Attorney general sues Providence-Swedish group, alleging it improperly pushed collecting payments from low-income patients

Swedish Edmonds Hospital campus

The Washington State Attorney General is suing Providence-Swedish Health Care Group, which includes Swedish Edmonds hospital. The lawsuit alleges that Providence-Swedish has failed “to ensure that eligible low-income Washingtonians receive the discounts to which they are legally entitled.”

The attorney general also alleges that the hospital chain is “aggressively collecting money” from low-income patients who are entitled to charity care. The state Charity Care law is designed to protect low-income patients from out-of-pocket hospital costs and applies to insured and uninsured patients.

Citing Providence-Swedish documents, the attorney general said that from September 2019 to September 2021, the hospital chain sent more than 46,000 accounts to collection agencies — accounts of patients whose income was between 150-200% of the federal poverty level. For a family of four in 2021, 150% of poverty level was $39,750; 200% of poverty level was $53,000.

The total outstanding balances were $53 million.

The lawsuit contends that Providence-Swedish also sent 8,500 more accounts of current Medicaid patients to debt collectors, totaling another $20 million.

Swedish Edmonds is a 217-bed hospital with more than 450 physicians and 1,400 staff. Swedish says the facility offers full medical and surgical services as well as Level IV emergency trauma treatment.

Swedish Edmonds

The lawsuit includes all non-profit Providence and Swedish medical centers statewide — Edmonds, Everett, two locations in Seattle, Spokane, Olympia, Centralia, Walla Walla and Richland, and other associated facilities.

The lawsuit charges that Providence-Swedish created “a corporate culture that prioritizes collection over charity care, aggressively attempting to collect payment at the time of treatment and continuing to collect post-treatment even when the hospitals know that a patient is eligible for financial assistance.”

The state also alleges that the hospitals trained employees to push for payment, implying that it is expected, while downplaying “a patient’s right to apply for charity care.” A rendering of a Providence-Swedish training brochure tells staff to “ask every patient every time” to pay their bills while avoiding talking about charity care.

Providence-Swedish Hospital training graphic provided by State Attorney General’s office.

Providence released a statement saying the group is “extremely disappointed… that the Attorney General has chosen to file inaccurate and unfair charges against us regarding our charity care and financial practices.” We have asked for a response from Swedish Edmonds, but they have not replied. We do not know how many of the 46,000 accounts sent to collection agencies were SwedishEdmonds patients.

In its statement, Providence said the lawsuit filing is “inconceivable” and “runs counter” to the information it provided to the Attorney General during the two-year investigation. The hospital group said that in 2020, it provided $79 million in free and discounted care.

“Providence remains unwavering in our commitment to working with patients through any financial issue, and we continue to offer a range of options to best support them, including charity care,” the statement said.

Attorney General Bob Ferguson’s office claims that the hospital group violates Washington’s Consumer Protection Act by:

  • Failing to screen patients for charity care eligibility before attempting to collect payment, as required by law
  • Concealing the availability of charity care with aggressive collection tactics
  • Deceiving patients by failing to notify them when they knew that they were care-eligible
  • Continuing to attempt to collect payment from patients they identified as eligible

The state alleges that from 2019 until late last year, Providence stopped automatically granting charity financial assistance for all patients with incomes of 150-200% over the poverty level because “they believed they might pay their bills if collection efforts continued.”

The lawsuit states that once accounts go to debt collectors, it’s likely to negatively affect a patient’s credit. The document includes an email warning to colleagues from the then-director of Providence’s financial counseling and assistance office that “we are sending the poor to bad debt.”

Ferguson is asking the courts to force Providence-Swedish to stop these practices, for a full write-off of the medical debts – $70 million – and refunds plus interest for patients who did not get financial assistance. The state has previously sued two other hospital groups along the same lines and forced them to settle.

The Attorney General is also working with lawmakers this session to expand the state Charity Care law coverage to more than one million Washington residents and increase financial aid for another million who are currently eligible. House Bill 1616 passed the State House of Representatives with strong bipartisan support and is now in the Senate for hearings.

— By Bob Throndsen







  1. There are two sides to every story. Swadish has been losing millions every year to care for low income people. It is in business to actually make a profit…
    Who pays the money back to Swedish when they can’t collect money for services performed? Does anyone know?
    Its the loss tax deductable?
    They need a classifier for poor people who repeatedly need care. With the power to force people(yes, I said force)… into drug and alcohol treatment, mental health care.
    I don’t believe trying to get a person to pay a legitimate bill is wrong. Owing the money can be used as a tool. A lot of poor people will, and often do, refuse support healthcare because of drug addiction, or mental confusion. Change is needed.

  2. Swedish is a non profit. As such it is exempt from many forms of taxation, indeed we here pay a portion of our property taxes for a public hospital which doesn’t exist but funnel the lease money from Swedish to another non profit Verdant. The debt for those buildings has been retired. It is millions of dollars a year. Verdant provides no direct health services. When Stevens became Swedish, many in this area became out of network so they cannot use Swedish without paying more. The cost of healthcare at Swedish went up. Non profit hospitals are given tax benefits to provide care for all, including those who cannot pay.
    Not making folks aware that there are funds available to help with the bill is contrary to their non profit status. Why would they do such a thing? There will be scrutiny of any public funds used for those bills and limits to what the hospital can charge. The folks needing help are the least likely to be able to cry foul or hire a lawyer to fight the charges, and the most likely to go bankrupt when they cannot pay the bill and the collections agency reports to credit bureaus.
    Swedish gains more from the non profit status in tax breaks and exemptions than they would “lose” by letting folks know there is aid available. They are not a for profit corporation for a reason. If they thought it would be to their benefit to be for profit, they would be. Two sides always.

  3. I think a second fact that should be known or asked is who really “owns” the bought out/combined Swedish, Everett Clinic, Providence and others. A medical insurance company? Are they non-profit? So did this collect the $$$ push come from something higher up than Swedish? I’d welcome feedback.

    1. I don’t know anymore. I always thought of it this way; a non profit is required to accept all to an emergency room, then they are treated. A Private Hospital does not have to accept medicaid for patients or patients with no insurance. Too bad this all happened and I am sure we will hear much more about it if it is true. Hi Joe.

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