These are the email exchanges between reporter Wendi C. Thomas and Methodist officials over more than a month as she tried to arrange interviews and get answers to questions regarding the hospital’s financial assistance policies and debt collection practices.

May 21, 2018 9:45 a.m.

Hi Wendi,

Monica Wharton mentioned you contacted her about a story you are working on. It is Methodist’s policy that all interviews go through our communications department.

Can I help you with something?

Let me know. Thanks.

Mary Alice Taylor

Sr. Corporate Communications Specialist

Strategic Planning and Marketing

*Editor’s note: Thomas approached Wharton, who is the chief legal officer for Methodist, at an event at the University of Memphis on April 3, 2018. In a conversation, Thomas told Wharton that she was beginning to look into the hospital’s use of the courts to collect debts. When Thomas contacted Wharton by email after the conversation, the hospital’s communication specialist replied.

June 7, 2019 11:27 a.m.

Mary Alice:

Per our phone call today: I’m working with ProPublica’s Local Reporting Network on a series of stories about systems that keep poor people poor in Memphis. The first story is about medical debt.

My analysis of Shelby County General Sessions Court records determined that Methodist files more lawsuits than any other local hospital, and in fact has filed more lawsuits than all but one creditor from 2014–18.

I’d like to talk to the hospital’s CEO, board chairman, CFO and any other officials about the hospital’s financial assistance policy, lawsuits filed against patients, the charity care you provide and how your policies dovetail or diverge from the statement of principles set forward by the United Methodist Church.

I also want to talk about the specific cases of two former patients, Carrie Barrett and Raquel Nelson. I’ve reviewed their court files and observed their proceedings in General Sessions Court. This afternoon I’ll forward the authorization releases they’ve signed and a copy of their driver’s licenses.

I’d love to do in-person interviews Monday or Tuesday. My deadline is June 18. The story would be published both on MLK50.com and on ProPublica’s site.

I look forward to meeting with you before then.

Thanks,

Wendi

Wendi C. Thomas

Editor, MLK50: Justice Through Journalism

June 10, 5 p.m.

Hi Wendi,

Touching base to let you know that we are looking into your request. Given your deadline, please provide a list of questions.

Thanks,

Rachel

Rachel Cordray

Senior Communications Specialist

June 10, 6:35 p.m.

My practice is not to share questions in advance of the interview, but here’s the topics that I want to talk about:

- the hospital’s financial assistance policy

- employee compensation and health insurance benefits

- the intersection between the hospital’s debt collection practices and the UMC’s Social Principles that speak directly to the poor and living wages

- the hospital’s relationship with Consolidated Recovery Systems/Revenue Assurance Professionals

- the hospital’s debt collection practices, including the use of the court

- executive compensation

- the specific cases of Carrie Barrett and Raquel Nelson, whose authorization releases and driver’s licenses I’ve sent you.

Again, this is not a list of questions but rather a list of areas that I’d like to cover in my interview.

Thanks again,

Wendi

Wendi C. Thomas

Editor, MLK50: Justice Through Journalism

June 13, 1:08 p.m.

Hi Wendi,

Our HIM department will handle your medical records request. Please contact J — — G — — at 901. — — — -. She is expecting your call. I will be in touch soon regarding the remainder of your request.

Thanks,

Rachel

Rachel Cordray

Senior Communications Specialist

June 14, 1:56 p.m.

Hi Wendi,

In response to your inquiry, please see the following information, which demonstrates our commitment to caring for all members of our community and being a good community partner. You are welcome to attribute any of the information below to a health system spokesperson.

Background on Methodist Le Bonheur Healthcare’s Commitment to Memphis

We strongly believe in providing exceptional care to all members of the community — regardless of their ability to pay.

Recognizing the unique needs of our patient populations, we have a thoughtful process in place designed to help patients with medical expenses.

Any patient who identifies as uninsured, or self‐pay, receives an automatic 70% discount for the care they receive.

We provide self‐paying patients with free assistance enrolling in government sponsored insurance programs.

Our desire is to work with patients early in the process to set up a payment plan that meets their individual need.

We work with patients to set up 0% interest payment plans.

Outstanding patient debts are only sent to collections and then to court as a very last resort, and only after continued efforts to work with the patients have been exhausted.

We are committed to ensuring access to quality care and have a hospital in all four quadrants of the greater Memphis area.

Our health system includes six hospitals and more than 150 clinics, outpatient centers and physician practices.

We are dedicated to strengthening the communities we serve and improving the well-being of families, and that commitment is demonstrated through our actions.

We provide more healthcare community benefit than any other health system in the region — over $226 million annually.

