Lawyers hired to collect HSA debts

| 12/10/2017 | 74 Comments

(CNS): As the hospital continues to battle with outstanding debt, officials told the Public Accounts Committee this week that a firm of local attorneys has been hired, following a request for proposals, to go after the outstanding cash, which may see people who haven’t paid their medical bills dragged through the courts. After two failed attempts at using collection agencies to recover the accumulated bad or doubtful debt at the hospital, which exceeds $100 million, it has switched to a law firm, which will be given a commission from the money it manages to recover, in contrast to previous contracts with debt collectors who earned their fee from the indebted patients.

During this week’s PAC hearing several different figures and explanations were given by various witnesses from the hospital about the debt. But based on the evidence given by HSA board chair Jonathan Tibbetts, the accumulative debt is currently $108 million, more than half of which accumulated over a twelve-year period.

The sudden increase over the last two years is as a direct result of problems relating to claims adjudication disputes and the fact that the government insurance company, CINICO, which makes up the vast amount of the hospital’s business, changed their third-party adjudicators twice in the last three years, impacting the payments.

Most witnesses indicated that aside from these issues, CINICO and most private sector insurers pay their bills. The debt is down to what was described as self-pay patients that have no insurance, are under-insured or who have used up all of their benefits and who have not paid their bills or co-pay element of the bill.

Given that the hospital has a policy of treating everyone who presents in need, the thorny issue of payment comes after the fact. Tibbetts said that the hospital has made strides in getting indigent patients the cover they need by referring them to other relevant agencies or creating payment plans for those who government cannot help, but over the years the hospital has largely struggled to collect from this group of patients.

Witnesses told the PAC that on two separate occasions the HSA contracted the services of debt collectors. One was an overseas agency recruited to go after patients with outstanding bills that were not living in Cayman, either because they were treated while here as visitors or because they have left the jurisdiction after being resident, but no one was able to give any figures regarding the amount that debt collector was able to recover.

Another was a local agency, which was said to have recovered only around 3% of the outstanding debt over a more than two-year period.

Lizzette Yearwood, the hospital CEO, told PAC that the hospital was settling the final details of how HSM, the successful bidder, will go after just $1 million of outstanding hospital debt over the next two years in what was carved out for the lawyers under a pilot collection programme.

Yearwood said the hospital will continue to collect the outstanding debt itself, as management and the board remain reluctant to write off the debt and they want to see if going down the legal road will help recover more from those patients who the hospital believes has the means to pay.

But as medical costs rarely come cheap, pursuing patients who haven’t paid could make for some uncomfortable results for government if people are forced into bankruptcy, poverty and homelessness to pay for treatment they cannot afford.

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Category: Government oversight, Health, Health Insurance, Politics

Comments (74)

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  1. anonymous says:

    Hate to break the news to all the brainwashed American Republicans and other mentally-challenged simple folks commenting to CNS on this issue, but the solution is what all developed countries (minus the “brilliant” U.S.A., of course!) have done, which is to institute a government-run health care system.




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  2. Anonymous says:

    Big bills we dont pay em, small bills we forget about em.




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  3. Anonymous says:

    Looks like some people gona have to heal up at HMP lol




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  4. Anonymous says:

    Pardon my cynical mind but isn’t there some irony in government awarding this contract to the same law firm that is suing it over the PR waiting list? You just can’t make this stuff up.




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  5. An says:

    It is ridiculous that the amount of outstanding debtors was allowed to get up $108 million dollars! And has been outstanding for approximately 12 years. This should have been the main subject that was discussed every time that the board of directors met. Good luck collecting that amount! I am sure that they will find that a lot of people might have left the island.




