Non Profit Hospitals - More Like Not Accountable
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Happy Tuesday Healthcare Advocates
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Attack on Transgender Care
In an attempt to terrorize patients, doctors and medical facilities, the Tennessee attorney general has requested and received transgender patient records from Vanderbilt University Hospital. He apparently has the legal right to do so searching for fraud and over-billing. However, these are HIPPA related records and need to be protected. The subpoena was issued before a July 1 ban in Tennessee on transgender related medical care there. This is a campaign of terror and intimidation against small minority. It also intimidates doctors, just like an abortion ban intimidates them from providing abortion care to save women. Link to the article.
The attorney general is Jonathan Skrmetti and here is his phone number (615) 741-3491. Let him know that intimidating doctors and patients is just that, terror and intimidation.
Hospital Shenanigans
We have reported a number of times on not for profit hospitals that operate as if they were for profit entities. There are tell-tale signs: not a lot of money allocated for charity medical work, like paying bills for low income patients, high salaries and bonuses for executives, fancy office spaces. You get the picture. Of course, the reason they want to be not for profit is that they can avoid federal corporate tax, state corporate tax, and property taxes. What a scheme, get your business to be tax free and pay giant salaries!!!
Recently in Pottstown, PA, a hospital was purchased and converted to a non-profit. They have managed to avoid $900,000 in yearly real estate taxes. They had eye-popping salaries, in lieu of profits. A court ruled that they did not deserve to be tax-exempt. The ruling is in appeal.
Here is a link to a Kaiser Family Foundation investigation on this type of hospital shenanigans.
Another part of the problem is that there are 100 million Americans with medical debt and hospitals, including tax exempt hospitals, are often some of the worst offenders when it comes to aggressive collection tactics. Where is that charitable nature for the poor and down-trodden? Not in the executive boardroom.
Anyway, the real issue is that the federal law, and often state laws are pretty weak when it comes to granting tax exempt status. You can read the IRS rules here. Nowhere does it call out providing care to those who cannot pay. If you take Medicare payments/Medicaid that is good enough. Or perhaps you have an educational or community outreach campaign, good enough. Nowhere is it called out how much of your surplus funds need to be spent for public good.
There are also shady accounting practices. We have reported on some of these previously. They include counting your advertising budget as public service (charity) expenditures, counting the shortfall between Medicaid and your list price as charity expenditure.
Wait, it gets worse. Part of the issue is that hospitals overcharge private insurance because they claim that Medicare and Medicaid don’t pay enough. Study says - that’s a lie. A recent state report from Colorado found that, even after accounting for low Medicaid and Medicare rates, hospitals get enough from private health insurance plans to provide more charity care and community benefits than they do currently and still turn a profit. In fact another recent report showed that 1350 hospitals expend far less than their tax benefit. There are only about 2,975 non profit hospitals btw.
Part of the problem is that there are few defined rules or minimums that hospitals have to meet so that expenditures are classified as a charity.
Here is a good report by American Progress on this subject with a number of concrete recommendations.
Set standards for charity care eligibility and obligation. This can include limiting tax benefits to the charitable amount provided to the community. Oregon requires charitable care be made available if income is below 4 x the federal poverty level. There are many ways to do it, but specifics are needed.
Tighten up the definition of community benefit. Billboards advertising the hospital can’t count.
Require hospitals to engage the community in needs assessments and implementation plans
Require nonprofit hospitals to participate in public health programs
Limit extraordinary debt collection practices - this is a charity - not loan sharking
Empower the FTC to regulate nonprofit hospital conduct - many of these problems are created by large hospital corporations that cross state lines and the FTC is specifically prohibited from investigating their amoral behavior.
Action
Contact your state and federal representatives and tell them that it is time for non profit hospitals to behave in the public interest if they want to keep avoiding taxes. They get billions more in tax breaks than they spend in alleged charity care. That includes clear standards for charity care eligibility and obligation, tighter rules on what constitutes public benefit, requirements to participate in public health campaigns, prohibitions from using aggressive collection tactics, and a requirement to engage the community in needs assessments and implementation plans.
If contacting federal reps make sure to tell them the FTC should have the power to investigate non profit hospitals as well as the IRS.
Here are two RESISTBOT actions one for state and one for federal representatives.
State : Text sign PGMOSX to 50409 to contact your governor and state representatives.
Federal: Text sign PLKKOS to 50409 to contact your Congressperson, Senators and the President.
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
https://www.commoncause.org/find-your-representative/addr/
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Organizations to Contact
NARAL - Pro Choice America
Planned Parenthood
Physicians for a National Health Plan
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water Resistbot write up