CLEVELAND CLINIC National class-action case goes up against hospital

The lawsuit claims it fails in providing care to noninsured patients
CLEVELAND (AP) -- The Cleveland Clinic may have to go to court to defend how it provides care for uninsured patients.
In July the clinic became one of the latest targets of a national class-action case against nonprofit health systems. The cases allege the systems failed to provide affordable medical care in exchange for the tax breaks as charitable organizations.
A separate lawsuit making similar allegations has been filed in federal court in Toledo against ProMedica Health System, which operates seven northwest Ohio hospitals.
Nonprofit hospitals routinely charge uninsured patients higher rates than the negotiated discounts that insurance companies pay for their members. When patients can't pay, hospitals try to collect using collection agencies, lawsuits, liens and garnishments of wages or bank accounts -- actions that could ruin a patient's credit. Court records provide documentation that the practice exists among Cleveland-area hospitals, The Plain Dealer reported Sunday.
Half charity care
By its own tally, the Cleveland Clinic provided $95 million in charity care last year at its large Cleveland campus, nearly half the $194.2 million in charity care the clinic attributes to its entire health system.
The Cleveland Clinic system had revenues of $3.5 billion in 2003, meaning charity care amounts to about 6 percent of income. The hospital system consistently has provided financial assistance to those in need, spokesmen for the clinic said.
Federal law lets nonprofit hospitals get tax exemptions but does not require them to provide charity care, only to serve a community benefit. Promoting health, pursuing scientific advances and teaching new clinicians are roles that satisfy the requirement.
An emergency room open to all is one of the few specific services that hospitals must provide to meet the community benefit standard.
Ohio requires hospitals to provide free care for the very poor through the Hospital Care Assurance Program, although questions arose last year about whether hospitals are doing enough to alert patients to their potential eligibility.
Experienced attorney
Mississippi attorney Richard Scruggs has coordinated more than 30 lawsuits against nonprofit hospitals. The cases seek unspecified damages. It makes a case for a contractual obligation for charity care because of the tax breaks, but the litigation doesn't challenge the clinic's tax-exempt status.
The clinic and other nonprofit organizations argue they contribute indirectly to taxes through employees. The clinic reports its 29,000 employees paid $57.8 million in state taxes and $27 million in local taxes last year.
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