We employ more than 250 associates dedicated specifically to community outreach and improving the health of all Memphians through our more than 20 evidence-based community programs, serving approximately 54,000 individuals and providing $25 million in community-based services — in homes, schools, child care centers, community centers and churches.

We raised nearly $24 million dollars to meet community needs through the combined efforts of our foundations.

Thanks,

Rachel

Rachel Cordray

Senior Communications Specialist

June 14, 4:38 p.m.

Rachel,

Am I to understand that you’re declining to provide an interview about a story that will get national attention? I would like to give your top officials an opportunity to hear what I’ve found through my reporting and to respond to specific points or clarify misunderstandings.

As I previously mentioned, my deadline is Tuesday.

Best,

Wendi

Wendi C. Thomas

Editor, MLK50: Justice Through Journalism

June 17, 1:11 p.m.

Wendi,

The information we provided gives an accurate picture of our process and commitment to caring for all members of our community.

Thanks,

Rachel

June 17, 4:22 p.m.

From: Wendi Thomas <wendicthomas@mlk50.com>

Sent: Monday, June 17, 2019 4:22 PM

To: Rachel Cordray <Rachel.Cordray@mlh.org>; Chuck Lane — CFO <Chuck.Lane@mlh.org>; Michael Ugwueke <Michael.Ugwueke@mlh.org>; Charles Lane — Emergency Program Manager <Charles.Lane@mlh.org>; Mary Alice Taylor <MaryAlice.Taylor@mlh.org>

Subject: Re: [EXTERNAL] following up on the interview request Re: Can I help?

Rachel,

It is certainly the hospital’s right to decline to be interviewed for this story, which I will note in my story, along with your written response. However, it is my responsibility to ensure you are aware of what my story will report so top officials have an opportunity to respond.

Both MLK50 and ProPublica believe in “no surprises” journalism, meaning we don’t want you to be surprised by what is published. To that end, see below.

My deadline is 5 p.m. Thursday for any final comment.

Thanks,

Wendi

Financial assistance:

Based on the hospital’s financial assistance policy (FAP) and the statement you provided, it does not appear that Methodist offers financial assistance for patients with insurance. Is that correct? If it is not correct, can you point me to where in your policies it explains the type of assistance offered to those with insurance?

Experts have said that failure to provide assistance to the insured would make the hospital’s FAP one of the most restrictive they’ve ever seen. Would you dispute that?

Your competitor Baptist Memorial Healthcare offers a discount for patients with a bill from a single medical event that exceeds $5,000. It does not appear that Methodist does so. Why?

Many other hospitals offer financial assistance for patients whose household income is far higher than the level Methodist has set. At some hospitals, patients with household income of up to 600 percent of the federal poverty guideline (FPG) still qualify. Given the high poverty rate in the community Methodist serves, why does Methodist’s FAP say that the hospital offers additional discounts, including writing off a bill, only to patients with a household income of less than 200 percent of FPG?

Dozens of patients I have interviewed say that they were not evaluated in any way for financial assistance. Are all patients evaluated? If so, how are you sure this happens? What is your response to these patients’ contentions?

In Section 501(r), the IRS mandates that nonprofit hospitals post their financial assistance policies in public areas including the emergency room. In late May, I visited the emergency rooms of all five Methodist locations (University, North, South, Germantown and Le Bonheur). In no ER was any information about the FAP, a plain language summary of the FAP or FAP application (FAP documents) posted. Failure to post FAP documents would seem to put the hospital in violation of federal tax law. Do you believe that you are complying with federal tax law? If so, can you tell me where, in each location, this information is posted and when it was posted in each?

When asked for information about financial assistance, a Methodist South emergency room staffer provided me with a document that references a new discount for patients with insurance (I am attaching that document). That document did not include any details about eligibility and does not appear online. Can you please explain this document, who it applies to, and to which hospitals it applies?

Your 2017 990 says: MHMH COMMUNICATES AND PROVIDES ASSISTANCE CONCERNING ELIGIBILITY FOR FINANCIAL ASSISTANCE IN SEVERAL WAYS. CHARITY CARE POLICIES ARE POSTED AND UPDATED AS PART OF THE ORGANIZATION’S SYSTEM POLICIES AND ARE AVAILABLE TO ALL STAFF THROUGH THE COMPANY INTRANET CONNECTIONS. IN ADDITION, PATIENT-FRIENDLY SUMMARIES OF THESE POLICIES ARE POSTED IN VISIBLE LOCATIONS THROUGHOUT ALL PUBLIC AREAS OF THE FACILITY.

