They needed emergency medical care. Now Atrium is suing them for bills they can’t pay.

A new study finds hospitals in North Carolina are not spending enough in “charity care” to justify their tax exemption.
A new report finds that Atrium received $440 million in tax exemptions in 2019-2020 but spent...
A new report finds that Atrium received $440 million in tax exemptions in 2019-2020 but spent less than 60 percent of it on charity care.(WBTV)
Published: Jan. 24, 2022 at 5:51 PM EST|Updated: Jan. 24, 2022 at 8:14 PM EST
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CHARLOTTE, N.C. (WBTV) - Mary Oliver says her husband Patrick typically has a clean bill of health. So, it was concerning when he started feeling numbness in his hands and feet and a burning sensation in his palms.

“It’s very unusual for him to have any kind of medical problems and then he started dragging one of his legs,” Mary Oliver told WBTV.

Because they were uninsured, Atrium’s emergency room seemed like the only choice.

More than a year later, the Olivers are now facing a lawsuit from Atrium Health for unpaid medical bills they say they can’t afford.

A WBTV Investigation found hundreds of local families in the same situation as the Olivers, being sued for unpaid medical bills that would cost them tens of thousands of dollars.

A new study is raising questions about whether hospitals like Atrium and others are providing enough free charity care for patients who can’t afford the treatment they need.

Mary Oliver said they knew money would be an issue, but said they had every intention of paying whatever bills they were sent.

Mary Oliver distinctly remembers filling out personal financial forms while waiting to find out the diagnosis for her husband.

“At that time, we weren’t really concerned a lot about what we were signing because we needed to see the doctor,” Oliver said.

Patrick told WBTV he was ready to leave the hospital after already spending hours receiving tests to determine the problem.

“I was really getting ready to leave after they did a certain amount of tests. The doctor, like I said, he was pretty nice,” Patrick Oliver said. “He said ‘No, I’ve got to hold you’.”

Oliver was kept in the ER overnight as Atrium ran more tests and gave him an MRI. The final bill kept racking up until they owed $29,410.85.

Mary Oliver said they were at the hospital for less than 24 hours, which is backed up by medical records filed in the lawsuit against them.

Oliver’s medical bills show four different MRI scans totaling more than $11,000.

Even after Atrium provided discounts for Oliver being uninsured, the total was $15,398.72.

“We know you have to pay for what you have to have done, but that’s ridiculous. I can’t think of anything you could do that could cost you $29,000 in less than 24 hours,” Mary Oliver said.

In an email, a spokesperson for Atrium Health said, “free care is available for patients at 200% of the federal poverty level and below and substantial discounts for patients up to 400% of the federal poverty level.”

But even with the discounts provided, the Olivers said they cannot afford what they currently owe.

North Carolina State Treasurer Dale Folwell is raising concerns about how many North Carolinians face medical bills like the Olivers.

“The citizens of North Carolina can no longer be punished by having their credit rating destroyed based on a product they would rather not have consumed, because that would mean they were healthy,” Folwell said.

Folwell’s office, along with Johns Hopkins and the NC State Health Plan, recently published a report revealing how little tax-exempt hospital systems in the Tar Heel state spend on “charity care,” which is basically financial assistance for bills patients can’t afford.

The report found “North Carolina hospitals reap lucrative tax breaks to care for the poor. Their communities help bear the burden for these tax breaks, but hospitals’ charity care varies wildly, with little accountability. Many nonprofit hospitals fail to give enough charity care to justify their tax exemptions.”

Atrium is a government entity and according to the report received $440.1 million dollars in tax exemptions in 2019-2020. But “charity care spending equaled less than 60% of its tax exemption,” about $260.1 million.

“Is that not enough to justify that tax exemption they’re getting?” A WBTV reporter asked Treasurer Folwell.

“Not in the in the eyes of the Internal Revenue Service, but unfortunately no one is actually enforcing this,” Folwell said.

The report found that in North Carolina, “there is no public agency or official who enforces how nonprofit hospitals are fulfilling their mission to provide charity care.”

Instead, hospital systems are often seeking additional tax incentives to grow larger.

