In June, Colorado Gov. Jared Polis signed into law HB24-1380, Regulation of Debt-Related Services. The law marked a milestone in a five-year investigation by a group of reporters into the debt-collection practices of the University of Colorado Health System (UCHealth).

Starting in 2019, journalists from five news outlets collected data on the number of lawsuits UCHealth brought against patients who had unpaid medical bills, according to reporting from Chris Vanderveen, the director of special projects for television station 9News, and John Ingold, a health reporter and cofounder of the nonprofit news outlet, The Colorado Sun.

Dubbed “Diagnosis: Debt Colorado,” the reporting project stems from a partnership led by the Colorado News Collaborative (COLab) and KFF Health News and included contributions from The Colorado Sun, 9News, Colorado Newsline and The Sentinel. In a series stemming from KFF Health News’ reporting on medical debt in the United States, the reporters explored the causes, scale and effects of medical debt on Colorado’s residents.

UCHealth is the state’s largest hospital system, collecting more than $6 billion in patient care revenue annually, Ingold and Vanderveen reported on Feb. 19, “UCHealth sues thousands of patients every year. But you won’t find its name on the lawsuits.”

In its mission statement, UCHealth says, “We improve lives,” the reporters noted. But from 2019 through 2023, the health system and its debt collectors filed 15,710 lawsuits, UCHealth revealed in response to questions from Ingold and Vanderveen, the two reporters wrote in that Feb. 19 article. That’s an average of 3,142 lawsuits per year, or more than eight per day, they noted. Yet almost none of the lawsuits were filed in UCHealth’s name, they added.

Veiled legal actions

In a broadcast on June 27, Vanderveen summarized the reporters’ findings. “As Colorado’s largest and most prominent medical provider insisted it was ‘not hiding anything,’ an exhaustive investigation discovered UCHealth, for years, used what amounted to a loophole in the state’s court system to keep private its aggressive bill collection practices,” Vanderveen wrote.

While journalists often cover hospitals’ confrontational billing and collection tactics, the investigative work of Vanderveen, Ingold and other journalists in this collaboration is significant because it shows how health reporters can uncover lawsuits when a hospital or health system conceals its legal actions against patients.

For their work, the collaborative efforts were particularly useful as were more traditional reporting strategies: soliciting patients’ hospital bills over multiple years, visiting courthouses when debt-collection cases were heard, and gathering the names of defendants and lawyers in those cases.

This spring, the investigation prompted the Colorado General Assembly to pass HB24-1380 to close a loophole that allowed UCHealth to sue thousands of patients under another business’ name, Vanderveen reported. Starting this fall, the law will force hospital systems to sue patients under their own names on debts the systems still own.

After the legislature passed HB24-1380, state Sen. Sonya Jaquez Lewis, praised the journalists’ work. “I really do think we owe you a little bit of thanks — maybe a lot of thanks and gratitude — for sure, because it pointed us in the right direction,” said Jaquez Lewis, a sponsor of the bill.

How the project unfolded

Early in 2020, UCHealth ended its years-long practice of suing patients under its own name, a change that was not disclosed to the state legislature or the public, Vanderveen reported. “The decision allowed UCHealth to continue to sue patients — roughly eight per day for years — with virtually no way to track its legal efforts,” the TV station explained. By allowing two of its third-party debt collectors to use their names as plaintiffs, “UCHealth turned a once-transparent process into a confusing and opaque mess for many of its patients,” the news station added.

When journalists asked about the issue, UCHealth’s administrators said the health system had sued more than 15,000 patients in five years, becoming one of the most aggressive litigants in Colorado, 9News explained.

Soliciting data from patients’ bills

Years before collaborating with other journalists to report on medical debt, Vanderveen asked 9News’ viewers to send in their medical bills. “Sometime between 2016 and 2018, we started a bill-solicitation program called, ‘Show Us Your Bills,’ and we got a lot of submissions,” he said in a phone interview. From those bills, Vanderveen built a database showing how often each hospital filed lawsuits, including the most aggressive litigants.

In 2020, COVID-19 forced all health care journalists to postpone their regular work, but later that year, Vanderveen became curious about how many hospitals filed debt-collection suits during the pandemic. His data showed a sudden drop in lawsuits from UCHealth.