During visits to Methodists’ emergency rooms and main lobbies, only one hospital — Le Bonheur — had a small sign posted to the left of the main doors as you exit. Can you please tell me where, in each location, this information is posted and when it was posted in each?

Neither Bon Secours Charity Health System in New York nor Bon Secours Health System Inc. in Virginia (Hampton Roads and Richmond) sue patients, although they will report unpaid bills to a credit bureau. Has Methodist considered not suing patients?

Vanderbilt University Medical Center requires a team leader to review cases that are subject to extraordinary collection actions (ECAs). Who at Methodist reviews cases before ECAs are taken?

An expert who reviewed Methodist’s 2017 990 and its FAP said that there is a discrepancy between the 990, which says free care is eligible for patients with household incomes up to 125 percent of the federal poverty guideline, and the financial assistance policy, which says eligibility is for patients whose household income is under 200 percent. Can you explain this discrepancy?

An expert who reviewed Methodist’s 2017 990 was surprised to find that in Schedule H, the hospital noted that $20 million, or about half of the total bad debt that year, was “bad debt attributable to patients who would have qualified for financial assistance.” The expert said that this suggests that the hospital knows that many of its patients would have qualified for financial assistance. Do you dispute that?

This expert also said that this also suggests that the hospital is failing to qualify eligible individuals for financial assistance. Do you do dispute that?

An expert who reviewed Methodist’s 2017 990 and its FAP noted a discrepancy between the two: The 990 says that the FPG is not used to determine eligibility for discounted care. The FAP says that there is a 75 percent discount for patients with income above 200 percent of the FPG. Please clarify this discrepancy.

Methodist’s FAP states that the hospital provides a 75 percent discount for those with income over 200 percent of the FPG, after income and asset review. An expert who reviewed this policy said that this is too vague and doesn’t meet the expectation that the policy clearly states who qualifies for financial assistance. Can you help explain, or dispute, that?

The hospital’s Community Health Needs Assessment notes the connection between poverty and poor health outcomes. How are these findings used to inform the hospital’s financial assistance, billing and collections policies?

What happens if a patient applies for financial assistance after the 240-day application period?

How many calls have you gotten in the last year from Tennessee Justice Center or others asking for relief for patients with high medical bills? What was your response to those calls?

Board members have said that during their tenure, the hospital’s billings, collection and financial assistance policies were not brought before the board, either in an informational setting or for input/feedback. Do you dispute that? If so, can you please share information on when the board discussed it?

Carrie Barrett:

Court records show that seven times Methodist added interest to Barrett’s debt. In one instance, the hospital added more than $7,000. Experts say that this repeated pursuit of a low-income patient comes close to harassment. How did you decide how and when to add interest?

The records indicate that Methodist filed garnishment attempts against Barrett nine times over eight years. How do you decide to repeatedly seek to garnish the wages of someone whose income has repeatedly been too low to meet the earnings exemption?

Employees:

In the hospital’s response to MLK50’s 2018 Living Wage survey, the hospital said that 18 percent of its employees earn less than $15 an hour. The UMC’s Social Principles clearly state that employers should pay workers a living wage. Why does the hospital’s compensation conflict with the denomination’s principles?

Court records show that some of the employees you are suing have incomes well below $25,000 per year. For the employees to whom you do not pay a living wage, with what income do you expect them to pay their hospital bills?

Faith and values:

How do the United Methodist’s Social Principles influence the hospital’s debt collection practices?

The UMC’s 2016 Book of Resolutions #4064 on faithful lending practices says: “Among our most pressing concerns are contemporary financial practices and business models that entrap people in cycles of debt.” Suing low-income patients and repeatedly adding interest to their debt would seem to be an example of entrapping “people in cycles of debt.” Do you dispute that?

Revenue Assurance Professionals/Consolidated Recovery Systems

Experts we’ve interviewed say it’s unusual for a hospital to own its own collections agency. Why does Methodist own its own collections agency? When did the hospital purchase or create it, and why?

Is there a contract or agreement between Methodist and CRS/RAP as it relates to collection goals/rates or compensation based on collection rates, successful judgments, garnishments, judicial attachments or any other extraordinary collection actions? If so, please share.

Based on our review of the court records for several Methodist patients/defendants, there is no set pattern by which the hospital or CRS/RAP adds interest to an account. Amounts are added at irregular intervals — some every few years, others every few months. Can you help explain, or dispute, that?

My reporting indicates that the hospital’s attorneys are notified when an employer returns a garnishment answer marked “net earnings less than exemptions,” which proves that a defendant is very low-income. Yet the hospital has continued to file garnishment attempts against those patients in future months/years. Why?

