Thread by @jayhancock1

1/n Great recent reporting by many newsrooms on aggressive hospital debt collection. We take a new dive, looking at insidious, long-term consequence of hospital lawsuits against patients: property liens. Our latest on hospital bill collection in Virginia. khn.org/news/uva-healt…

2/n After we began asking VCU Health last year about suing patients, it & affiliate MCV Physicians said they would release old judgments and cancel ALL liens from court cases going back 20 years. Highly unusual and lots of trouble for the system.

3/n We reported this in the spring. Here's that story. What VCU Health didn't know: HOW MANY liens they had placed in scores of courthouses across the state.
khn.org/news/medical-d…

4/n What they found: 45,000 property liens JUST in Richmond, potentially attached to patients homes, poised to take home equity from patients. They now estimate they hold another 35,000 liens across Virginia.

5/n UVA Health has also placed thousands of liens -- not just in Virginia but in other states, we reported last year. But UVA has not committed to removing old judgments and liens. A committee has been meeting in the wake of our 2019 report to consider new reforms.

5/n UVA Health has also placed thousands of liens -- not just in Virginia but in other states, we reported last year. But UVA has not committed to removing old judgments and liens. A committee is considering new reforms in the wake of this 2019 report.
khn.org/news/uva-healt…

6/n Property liens are complex, misunderstood and very difficult to quantify and analyze -- including for the health systems that create them. They are land mines planted by hospitals and other creditors that can blow up decades later.

7/n Virginia property liens expire after 20 years. But UVA Health goes to the trouble of keeping track and renewing some for ANOTHER 20. We found recently-renewed UVA liens that make it possible for the system to seize home equity until 2038 for cases from the 1990s.

7/n Virginia property liens expire after 20 years. But UVA Health goes to the trouble of keeping track and renewing some for ANOTHER 20. We found recently-renewed UVA liens that make it possible for the system to seize home equity until 2038 for cases from the 1990s.

8/n UVA Health lawyers also search for out-of-state real estate owned by patients whom they sue. I found UVA “foreign judgments” (out of state) docketed as far away as Nevada, where they created a lien on one family’s vacation condo.

9/n To create a property lien in Virginia, hospitals and other creditors docket a court judgment won against a patient in the land records of the county or city circuit court. Health system lawyers do not have to find or identify the real estate.

10/n Instead, the docketed judgment is a lien against ANY real estate owned by the patient or other debtors in that jurisdiction. Title companies find the liens when a homeowner sells or refinances. They won't close the deal until the debt is paid -- plus interest.

11/n That also means the health systems create many liens that will never pay off because debtor patients own no property in that jurisdiction or anywhere. Nobody knows how many. We asked UVA how much they reap annually from liens. They wouldn’t say.

12/n In Virginia liens accumulate simple interest at 6% a year. Homeowners often have no idea they exist. They get a bad-news, pre-closing call from the title agent saying UVA, VCU or some other creditor will take part or all of what the house is worth.

13/n VCU Health had no idea how many liens its own lawyers had created. Some judgments -- big-dollar lawsuits -- are automatically put in the local lien docket. Thousands of others are proactively docketed by the creditors -- they pay a fee to create a lien.

14/n The lien system (for that matter civil state courts generally) in Virginia and elsewhere is designed to favor creditors to the disadvantage of debtors, journalists and the public. Impossible to see the big picture.

15/n Va. has more than 100 circuit courthouses. Many/most have their own IT systems to warehouse liens. Different vendors! Don't talk to each other. Option 1: Go to the courthouse, use bad software to access records. (Can't even sort 100s of cases by date, in my experience.)

16/n Option 2: Pay lots of money ($600 in Albemarle County) for internet access. Only gets you into ONE COUNTY. This is public data. It's siloed & held hostage for revenue. (A little instructive exhibit in #publicchoice theory, in which govt agencies act like businesses.)

17/n There are unknown millions of creditor liens in courthouses across the country -- from landlords, credit card companies, hospitals, doctors etc. All siloed, all hard to access. Credit-rating agencies know about state-court money judgments. They are clueless about liens.

18/n Reminder. Last year we found UVA Health sued patients 36,000 times over 6 years for more than $100m. 1000s of liens. Many of these patients HAD INSURANCE but couldn’t pay deductible or it was thin. For the uninsured UVA often sued for amounts far higher than cost of care.

19/n One new & frankly outrageous example we recently uncovered & mention in this story. Mike Miller had insurance. Out of network cancer treatment at UVA. Commercial insurance would have paid $13,000. UVA sued Miller and won at the chargemaster rate that nobody pays: $129,000!!

20/20 Lots of recent & justified attention on the growing number of hospital lawsuits against patients & frequently resulting bankruptcies. Liens that last decades - and accumulate interest year by year - are a lesser known but another devastating result of these lawsuits.