Study Finds New York Hospitals Flout Charity Rules For most of her life, Hope Rubel was a healthy woman with good medical insurance, an unblemished credit history and a solid career in graphic design. But on the day an ambulance rushed her to a Manhattan hospital emergency room shortly after her 48th birthday, she was jobless, uninsured and having a stroke. Ms. Rubel's medical problem was rare, a result of a benign tumor on her adrenal gland, but the financial consequences were not unusual. She depleted her savings to pay $17,000 for surgery to remove the tumor, and then watched, "emotionally paralyzed," she said, as $88,000 in additional hospital bills poured in. Eventually the hospital sued her for the money. Yet that year the hospital, NewYork-Presbyterian/Weill Cornell, had already collected $50.2 million from the state's so-called Indigent Care Pool to help care for people like Ms. Rubel who have no insurance and cannot pay their bills. New York's charity care system, partly financed by an 8.95 percent surcharge on hospital bills, is one of the most complicated in the nation, but many states have wrestled with aggressive debt collection by hospitals in recent years. Like New York, several passed laws curbing hospitals" pursuit of unpaid bills, including Illinois, California and Minnesota. But a new study of New York hospitals" practices and state records finds that most medical centers are violating the rules without consequences, even as the state government ignores glaring problems in the hospitals" own reports. "The entire system is corrupted, and it isn't working for patients," said Elisabeth R. Benjamin, vice president of health initiatives at the Community Service Society of New York, a nonprofit antipoverty group, which is releasing the two-year study on Monday. The state's Department of Health acknowledges systemic problems, including the need for better reporting and enforcement, a spokesman, Michael Moran, said. A group of patient advocates and hospital administrators is being convened to develop a better system, he said, and the department is engaged in "a comprehensive data integrity project that will include the retention of an outside auditor." The study found that some hospitals did not provide financial aid applications at all, and that many made impermissible demands for irrelevant documents or failed to supply key information, like eligibility rules for big discounts required by state law in 2007. Data reported to the state was obviously faulty, it found. Yet even hospitals that reported they had spent nothing on financial aid, or had filed hundreds of liens against patients" homes, were allowed to collect without questions from the charity care pool, which distributes more than $1 billion a year. Hospitals are not legally barred from seeking judgments or liens, but must first offer an aid application, help the patient complete it, and wait while it is pending. Instead, many hospitals turn to collection agencies, and sue when that fails. The unpaid bills - typically reflecting much higher rates than what insurers pay - are then treated as the equivalent of charity care. Change is now urgent, health care experts agree, because the state pool stands to lose hundreds of millions of federal dollars in 2014, when provisions of the health care overhaul will no longer treat so-called bad debt, based on uncollected bills, as if it were charity care. "There's a law in place, and obviously it should be complied with," said David Rich, an executive with the Greater New York Hospital Association, a trade group. But, he added, "hospitals are providing a lot of charity care at a loss." He said hospitals were improving their compliance with the law, which requires aid to patients with income up to 300 percent of the poverty line, or up to $33,000 for a single person. But, often stymied by patients who fail to complete applications for aid, he said, many hospitals have moved to simply deeming some patients eligible without an application, using what he called "a soft credit check" at registration to gauge income and assets. Myrna Manners, a spokeswoman for NewYork-Presbyterian Hospital, said that it would be inappropriate to discuss specific cases, but that the hospital "proactively helps patients at every step" of the financial aid process. It approved 25,861 applications in 2010, the most recent annual data. "Where there has been a determination that there is an ability to pay, we still go to all lengths to ensure that we resolve the matter before it becomes a legal action," she said. Court records abound in judgments against patients who say they had little or no chance to apply for help. A couple fighting foreclosure in Elmont, Nassau County, has a $41,000 default judgment from NYU Langone Medical Center for emergency surgery on their disabled adult son in 2007, when their insurance unexpectedly dropped him. He was eventually approved for Medicaid, but it would not pay for the surgery retroactively. The mother, Myrlene Stimphil, 55, a nurse at a city hospital, said she had sought a reduced payment plan from NYU Langone, but was told only that the hospital would get back to her. Instead, she said, collectors were calling her son, now 24, who suffered brain damage at his premature birth.