Virginia hospitals and medical providers sought to collect $1.4 billion in medical debt through over 1 million lawsuits against patients between 2010 and 2024, according to a recent study on medical debt.

This is a first-of-its-kind comprehensive medical debt study, according to Julie Havlak, manager of research and communications at Patient Rights Advocate, one of the study authors. She said that makes it difficult to compare with other states, but the outcome in Virginia hints that national numbers could be much worse than researchers previously thought.

“In previous states, people were shocked when we found 10,000, and I think the next largest report found that hospitals in New York state filed 80,000 lawsuits,” Havlak said. She was referencing a 2020 report from nonprofit Community Service Society of New York, which tracked lawsuits brought by nonprofit hospitals since 2015 and state-run facilities since 2019.

The Virginia study was done by researchers at George Washington University Law School, Stanford University School of Medicine and Patient Rights Advocate, a nonprofit focused on healthcare price transparency. Havlak said the team manually reviewed and coded all medical debt lawsuits filed in Virginia circuit and district courts in that time frame. Researchers matched records to plaintiffs, and found 1.15 million court actions and 403,924 garnishment actions, which is much higher than they expected.

The Virginia Hospital and Healthcare Association, which represents multiple hospital systems named in the report — including Sentara Health and VCU Health — has refuted the study, saying it relied on misconstrued data. In a statement to The Virginian-Pilot, Vice President of Communications Julian Walker referred to Patient Rights Advocate “as an agenda-driven organization with a track record of making misleading claims about hospitals.”

“Virginia hospitals have a well-documented record of making significant investments in expanding access to care and providing free and discounted care to low-income individuals across the Commonwealth,” Walker wrote in a statement. “Each year, Virginia hospitals incur hundreds of millions in bad debt from unpaid medical bills.”

The lawsuits

Many of these lawsuits “originated from hidden prices, predatory contracts, and opaque billing,” according to the report. The researchers encountered patients who sold their possessions, took out high-interest loans, struggled to pay for rent and groceries and avoided future medical care as a result.

“This is necessary medical care that patients never knew what the cost was going to be, and never had the opportunity to give financial consent, and after they were sued, most of the patients didn’t understand what they were being sued for,” Havlak said. “There’s a huge imbalance of power here, because the hospital has the information.”

Nonprofit hospital-owned providers were responsible for over half of the lawsuits against patients in Virginia. The study asserts that Sentara Health, a not-for-profit healthcare delivery system, was the health system that brought the most lawsuits in the state with over 106,000 court actions during over 14 years. Sentara is one of the largest health systems in the Mid-Atlantic region and operates 12 hospitals in Virginia and North Carolina. The study said the healthcare system charged patients prices that varied by as much as 77 times across its hospitals.

“This report is a clear example of selecting information that supports predetermined arguments, misconstruing data, and ignoring many of the facts around healthcare in Virginia as well as the complex nature of healthcare in general,” Sentara Health said in a statement after the study was released.

Sentara’s response does not specify what data was misconstrued. The statement reassures Sentara’s commitment to “thoughtfully distinguish between those unable to pay and those able but unwilling.”

“I am well aware of the context in which healthcare is financed and paid and delivered,” Barak Richman, co-author of the study and professor at GW Law, said in response to the allegation that the study ignored the complexity of healthcare and misconstrued data. “It is within that context that we have illustrated a very simple number, which is the number of times hospitals have sued patients to collect on medical debt.”

Out of the found medical debt collection lawsuits, 20 law firms were responsible for 52% including a Virginia Beach debt collector, Tiffany and Tiffany, or Tiffany and Brown. The Hampton Roads-based firm filed over 94,000 medical warrant in debts and garnishment orders within the 14 year time frame, making it second on the report’s list of 20 Virginia law firms. Tiffany and Brown did not respond for comment.

An unexpected bill

On Jan. 1, 2023, Kanise Marshall gave birth to her second son at Sentara Martha Jefferson Hospital in Charlottesville, but soon, he was whisked away. The baby had swallowed fluids, his oxygen levels dipped, and he was moved to the specialty care nursery. Marshall faced complications, too, and was diagnosed with postpartum cardiomyopathy, a form of heart failure.

The total charges came out to more than $46,000. Marshall’s insurance, Anthem, paid about $25,000, and a contractual adjustment took off over $18,000, according to billing documents Havlak provided to The Virginian-Pilot for review. That March, she received a bill and set up a payment plan of $69 a month for the resulting special care unit and cardiologist bills.

Marshall hadn’t heard from the hospital, so she assumed she was up to date on her bills.

In November 2025, the couple was served a lawsuit saying she owed about $2,600. Marshall called the hospital to see what could be done about the outstanding $2,634.19 debt plus interest. She said the hospital suggested splitting it into two payments, but the family couldn’t afford it.

“I have two kids now, my husband lost his job in ’25,” Marshall said. “We’ve had to restructure our lives, and then we get hit with this bill out of nowhere. And yeah, $2,600 five years ago for me wouldn’t have been a lot. Not everyone’s situation remains static.”

That’s where Havlak and her team stepped in. At a court date this January alongside Marshall, Havlak contested the charges. Patient Rights Advocate took issue with the hospital’s billing structure, citing overcharges, as well as lower costs if Marshall was insured through a different company.

About a month later, Marshall said the hospital called and asked her to set up a payment plan more costly than the original, and wouldn’t take anything less. She suggested the hospital send the paperwork to the attorney from Patient Rights Advocate, and then the correspondence ended.

“I don’t mind paying what is owed, as long as it’s explained why it’s owed by me,” Marshall said.

Sentara was unable to respond to Marshall’s specific concerns due to patient privacy laws. But in a written statement, a company spokesperson said less than 0.05% of the system’s patient visits in 2024 resulted in court cases. Sentara does not garnish wages, but processes garnishments as required by law, and does not report to credit agencies, the statement said.

Marshall is now waiting to hear when her next court date is as it’s been pushed back.

“I don’t know what changed between 2017 when my first child was born … because they do provide amazing care,” Marshall said.

Maggie Allwein, 757-672-3310, maggie.allwein@virginiamedia.com