A report by The Times-Picayune has uncovered how an overburdened system in Louisiana, riddled with inconsistencies between parishes and hospitals, has led to sexual assault victims being charged for exams, as well as emergency room visits, lab work, pregnancy tests and medication to help prevent HIV infection.

A New Orleans woman told the newspaper how she was taken to the hospital after her assault, and she was questioned, photographed and submitted to a series of tests—a process totaling around six hours. She was then allowed to shower and finally sent home. Eight days later, however, she received a bill for $2,000. Though her insurance covered $1,400, she still owed $600 out of pocket. A few days later, she received a second invoice for $1,700. “You never really think, Is rape covered by insurance?” she said.

Another victim from the East Baton Rouge Parish was charged $4,200 by Our Lady of the Lake Regional Medical Center following treatment for a violent sexual assault. Her mother has since appealed the charges and last week found that a charitable fund at the hospital would cover the costs.

The Violence Against Women Act, a federal law amended in 2005, is supposed to ensure that the cost of rape kits does not fall on the patients, whether or not they report the incident to police. And while Louisiana state law mandates free forensic exams, it also requires that patients who don’t report their attacks to police should be treated as “regular emergency room patients,” meaning they would be responsible for the costs of all tests.

At the heart of the problem, though, is that procedure and billing differ from parish to parish, hospital to hospital. Some are charging for exams. Some are requiring admission to the ER. And most are billing patients for all of the additional procedures that are usually performed during a forensic examination, including pregnancy and HIV tests, and any associated medications.

Sure, the Louisiana Crime Victims Reparations Board will reimburse 100 percent of medical costs. But there are conditions. The Times-Picayune explains that in order to be reimbursed, victims must report the assault to the authorities, and they can’t have been involved in any other illegal activity at the time or have any felonies to their name in the past five years. And perhaps the most alarming stipulation? The victim can’t have acted in a way that “contributed to the crime.”

Advocacy groups are worried that these suspect billing practices and the hurdles to recouping costs—including the pressure to report—could result in fewer victims coming forward to seek medical treatment in the first place. “Sexual assault is already one of the most underreported crimes, period,” said Amanda Tonkovich, coordinator of the New Orleans Sexual Assault Response Team. “Even if people don’t want to report, we want them to come to the hospital and make sure they’re OK, medically speaking.”

Still, there is some good news. Following the newspaper’s investigation, the Louisiana Department of Health and Hospitals released a statement admitting to systematic failings and promising to improve services.