By Wendi C. Thomas, MLK50: Justice Through Journalism

with Maya Miller, Beena Raghavendran and Doris Burke, ProPublica

After nine visits to the emergency room at Baptist Memorial Hospital in 2016 and 2017, Jennifer Brooks began receiving bills from an entity she’d never heard of, Southeastern Emergency Physicians.

Unsure what the bills were for, Brooks, a stay-at-home mother, said she ignored them until they were sent to collections. She made payment arrangements, but when she was late, she said the collection agency demanded $500, which she didn’t have.

In December, Southeastern sued her for more than $8,500 in unpaid bills — a third of what her husband makes per year as a cook.

The case against Brooks is one of more than 4,800 lawsuits Southeastern has filed against patients in Shelby County General Sessions Court since 2017. In the first six months of this year, Southeastern filed more lawsuits than local hospitals Methodist Le Bonheur Healthcare, Baptist and Regional One combined.

Lawsuits against poor patients over unpaid medical debts have received widespread media attention over the past few years. In almost all cases, the plaintiff has been a hospital system, often a nonprofit.

What sets the practices of Southeastern, and its parent, TeamHealth, apart is that it is a physician staffing firm that contracts with the doctors who treat patients in four of Baptist’s emergency rooms around the region. Physicians historically have avoided suing patients en masse, instead choosing to send unpaid bills to collections or writing them off as bad debt.

TeamHealth is owned by the Blackstone Group, a private equity firm. In 2017, Blackstone acquired TeamHealth and its subsidiary Southeastern in a $6.1 billion deal. It was just one in a growing number of large private equity investments in health care in the last decade.

“There is this tension between being a health care provider and doing what’s best for their care … and being a profit-maximizing firm that aggressively goes after patients,” said Brian Shearer, legal director for Justice Catalyst Law, a New York-based social justice nonprofit, though he added that he wasn’t aware of any lawsuits by providers like Southeastern.

TeamHealth initially defended the lawsuits in an interview with MLK50 and ProPublica, saying they reserved legal action only for patients who’d made no attempt to pay.

But late last week, faced with additional questions by the news organizations, the company reversed course, issuing a statement saying it would no longer sue patients and wouldn’t pursue the lawsuits it has already filed. “It’s difficult to ensure that only patients with a strong ability to pay are ultimately impacted, so we’ve decided to eliminate it,” a TeamHealth spokesman said.

TeamHealth also had policies in place that made it difficult for patients to access charity care, a form of financial assistance for low-income patients. Two former TeamHealth employees told MLK50 and ProPublica that they were instructed not to mention the term charity care when patients called with questions about their bills.

After the company was asked about this, TeamHealth president and chief executive officer Leif Murphy announced a new discount policy for patients without insurance.

“Effective December 1, 2019, we are implementing discount policies for our uninsured population to reduce the cost of care by as much 90%, and up to 100[%] when necessary. We will proactively include eligibility criteria in our invoices to help promote participation rather than force patients to seek assistance,” Murphy wrote in a letter to employees.

TeamHealth’s abandonment of its lawsuits, as well as the implementation of a new financial assistance policy, marks the second time in five months that a major health care entity in Memphis has overhauled its practices amid questions from MLK50 and ProPublica. In July, Methodist, a nonprofit faith-based hospital system, announced it would curtail its lawsuits over unpaid debt against poor patients. It has since zeroed out the balances owed by more than 5,100 patients and reduced bills for more than 2,200 others, according to a hospital spokesperson.

TeamHealth declined to talk about the suits involving patients interviewed for this story, even though the patients gave the company permission to do so.

Mark Rukavina, business development manager at Community Catalyst’s Center for Consumer Engagement in Health Innovation, a national advocacy organization, said nonprofit hospitals shouldn’t work with physicians groups that aggressively pursue patients for medical debts.

“They could say, ‘If you’re going to provide services in our hospital, you’re going to comply with our financial assistance policy,’” Rukavina said.

The lawsuit from Southeastern was just a small part of Brooks’ debt, but learning that TeamHealth won’t pursue her case was good news, she said. Plus, she now has TennCare, the state’s version of Medicaid, which she hopes will spare her from other large medical bills.