Allina's medical billing practices under investigation by Minnesota AG's office

Photo: Reza Estakhrian/Getty Images

The Minnesota Attorney General's office has announced an investigation into Allina Health's billing practices. 

Attorney General Keith Ellison said a June 1 New York Times article reported that Allina has cut off nonemergency medical care to patients who owed medical debt. This Termination of Care Policy has reportedly been enforced on patients who had relatively small amounts of debt and in some cases, patients with chronic conditions who relied on continuous care to manage their conditions, the report said. 

On June 9, Allina announced it would "pause" its Termination of Care Policy, according to the AG's office.

In 2005, the Minnesota Attorney General's office initiated a Hospital Agreement by protecting patients from abusive, harassing and deceptive practices when hospitals in the state seek to collect medical debt. The agreement also prohibits unfair practices in billing and collections and mandates that Minnesota hospitals provide discounts on healthcare services for certain patients and reasonable payment plan options to all patients.

The agreement covers all 128 nonprofit hospitals in Minnesota and was most recently renewed in July 2022 for a period of five years. 

Under the Hospital Agreement, Minnesota hospitals must provide patients with the opportunity to apply for charity care if there is reason to believe the patient may be eligible. 

In 2023, the Minnesota Legislature passed, and Governor Tim Walz signed, a bill that put into state law various provisions that echoed the Hospital Agreement, including:

• requiring that hospitals post notice of the availability of charity care in various locations and languages throughout the hospital facility.
• requiring that hospitals screen uninsured patients and patients whose insurance status is unknown for eligibility for charity care. 
• requiring hospitals to assist eligible patients with applying for charity care.
• including referring the patient to the appropriate department in the hospital for follow-up.
• barring hospitals from imposing an unreasonable burden on patients during the charity care application process.
• prohibiting hospitals from engaging in various types of collection efforts before first determining whether the patient is eligible for charity care.

In addition to the recent legislative session, a new law supported by the AG requiring hospitals to screen certain patients for charity care eligibility starts on November 1.

"I continue to be concerned about reports of Allina denying needed non-emergency medical care solely on the basis of medical debt," Ellison said. "Allina is bound under the Hospital Agreement to refrain from oppressive billing practices and provide charity care when patients need and qualify for it, as all Minnesota hospitals are. Denying patients needed care on the basis of medical debt harms every Minnesotan, whether or not they are Allina patients. My office has heard from a good number of Allina patients who have shared their own upsetting stories of being denied care for this reason. I continue to encourage people who have experienced or are familiar with these practices to keep contacting my office so we can determine the scope of the problem and whether any laws or agreements have been broken."

Allina Health said by statement, "Allina Health remains committed to the creation of the highest quality, affordable and accessible care. Our policy that interrupted the scheduling of non-emergency, outpatient clinic care for patients who do not engage after significant outreach to support the resolution of their medical debt has been extensively reviewed. We have determined there are opportunities to engage our clinical teams and technology differently to provide financial assistance resources for patients who need this support. We will formally transition away from our policy that interrupted the scheduling of non-emergency, outpatient clinic care." 

WHY THIS MATTERS

The attorney general's office said its investigations of Allina and other medical providers are ongoing. 

In December 2022, the attorney general's office announced an investigation into Mayo Clinic over allegations reported in the Rochester Post-Bulletin that Mayo had sued patients who qualified for charity care over their medical debt. 

The investigation into Mayo Clinic is ongoing, according to the AG. 

THE LARGER TREND

The attorney general's office has in the past enforced provisions of the Hospital Agreement. In October 2020, the AG's office said it had reached a settlement with Hutchinson Health Hospital that required the hospital to restore more favorable payment plan terms that it had unilaterally terminated for many of its patients, which had the effect of increasing patients' monthly medical bills beyond what they agreed to pay and led to ballooning payments and defaults. 

By June 2021, that settlement had resulted in $184,000 in medical-debt forgiveness for affected patients, the AG's office said. 

ON THE RECORD

AG Keith Ellison said, "The high cost of healthcare in Minnesota and across the country makes it tough enough to afford your life," Attorney General Ellison said. "Medical-billing practices that are aggressive, abusive, or deceptive also make it hard to live with the dignity, safety, and respect that everyone is entitled to. The Minnesota Attorney General's Office has long been concerned with medical billing and has acted for years to protect Minnesotans from abusive and deceptive practices. With recent reports in the media and from consumers that problems continue, we're taking several steps to renew our focus on this longstanding concern." 

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org