Both the Charlotte City Council and the Mecklenburg Board of County Commissioners recently approved to reimburse Atrium and private developers $74.5 million in infrastructure public improvements, which includes a parking garage, to begin construction of an innovation district and medical school in Dilworth.

“What we’ve seen across North Carolina is that we’ve seen the consolidation of health care into the hands of these multimillion-dollar executives, who run these multibillion-dollar corporations, who are disguised as nonprofits and no one is overseeing it,” Folwell said.

Atrium refused to answer WBTV’s questions on-camera for this story but in an email, spokesperson Dan Fogleman wrote – “the fact is, we provide way more than that” and claimed Atrium “gave back more than $2.3 billion in free and uncompensated care and other community benefits in 2020.”

Fogelman said the hospital eats unreimbursed costs from Medicare and Medicaid, $1.34 billion dollars in 2020 alone.

The report specifically addresses this type of contribution and calls it lacking, saying “many of North Carolina’s hospitals have also publicized bad debt and Medicare underpayments as community benefits. While the IRS restricts the use of these categories in calculating community benefits, some hospitals employ these numbers to inflate the size of their community benefit spending.”

That leaves people like the Olivers stuck in the middle. Atrium sued the couple for more than $17,000 in October, including attorney’s fees.

“Police officer came to the door to deliver the papers and when I opened it up, we could not believe it,” Mary Oliver said.

In Mecklenburg County alone, WBTV found 111 similar lawsuits just in 2021, often for tens of thousands of dollars. Many of them ended in judgments against the patients.

The Olivers are still fighting.

“I’m hoping something comes out of this because we do not need a judgment, can’t afford a judgment and can’t afford all of that money,” Oliver said.

Patrick Oliver was diagnosed with spinal stenosis, but he ended up qualifying for a program that paid for his operation with a different healthcare provider, costing him zero dollars.

Below is Atrium Health’s full response to questions asked by WBTV.

“You cited a report with a low figure for charity care and, the fact is, we provide way more than that. Not only does Atrium Health provide the most health care to residents throughout the state, we are also proud to be the largest provider of community benefit. Our enterprise gave back more than $2.3 billion in free and uncompensated care and other community benefits in 2020. (Just Mecklenburg Co.in 2020 - $910M)

Our financials are audited every year and one of the key shortcomings of the report you’re referencing is that it excludes non-payments and underpayments from the overall benefit number.

Atrium Health is the largest Medicaid provider in the state – and we treat 70% of the Medicaid population in Mecklenburg County. What many people don’t understand is that Medicare and Medicaid programs do not reimburse hospitals for the full amount of what it costs to deliver the care in many instances. We can’t turn these patients away or negotiate higher reimbursements. Government payers recognize this fact and expect hospitals to make up the difference through efficiencies and from other revenue sources. The financing of this unpaid government debt is considered a community benefit.

Free care is available for patients at 200% of the federal poverty level and below and substantial discounts for patients up to 400% of the federal poverty level. We also incurred $1.34 billion in unreimbursed costs of treating Medicare and Medicaid patients during 2020.

We also look out for the those in need in other ways. Throughout the COVID pandemic, Atrium Health eliminated disparities by ensuring racial equity in access to testing and vaccines. We took both directly to into underserved neighborhoods. And, as the state faces an ongoing behavioral health crisis, Atrium Health has maintained a deep commitment to our behavioral health programs, investing more than $79 million per year into treating some of the most vulnerable members of our population.

Due to privacy protections for our patients, we can’t speak to any specific case. It is important to note that, with our “for all” mission, we don’t turn anyone away – regardless of their ability or inability to pay – but we are required to treat every patient who doesn’t qualify for financial assistance the same when it comes to collection practices, regardless of the amount due. Where people accumulate bills and need help, we’re happy to work with them to establish a payment plan for what they can afford. When provided with the proper information, we can typically determine plans or programs that could help them resolve – or eliminate – their debt.

Atrium Health strives to provide financial assistance based on a patient’s ability to pay while modeling the Atrium Health core value of caring. Our financial assistance programs are designed to ensure help is provided to patients demonstrating a financial need and to ensure Atrium Health complies with any required federal or state regulations related to financial assistance. For more information, patients can contact Patient Customer Service at 704-512-7171 or visit www.AtriumHealth.org.”

Atrium Health Spokesperson

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