WASHINGTON—Yesterday, the National Health Law Program (NHeLP) joined with Florida Legal Services (FLS) to file a ground-breaking administrative complaint with the IRS against the Jackson Health System (JHS), Miami-Dade County’s publicly funded health care system, alleging Jackson is violating requirements governing billing and collection policies of non-profit health providers for low-income patients. This is the first time advocacy organizations representing low-income people have filed such a complaint.
“Congress took a much-needed step to ensure that people are aware of these financial assistance programs and that they are not deterred from seeking that care because of unreasonable billing practices,” said Sarah Somers, managing attorney at NHeLP. “These new requirements help advance the ACA’s goal that all citizens and lawful residents have access to affordable health, and those requirements must be enforced.”
While other non-profit hospitals throughout the country, including those in Miami, have posted their full financial assistance policies on-line and engaged community members in their community needs assessment process, the complaint alleges that JHS has failed to do so. Among other things, the complaint asserts that many low-income Miami Dade county residents who received care at JHS are completely unaware of the financial assistance program until they seek legal assistance for medical debt from their treatment at JHS. As a result, county residents have been subject to collection actions for hundreds or thousands of dollars for medically necessary services received at JHS, even though they would qualify for the financial assistance program.
“We appreciate that JHS provides a critical function as a safety net and has limited resources,” said Miriam Harmatz, a senior health law attorney at FLS. “However, virtually all of the low-income uninsured county residents who are experiencing difficulties with JHS would be eligible for Medicaid (with virtually all of the cost covered by the federal government) if the Legislature would just accept federal funding. The county should not have to pick up the bill for these individuals. In the meantime, however, JHS needs to ensure that people who are eligible for this county funded care can actually get it. “
The complaint also highlights the fact that a significant percentage of Miami-Dade county’s low-income beneficiaries would have been eligible for Medicaid coverage under the ACA and that more than 165,000 of these individuals are currently in the “coverage gap” due to the Florida Legislature's refusal to expand Medicaid. The complaint asserts that because of JHS’s violations, many of these uninsured patients will likely continue to believe that they cannot receive services and may either forgo necessary medical care to avoid medical debt or be subjected to billing practice that violate the ACA.
For example, Dade County resident Jacqueline Samuels has end stage renal disease. She had surgery to install a shunt so that she could receive dialysis. Under JHS’s financial assistance program, the most she could be charged for a procedure is $200. Yet she later received a bill for $4,524 for anesthesia services. When she could not pay, the bill was turned over to a collection agency. JHS retracted the bill only after intervention from an attorney.