Defendants have said they tried to negotiate payments with CRS after they were sued, and CRS told them they had to pay a certain amount. Are you confident that CRS representatives are being honest with debtors?

My reporting indicates that interest continues to accrue on a defendant’s debt after a judgment is rendered, even when the defendant is paying as agreed on a court-ordered payment plan.

Can you explain why, particularly for low-income defendants?

Has Methodist considered not charging its patients’ interest?

Executive Compensation:

According to your 2017 990 tax filing, former CEO Gary Shorb’s compensation that year was $1.2 million for serving as senior advisor to the president. Methodist’s website says Shorb would serve as senior advisor through April 2017. That would indicate that Shorb was paid million $1.2 for four months of work. Can you explain that?

What explains the dramatic increase — and then drop — in Shorb’s compensation between 2014 -2015? According to tax filings, he made $2.5 million in 2014, then $5.3 million in 2015, $2 million in 2016 and $1.2 million as senior advisor in 2017.

How much did Ugwueke earn in 2018?

Are both the hospital’s CEO and CFO aware of this interview request and the subject of this upcoming investigation, which will get national attention?

Wendi C. Thomas

Editor, MLK50: Justice Through Journalism

June 18, 5:30 p.m.

Hi Wendi,

Confirming that we have received your follow up below. We are currently in the process of reviewing. Given the number of additional questions, is it possible to extend the deadline beyond 5 p.m. Thursday?

Thanks,

Rachel

Rachel Cordray

Senior Communications Specialist

June 18, 5:50 p.m.

Rachel:

All of these questions correspond directly to the list of topics I provided you by email on Monday, June 10. If you scroll down, you’ll find that email in this exchange.

I can extend the deadline until Friday at 5 p.m., which will be 14 days (10 business days) since my initial request.

Best,

Wendi

Wendi C. Thomas

Editor, MLK50: Justice Through Journalism

June 21, 3:33 p.m.

Wendi,

We appreciate the opportunity to provide responses to your questions and to share additional and important facts to inform your article.

We hope your article will provide an accurate portrayal of Methodist Le Bonheur Healthcare, our 13,000 Associates and 2,300 medical professionals who work each day to provide exceptional care to the communities we serve.

To that end, the responses below demonstrate our commitment to patients and families through our actions. We have worked to provide you with information to give your readers an informed view of our organization and of our team. We hope these facts are included in your reporting, so that the representation of our organization is a fair one.

The information below can be attributed to a health system spokesperson.

Thanks,

Rachel

To accurately represent our full commitment to the greater Memphis community, it should be noted that:

We are committed to ensuring access to quality care and have a hospital in all four quadrants of the greater Memphis area, unparalleled by any other healthcare provider in our region.

Our health system includes six hospitals and more than 150 clinics, outpatient centers and physician practices.

As the second-largest private employer in Shelby County, we recognize the responsibility we have as an organization to contribute to the success of the diverse communities we serve and are purposeful about creating jobs in our community — intentionally choosing to keep services like printing, laundry and others in-house that are typically outsourced by the healthcare industry.

We are dedicated to strengthening the communities we serve and improving the well-being of patients and families, and that commitment is demonstrated through our actions.

We provide more healthcare community benefit than any other health system in the region — over $226 million annually.

We employ more than 250 associates dedicated specifically to community outreach and improving the health of all Memphians through our more than 20 evidence-based community programs, serving approximately 54,000 individuals and providing $25 million in community-based services — in homes, schools, child care centers, community centers and churches.

We raised nearly $24 million dollars to meet community needs through the combined efforts of our foundations.

We strongly believe in providing exceptional care to all members of the community — regardless of ability to pay, and work diligently to honor that commitment for our patients:

Recognizing the unique needs of our patient populations, we have a thoughtful process in place designed to help patients with medical expenses.

We are committed to working with all patients who are struggling with medical expenses. Our desire is to work with patients early in the process to set up a payment plan that meets their individual need.

We will provide any patient — insured or uninsured — with assistance through a 0% interest payment plan and payment plans can be tailored based on the patient’s need.

We are willing to set up these payment plans at any point, up until legal proceedings begin.

Any patient who identifies as uninsured, or self-pay, receives an automatic discount of at least 70% for the care they receive.

It should be noted that we more frequently provide patients a discount of greater than 70%.

In fact, we collect just 1% of total charges on self-pay patients. Uninsured patients 125% or less of the Federal Poverty Guideline receive free care. Uninsured patients greater than 125% of the Federal Poverty Guidelines are eligible for a 70–99% discount on their care.

As a nonprofit organization, we take seriously our responsibility to provide care to all of our patients, and we take steps to provide financial relief for patients in need.

