patients’ access to health care services. Investigators sought documents that match certain search parameters, including key words like “bad debt” and “charity” that appear near each other.

Providence said it has cooperated fully in the investigation by producing 100,000 documents, responding to questions and making 10 witnesses available for lengthy interviews. The health system, though, argued the Justice Department’s later document requests were “overly broad.”

It said it estimated the department’s requests cover another 200,000 documents, which it said would take its attorneys 3,500 hours to review at a cost of about $675,000. Providence said it has already spent $2.4 million responding to the DOJ investigation. In a statement, Providence said it simply asked the Justice Department to narrow its requests for records.

“We intend to defend our position in court and look forward to reaching a resolution that is satisfactory to all parties,” Providence said in the statement.

Providence earlier this year settled a lawsuit brought by Washington state’s attorney general over charity-care claims. The health system, which has its headquarters in Renton, agreed to refund $21 million paid by low-income patients in Washington who were eligible for charity care and erase $137 million in outstanding debt.

Central to both cases is a Providence initiative to increase its cash collections that began in 2018.

In its filings, the Oregon Justice Department disclosed documents obtained from Providence that it says suggest the program was designed to squeeze patients for payments, then send them to collections if they couldn’t pay.

An email and training materials, for example, outlined policies that encouraged employees to seek upfront payments — even partial payments — during meetings with patients in their hospital rooms and to bring up the possibility of financial assistance only as a “last resort.”

It called the program “RevUp.” Providence has said the program was short-lived and primarily aimed at commercially insured patients with the ability to pay, but it also has acknowledged the program was “not consistent” with its values.

Other documents, the Justice Department said, suggest Providence sent patients enrolled in Medicaid to collections in violation of state law.

Providence had systems to identify patients eligible for charity care, according to Justice Department filings. But state attorneys say the health system delayed notifying those patients of their eligibility and took payments from them regardless, then made them apply for refunds, in some cases under a 30-day deadline.

Oregon’s Justice Department began its probe in 2022, acknowledging its consumer protection unit was pursuing a civil investigation but saying little more at the time about the subject matter. It followed the Washington state investigation, as well as a New York Times investigation of the RevUp program that included examples of Oregonians who qualified for charity care but were charged anyway, then hounded by collections agencies.

Providence operates in six western states. It has eight hospitals in Oregon and more than 200 clinics and other offices.


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