Baltimore hospital filed 2,400 lawsuits often against poor and black patients for unpaid medical bills between 2009 and 2018

Johns Hopkins hospital in Baltimore, Maryland, filed more than 2,000 lawsuits often against poor and African American patients, and including many of their own neighbors, for unpaid medical bills, a new study has revealed.

The hospital, one of the state’s largest, filed 2,400 lawsuits between 2009 and 2018 that totaled $4.8m in alleged debt from patients, according to a report from the American unions AFL-CIO and National Nurses United and community advocacy group Coalition for a Humane Hopkins. The median unpaid debt that led to a lawsuit was $1,438.

The report took a closer look at suits against patients who live in Baltimore, which made up 46% of the total lawsuits the hospital filed. The zip codes with the most patients, according to the report, are made up of predominantly African American and low-income patients. Nine of 10 zip codes with the highest number of patients sued by JHH have poverty rates that are higher than the state average.

JHH has a history of filing thousands of lawsuits for unpaid medical bills. A 2008 investigative series from the Baltimore Sun revealed that JHH and Johns Hopkins Bayview medical center, another hospital within the Johns Hopkins network, collectively filed 14,000 lawsuits against patients from 2003 to 2008. While the number of lawsuits has since dropped, the report notes that they have started to rise again over the last five years.

Johns Hopkins Medicine did not respond to the Guardian’s request for comment.

Not-for-profit hospitals suing their patients has been a long-criticized practice – particularly because these hospitals get tax breaks on federal, state and local levels – but has continued for years in the United States

Lawsuits are filed by hospitals in many places, not just Baltimore. An investigation from ProPublica and NPR found that a single hospital in St Joseph, Missouri, filed 11,000 lawsuits over a four-year period. Another hospital in Evansville, Indiana, filed 20,000. Though public investigations have led these hospitals to change their financial assistance policies and forgive the debts of some of their patients, no one tracks how often hospitals sue their patients outside of these investigations.

Medical debt is considered a “low priority debt” by the National Consumer Law Center, below other types of debt like unpaid credit card bills or a mortgage because it typically carries low or no interest.

A 2016 study found that one in six Americans have medical debt on their credit reports, worth a collective $81bn.

Measures to prevent hospitals from issuing large, surprise health bills have been introduced to Congress, though gridlock around the Affordable Care Act has largely prevented anything from getting passed. Meanwhile, medical costs continue to rise, with the average American family of four spending about $28,000 for healthcare a year even with insurance.