Before any patient statements are sent, all accounts are evaluated by a financial assistance qualifying tool, which uses various data points to measure a patient’s ability to pay. If we find that a patient is unable to pay their bill, then the patient’s account is written off before a statement is ever sent. This process happens automatically and requires no action from patients.

We have a dedicated team that reviews patient billing, and collections on accounts greater than $5,000 are specifically reviewed by a director-level leader.

Unlike most healthcare systems, we chose to create and own our own agency (RAP) to ensure patients are treated with courtesy and respect at every point of the billing process and to create jobs in the Memphis community. If we were to outsource these services, we would not have the same level of patient-centered focus, and we would be sending jobs outside our community.

We provide self-paying patients with free assistance enrolling in government sponsored insurance programs.

We are committed to sharing information with our patients regarding their financial assistance rights and offer numerous opportunities for patients to access financial assistance resources:

Uninsured patients are provided financial assistance forms during registration, so we can immediately begin providing assistance to patients in need.

Our standard billing letters and account statements to all patients include information about our financial assistance policy and provide details about accessing assistance, including patient rights and how to contact us.

When we contact a patient by phone or the patient calls us for billing purposes, it is our standard practice to proactively share information about accessing financial assistance.

Outstanding patient debts are only sent to collections and then to court as a very last resort, and only after continued efforts to work with the patients have been exhausted.

Court action is what begins interest on the date of judgment and it accrues daily.

We do not add interest to the accounts of patients; however, once a legal judgment is made, payment amounts are set by the court and will include mandated statutory interest.

Like all health systems, we are legally and contractually obligated through our agreements with insurers to collect copays and deductibles.

We know some insured patients have high copays and deductibles that place a financial burden on the patient. As a mission-driven organization, we will work with these patients seeking assistance.

Rachel Cordray

Senior Communications Specialist

June 21, 6:38 p.m.

Rachel:

Thank you so much for your response. Obviously, I would have preferred to have a conversation and a more organic back and forth instead of an email exchange, but I appreciate the statement Methodist provided.

For the sake of absolute clarity and accuracy, I have some follow up questions.

1. I talked to several Methodist employees/defendants in debt suits filed by the hospital who said they were worried that the hospital would fire them if they spoke to me about their case. Is there any Methodist poIicy/rule that prohibits employees from talking to a journalist about their situation as it relates to a hospital debt lawsuit filed against them by Methodist? If so, may I see a copy of that policy and is a violation of that policy grounds for termination?

2. In your statement you say:

“We know some insured patients have high copays and deductibles that place a financial burden on the patient. As a mission-driven organization, we will work with these patients seeking assistance.”

Please provide clarity about what “we will work with these patients” means.

3. Your latest statement, including the segment quoted above, does not answer the question I’ve asked multiple times: Does Methodist’s financial assistance policy offer assistance to people WITH insurance? If so, please point me to the language in your FAP that says that financial assistance is available to people with insurance.

4. I asked if Methodist has posted in its public areas, including its emergency rooms, information about the financial assistance policy, a plain language summary of the FAP or FAP application (FAP documents per IRS Code Section 501(r)). During my visits to the ER of all five Methodist locations in Shelby County, there were no signs or conspicuous public displays in any of the ERs and one small sign in Le Bonheur’s main lobby. Failure to post FAP documents would seem to put the hospital in violation of federal tax law. Your statement did not address that question. I am therefore led to conclude that the hospital does not have in its Shelby County emergency rooms any signage or public displays that reference financial assistance. If that is incorrect, this is your last opportunity to correct that.

5. When asked for information about financial assistance, a Methodist South emergency room staffer provided me with a document that references a new discount for patients with insurance (I am attaching that document). That document did not include any details about eligibility and does not appear online. I asked you to explain that document, to whom it applies, and to which hospitals it applies. Your statement did not answer that question. Given that this document is shared with the public, I am perplexed as to why you would not explain the discount program for the insured to me. If I were a patient at Methodist South, would you share that information with me? This is your last opportunity to provide information about this discount program.

The hospital has until 4 p.m. Monday to respond.

Thanks,

Wendi

Wendi C. Thomas

Editor, MLK50: Justice Through Journalism

June 24, 3:14 p.m.

Wendi,

The information we have provided gives a thorough and accurate accounting of our commitment to our patients, which includes the responsibility we have to provide exceptional care to all regardless of ability to pay, as well as the steps we take to provide financial relief for any patient in need whether they are insured or uninsured.

Thanks,

Rachel

Rachel Cordray

Senior Communications Specialist

Where do we go from here?