Sun special investigation: In Their Debt

Three decades ago, Maryland officials devised a novel system — now the only one of its kind — in which a state agency sets hospital rates for all patients. It was designed in part to guarantee hospital care whether patients could afford it or not. Hospitals received $921 million last year to cover costs of providing free and unpaid care, according to the most recent state records, and all hospital patients in Maryland contribute through the rates they pay. But an eight-month investigation by The Sun found that over the past five years some of Maryland's 46 nonprofit hospitals have received millions of surplus dollars from the payment system even as they sued tens of thousands of patients over unpaid bills. Many of these suits have been filed against patients in the poorest areas of the state.

December 21, 2008

First of three parts

In their debt

Maryland hospitals have stepped up debt collection, sometimes from the poor, and Gov. Martin O'Malley demands a review

• Database: Judgments won by Md. hospitals
• Photos: Charity and lawsuits
• Videos about hospital debt in Maryland

December 22, 2008

Second of three parts

Their day in court

Hospital debt collection lawsuits can zoom through the courts, pitting experienced law firms against ill-informed defendants

• Photos: Millions sought in lawsuits

December 23, 2008

Third of three parts

Loose rules

Maryland hospitals have fought back efforts by lawmakers to tighten oversight of collection policies

• Photos: Cost Review Commission meeting

December 24, 2008

Sun follow-up

Tighter hospital control sought

Lawmaker, judge look at ways to ease debt burden on poor

February 10, 2009

Bill introduced to set standards on free, reduced-price care at hospitals

Measure would prohibit liens, require 'charity care' for certain income level

March 29, 2009

House votes help for lower-income patients

Lower-income patients who lack insurance would be guaranteed free care at Maryland hospitals, which also would have to follow consumer-friendly debt-collection policies, under legislation adopted by the House of Delegates on Saturday.

April 1, 2009

Health care bill passes in the Senate

The Maryland Senate unanimously approved legislation that would require hospitals to provide free care to uninsured patients with incomes of less than 150 percent of the federal poverty level.

About this series

To examine debt collection practices by Maryland hospitals, The Baltimore Sun compiled a database of 132,000 collection lawsuits filed by hospitals across the state from January 2003 through June 30 of this year. The Sun also compiled a partial database of judgments after state officials didn't respond to repeated requests for a complete file. The incomplete database contained $101 million in such judgments without counting most judgments of less than $2,000. Thousands of computerized court docket entries were analyzed to identify hospitals and lawyers filing large numbers of these lawsuits as well as document cases that ended in judgments, liens or other actions against patients. Reporters reviewed samplings of court files in several busy court districts, observed the collection process play out in the busiest of these courts in Baltimore City, and interviewed lawyers and patients involved in those proceedings. The Sun also obtained five years of financial records and other documents from the Maryland Health Services Cost Review Commission, which over a period of several months provided the newspaper with four different sets of data, each time contending that the previous version contained inaccuracies.