Also in 2020, two Kaiser Health News journalists — senior correspondent Jay Hancock and data editor Elizabeth Lucas — were Pulitzer Prize finalists for reporting in 2019 on the predatory billing practices of the University of Virginia Health System. In an eight-part series, Hancock and Lucas exposed how UVA “relentlessly squeezed low-income patients — many into bankruptcy — forcing the nonprofit, state-run hospital to change its tactics,” the Pulitzer prize committee wrote, as AHCJ reported in a tip sheet published that same year.

Did UVA’s experience prompt UCHealth to change its tactics? Vanderveen wondered. “On the surface, it appeared as if UCHealth had a change of heart because no more lawsuits were filed under UCHealth’s name,” he explained. “It went from about hundreds per quarter to like two or three per quarter.” About that same time, he heard about Credit Service Co., a debt collector in Colorado Springs, that was a party to some UCHealth lawsuits against patients, he said. [See image from 9News.]

A trove of data in court filings

As Vanderveen’s data showed, UCHealth never stopped suing patients in early 2020. While it didn’t do so in a publicly traceable way, he could still find cases by searching court records for Credit Service Co. as a plaintiff, he said.

Visiting the courthouse was also useful, Ingold added. “Going to court is something I would highly recommend, because your local jurisdiction is probably hearing many debt-collection cases on the same days,” he said. “Plus, the lawyers who handle those cases are all the same people.” These courts had long dockets of cases that debt collectors filed, he noted. 

Inside Colorado’s courts, the reporters found defendants waiting to respond to debt-collection summonses. “Chris [Vanderveen] would walk up and down a row of people, and ask, ‘Who’s here for a UCHealth case,’ and ‘Who’s being sued by the Credit Service Company?” Ingold said. Several defendants raised their hands, he noted. At the same time, Ingold found people named in suits that other health care entities brought, leading to more stories.

In addition, the reporters called legal services groups, consumer assistance programs, law school clinics and any other organization helping consumers, especially those with low income, Ingold said. They would have at least some insight into who is suing over medical debt.

Another reporting strategy is to seek defendants who filed answers to complaints, meaning the case may go to a hearing or trial, Ingold advised. In those case files, reporters may find creditors’ names, he said. Also, defendants who challenge these cases may want to talk to reporters, he added.

The value of collaboration

One of the most important lessons learned was the teamwork that came from the collaborative nature of the project. At COLab, journalists no longer compete as they once did to be the first to break stories. Instead, COLab journalists from different newsrooms work on projects together to serve the public good, Ingold explained.

“What we produce for the news collaborative can be distributed to pretty much any newsroom in Colorado that wants it,” he added said. “My story about the lawsuits ran on our site, at www.ColoradoSun.com, and it ran on the websites of the other news collaborators. Also, it ended up in The Denver Post and a number of other places around the state.”

COLab makes efficient use of the limited staff left behind in many newsrooms when fewer news outlets can devote multiple staff to any one project, he commented. “Also, we can help all the participating newsrooms by providing content everybody can use,” he added.

In addition to working with multiple newsrooms in Colorado, COLab also worked with Noam N. Levey, a senior correspondent at KFF Health News, who has led KFF’s award-winning project, Diagnosis: Debt.

Levey introduced the Colorado reporters to the staff at the Urban Institute who have researched how medical debt and collections affect immigrants and people of color, said Tina Griego, COLab’s managing editor. Data from the Urban Institute led to this story, “Medical Debt Affects Much of America, but Colorado Immigrants Are Hit Especially Hard,” by Rae Ellen Bichell and Lindsey Toomer, of Colorado Newsline, Griego explained. Bichell is a Colorado correspondent for KFF Health News and Toomer covers politics and social justice for Colorado Newsline, which is part of the States Newsroom, a nonprofit covering state capitals.

Resources

• “UCHealth sues thousands of patients every year but doesn’t use its own name to do it,” Colorado Sun and 9News, Feb. 16, 2024.
• “Colorado hospital giant’s lawsuits fill county courtrooms with defendants and confusion,” 9News, March 1, 2024.
• “Medical Debt Affects Much of America, but Colorado Immigrants Are Hit Especially Hard,” April 3, 2024.
• “Hospitals suing patients over unpaid bills would have to put their names on lawsuits under new Colorado measure,” Colorado Sun, April 12, 2024.
• “Loophole allowed UCHealth to sue thousands of patients under another business’ name,” 9News, June 27, 2024.