August 10, 2022

Senator Warren and Rep. Castro Call On Department of Defense to Improve Military Treatment Facilities’ Misleading and Confusing Billing Practices and Protect Civilian Patients from Crushing Medical Debt

“Civilians receiving unexpected emergency care at military treatment facilities can incur massive medical debt thanks to unusually aggressive billing practices and DOD misinformation on how to seek relief for medical debt”

Text of Letter (PDF)

Washington D.C. – U.S. Senator Elizabeth Warren (D-Mass.) and Representative Joaquin Castro (D-Texas) sent a letter to Secretary of Defense Lloyd Austin raising concerns that the Department of Defense (DOD) may be misleading or misinforming civilians about debt they incur when they receive emergency medical care at military health care facilities, and calling for improved billing practices to protect patients.

A Government Accountability Office (GAO) report, requested by Senator Warren through an amendment to the National Defense Authorization Act for fiscal year 2021 and released last month, uncovered troubling revelations about MTFs, including indications that these facilities are not adequately informing civilians about their options for medical debt relief. 

“No American should struggle to access health care or be forced to take on significant medical debt to get the care they need.” said Senator Warren, “It is essential that the DOD promotes policies to ensure that our nation's health care system provides high-quality, affordable health care that does not lead to debt or bankruptcy or force families to choose between medical care and other necessities.”

“For years, I’ve worked to help San Antonio families who faced medical bills after receiving trauma care at Brooke Army Medical Center,” said Congressman Castro. “The GAO's report is damning evidence that this problem goes far beyond San Antonio. It is unacceptable that the Department of Defense is failing to use the flexibility granted under the amendment I passed in 2020 to waive civilian medical bills. These outrageous billing practices need to end. The House recently passed my amendment in the 2023 National Defense Authorization Act to require the Secretary of Defense to waive extraordinary fees for civilians and I urge the Senate to ensure that this amendment is passed into law.”

The GAO report found that 67% of the civilian emergency patients who received treatment did not have insurance, leaving them highly vulnerable to massive medical bills. Press and congressional reports of unusually aggressive billing practices by MTFs include more than $28,000 to repair a fractured heel bone, $1.7 million for life-saving treatment for a burn victim, and $210,008.07 plus interest for treatment to repair a ruptured bladder.

The report also found that DOD military treatment facilities were misleading and misinforming the public about their right to seek relief for this debt and revealed that some outstanding debts are likely based on false or incomplete information. Their review found at least 23 percent of patients had been assigned the wrong billing category code. MTFs have tried to establish a patchwork of systems to seek reimbursement through Medicare and Medicaid, but have repeatedly encountered billing issues or had claims rejected. 

Under the 1996 Debt Collection Improvement Act, the Department of Defense, Treasury, and the Department of Justice have the authority to “compromise” or settle debts with individuals for less than the full amount owed. This authority, however, is not being used to its full potential. Of the 26,696 civilian medical debt cases GAO reviewed, only 0.1 percent were reduced. GAO also found DOD lacks the data necessary to accurately assess whether treatment for civilians enhances medical readiness, has weak internal controls to accurately track debts collected, and seemingly refuses to exercise these waiver authorities. 

“These hospitals can be invaluable resources for their communities,” said the lawmakers. “But as the GAO points out, increased financial risk to civilians creates a barrier to further expanding services. MTFs can enhance community relations by clearly communicating available debt relief options to patients and the DOD can help thousands of Americans who have incurred medical debt at these facilities by waiving that debt.”

Senator Warren has long fought to make sure there is affordable access to healthcare for all and that the government’s aggressive debt collection practices don’t unfairly target patients:

  • In June 2020, the Senator introduced The Financial Relief for Civilians Treated at Military Hospitals Act to cancel all pre-existing medical debt incurred by civilians at military hospitals and prohibit military hospitals from charging civilians who receive emergency treatment at the facilities through no fault of their own 
  • In January 2020, Senator Warren sent letters to the Department of Treasury and DoD requesting more information about the collection of military hospital debt from low-income, civilian patients and asking whether their collection practices may be disproportionately affecting vulnerable Americans, including the uninsured, low-income families and individuals, and those receiving Social Security benefits.