A small number of Virginia hospitals and law firms filed more than a million lawsuits for medical debt between 2010 and 2024, imposing financial hardship on hundreds of thousands of patients, according to a report released on March 26.

Researchers from Stanford University’s Clinical Excellence Research Center, George Washington University Law School, and Patient Rights Advocate examined 15 years’ worth of civil lawsuits and reported that a “medical debt ecosystem” in the commonwealth leaves unwary patients in a state of poverty and poor health.

Some hospitals dispute the findings, saying they are misleading and do not reflect recently passed consumer protection laws or changed practices within the medical community.

The Debt Trap

More than 100 million Americans collectively have some $200 billion in medical debt, and many of those patients face lawsuits from their providers when they are unable to pay.

Medical debt begins with unclear pricing, according to the report’s authors, who said patients are often asked to enter financial agreements that obligate them to unspecified costs.

And the prices sometimes vary widely from patient to patient, the report stated. In one case, a service ranged from about $1,600 to more than $121,000 in hospitals within the same health system.

Hospitals and other medical providers in Virginia brought nearly 1.2 million court actions against patients during the 15-year period studied in the report, seeking to collect $1.4 billion. That represented 27 percent of all debt collection lawsuits in the state, the report stated.

Ten health care providers accounted for nearly half (48 percent) of those court actions.

Previous studies have indicated an increase in medical debt collection in the 2010s.

“A highly lucrative industry is capitalizing on patients’ inability to pay,” Noam N. Levy wrote in an article for the health industry research group KFF in 2022.

Virginia passed a price transparency law in 2016 and another to combat surprise medical bills in 2020.

The commonwealth launched a public awareness campaign in 2023 to inform the public about these laws, and it maintains a web-based price transparency tool for patients.

Debt-Health Spiral

For many patients, medical debt is the beginning of a downward spiral that affects physical and mental health as well as financial well-being, the report concluded.

The Virginia lawsuits resulted in more than 400,000 wage and bank account garnishments.

A 2024 survey reported that 65 percent of bankruptcies stemmed from medical issues such as doctor bills, prescription medicines, or illnesses that caused the patient or a partner to miss work.

Beyond the possibility of bankruptcy, medical debt affects patient health because uncertainty about costs deters many people from seeking treatment, the report found.

“People are getting sued for medical bills they never received a price for up front,” Ilaria Santangelo, director of research for Patients Rights Advocate and an author of the report, told The Epoch Times.

“This is taking a real toll on their financial health and physical health.”

Between 47.5 million and 51.6 million people experience problems such as postponing medical care, not filling prescriptions, not seeing specialists, not complying with doctors’ advice, or using alternative care because of cost, according to a study published in the Journal of General Internal Medicine.

Charity Care

“A huge cohort of the people being sued were low-income patients,” Santangelo said. “A lot of them are supposed to qualify for charity care, and I don’t know if it’s the hospital not asking what their income status is or turning a blind eye.”

Julian Walker, vice president of communications for the Virginia Hospital and Healthcare Association, told The Epoch Times that Virginia hospitals have worked with elected leaders to enact consumer reforms.

“In 2024, Virginia hospitals provided more than $457 million in charity care/financial assistance, incurred more than $428 million in bad debt expense, and provided more than $1.1 billion in community programs and services,” Walker said.

Virginia passed a law in 2022 requiring hospitals to post information on charity care policies, tell uninsured patients about financial assistance and payment plan options, and report the amount of assistance they provide.

The 2022 law also limits the steps hospitals can take to collect medical debt, as does a 2025 law.

The Epoch Times requested comments from 10 health care providers named in the report as most frequently having sued patients.

A spokesperson for the University of Virginia Health told The Epoch Times that it had revised its billing policies and practices between 2019 and 2021 based on patients’ ability to pay.

“Our goal is to not need to use the collections process and instead work with our patients to provide financial assistance for those who qualify and offer fair payment options for all patients,” the spokesperson said via email.

He said that the hospital has not filed new lawsuits against patients for nonpayment since 2019 and has released all liens and judgments for patients at or below 400 percent of the federal poverty level.

A spokesperson for Virginia Commonwealth University Health told The Epoch Times that it had concerns regarding the accuracy of the report and was thoroughly examining its records.

Sentara Health, the provider identified in the report as having filed the most patient lawsuits, also questioned the report findings.

Sentara, which operates 11 hospitals in Virginia and one in North Carolina, said in a statement provided to The Epoch Times that it provided $185 million in uncompensated care in 2025 and seeks to identify patients qualifying for charity care.

“Our goal is to support patients during difficult times—not add financial strain,” the statement said, while acknowledging that it does proceed with collection action against those it deems “able but unwilling” to pay.