Therefore, healthcare providers can be held liable for the hefty financial penalties imposed by the CFPB for FDCPA violations. In addition, CFPB works with the US Department of Health and Human Services (HHS) and other agencies to ensure that patients are not forced to pay more bills than they actually pay. Therefore, it is important for healthcare providers not only to understand the obligations imposed by the FDCPA, but also how the FDCPA interacts with other health laws and regulations.
For example, in January 2022, Congress passed the No Surprise Act (NSA). It protects members, beneficiaries and subscribers of group medical plans and individual health insurance against “surprise medical costs” that typically arise when an individual becomes ill. Health insurance receives care from out-of-network hospitals, doctors, or other providers you didn’t choose. The NSA, in part, prohibits separate out-of-network cost sharing, including out-of-network co-insurance or copayment, for all emergency services and some non-emergency services. It also prohibits separate out-of-network billing by healthcare providers working in in-network facilities for supplementary care such as radiology and anesthesiology. This includes the elimination of “balance billing” that occurs when an out-of-network provider or facility bills the consumer for the difference between the charges billed and the amount paid by the consumer’s health plan. . Instead, providers should ensure that patient costs, such as coinsurance and deductibles, are no higher than if the services were provided by providers within the network, and such costs are Must account for in-network deductions and out-of-network deductions. -Pocket max.
The NSA has also established rules outlining the need for health care providers to establish an independent dispute resolution process to determine out-of-network payments between health care providers or facilities and health insurance plans. . Submit good faith quotes for medical items or services. Establish a patient-provider dispute resolution process for uninsured individuals. Provide a way to appeal certain health insurance decisions.
The CFPB issued a 2022 bulletin reminding debt collectors that trying to collect debt from claims that exceed the amount allowed by the NSA may violate the FDCPA. FDCPA Implementing Rule F prohibits the use of “false, deceptive, or misleading expressions or means in connection with debt collection.” debt. ” The FDCPA and Regulation F also prohibit the use of “unreasonable or unreasonable means to collect or attempt to collect a debt.” unless such amounts are expressly authorized by the contract creating the liability or otherwise permitted by law. “
A debt collector is in violation of the FDCPA if a consumer states that he or she is obligated to pay charges that exceed the amount permitted by the NSA for debt arising from emergency services out-of-network charges. In this situation, the health care provider who made the NSA-violating bill could also be held liable for the actions of the debt collector acting on the health care provider’s behalf.
After discovering violations during regularly scheduled debt collector inspections, targeted reviews (usually involving a single entity with a significant volume of consumer complaints or specific concerns), the CFPB , has the power to initiate administrative enforcement proceedings or civil proceedings. brought to the attention of the CFPB) or horizontal review (including investigation of multiple entities). The CFPB is entitled to “appropriate legal or equitable remedies for violations of the Federal Consumer Finance Act.” This includes but is not limited to:
- Termination or modification of contract
- Return of money or return of real estate
- return
- Exploitation or Compensation of Unfair Wealth
- Payment of damages or other monetary relief
- Notice of Violations
- Restrictions on the activities or functions of the other party in litigation;
- Civil financial penalties (may apply to either victim or financial education).
These penalties may also apply to health care providers if they are found to be vicariously liable for the actions of a debt collector. The CFPB can also take steps to notify other government agencies, such as HHS and the Centers for Medicare and Medicaid Services (CMS), that a particular healthcare provider is attempting to collect debts that violate her NSA. increase. Healthcare providers may also be named in lawsuits brought by consumers for FDCPA violations. The consumer may sue the debt collector for her FDCPA violation in an appropriate U.S. district court or other court of jurisdiction for one year from the date the violation occurred. A debt collector found to have violated the FDCPA may be liable for:
- the actual damage suffered due to the failure
- PUNITIVE DAMAGES, UP TO $1,000, PERMITTED BY COURT IN INDIVIDUAL ACTION
- The class action will pay each named plaintiff an award of up to $1,000 and an award of up to $500,000 or 1% of the net worth of the debt collectors, whichever is less, to be distributed to all members of the class.
- costs and reasonable attorneys’ fees in such litigation;
The CFPB also enforces the Fair Credit Reporting Act (FCRA), which prohibits providing inaccurate information to consumer reporting agencies after receiving notification from a consumer that the information is inaccurate. Debt collectors may also violate the FCRA if they report that a consumer has to pay debts from claims that exceed the amount allowed by her NSA. FCRA violations can subject a debt collector to statutory damages of $100 to $1,000 per violation. Again, if a healthcare provider makes bills in violation of the NSA and sends those bills to a debt collector, the healthcare provider will also be held vicariously liable for her FCRA violations or the CFPB. could alert other federal agencies of NSA violations by health care providers.
Ultimately, attempting to collect medical debt beyond the amount allowed by the NSA can subject debt collectors and providers to enforcement action for FDCPA violations. Similarly, debt collectors and creditors can violate the FCRA and Regulation V by reporting that a consumer owes medical debt in amounts that exceed her NSA. Healthcare providers should ensure they are NSA compliant and aware of the practices used by debt collectors held on their behalf.