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  6. Just Commentin' says:

    More moronic fluff from the same government who showed what a pathetic laughingstock it can make out of itself by seizing body massagers at Reflections because Customs agents claim they can be used as “adult toys” or “marital aids”. What a joke! This is the level of total and absolute ignorance and incompetence that pervades every department and aspect of the Cayman Islands government from the Legislative Assembly right on down through every department. I have friends and family members working for government and I can tell you with absolute certainty that the smart industrious ones carry the load left by the nincompoops that are the majority. Add to it that we have incompetent and under-performing legislators who make moronic laws and there you have it. The story about the massagers is iconic of the low level of intelligence and rational thought in our government. No wonder HSA is struggling and no wonder our system of delivering affordable care is abysmal! The USA is coming to realise that their whole health care delivery system needs to be restructured; but even ObamaCare is quantum measures better than the sorry system that our equally sorry leaders have cursed us with. Our rotten bunch of ivory tower dwellers are so out of touch that their best idea is to sic lawyers on everyone. They are a detestable, despicable lot every one of them, and in this case, the head of HSA and the Minister of Health in particular.




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  7. Anonymous says:

    LOL!!!! This is Obama Care. Free health care for everyone and the government will pay for it. Socialism/ communism does not work and never will. At the end of the day the money runs out. Then government will hike up the taxes. Some people will continue to eat junk and get sick and won’t care because they are not paying for insurance.




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    • Anonymous says:

      The fraud in the US system is enough to pay for the entire UK National Health Service. The UK also has better life expectancy that the U




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      • Anonymous says:

        If you get sick with any disease, there is no country in the world that offers better treatment than the U.S. Life expectancy cannot be simply measured by government vs private health care. Fact is your chances of surviving common deadly diseases is higher in the United States at the point of detection than anywhere in the world. That’s why people from around the world including the UK go there when they want the best treatment available. Google it.




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        • Anonymous says:

          Oh come on, the US ranks bottom of health outcomes in the developed world. More Americans have more than one chronic condition than any other country in the developed world. Americans pay more money for less health services compared to every other country in the developed world.




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          • Anonymous says:

            You either don’t know the facts or you’re lying. If you have cancer or most any life threatening disease, the best place for treatment at the point of detection is the good ‘ol USA.
            In fact, the American tax payer and healthcare consumer for years has largely subsidized global advances in medicine through free markets. You’re welcome.
            Life expectancy stats include deaths from many things that have nothing to do with the healthcare industry.
            Try doing some research instead of repeating the socialist talking points.
            Here’s a link to get you started.
            http://www.ncpa.org/pub/ba649

            CNS: The National Center for Policy Analysis is one of a number of operations that presents itself as an independent think-tank that is actually largely funded by the Koch brothers, who spend millions spreading false information to make sure they keep billions. A lot of their money comes from the oil industry, so they also fund “think-tanks” that (Surprise! Surprise!) come up with evidence that climate change is a hoax.

            Try researching them. Here’s a couple of links to get you started:

            http://www.greenpeace.org/usa/global-warming/climate-deniers/koch-industries/

            https://www.youtube.com/watch?v=yLvpwrCfqFI




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            • Anonymous says:

              So rather than dispute the research, CNS wants to go all Tin Foil hat..lol. Would you like more links?

              CNS: I am not entering into the argument about which country has the best healthcare. If I was I would be presenting information about healthcare. I am simply pointing out that the sources you use in your arguments are unreliable. The influence of the Koch brothers in a number of issues should be more widely known and understood.




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              • Anonymous says:

                So the Koch brothers dictate to the groups they donate to…Conjecture much?

                CNS: The billionaire Koch borthers fund “think-tanks” and those “think-tanks” come to conclusions that support the Koch brothers’ stated aims (which essentially keep the money flowing their way). They also pour money into buying politicians (sorry, I mean support thier campaigns), who then also support the brothers’ stated aims, often citing those “think-tank” conclusions. I realise you might not be a Bernie Sanders fan but …. https://www.sanders.senate.gov/koch-brothers . They basically want to deregulate everything so that they can do what they like.




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              • Anonymous says:

                And that’s why you’ve pointed out that the donors to Greenpeace are largely a bunch of alt left nut bags and that’s why the founder of Greenpeace resigned.
                But please continue to be an unbiased referee…smh…

                CNS: OK, try this on: Let’s skip over the fact that Patrick Moore now acts as a consultant and spokesperson for the groups he used to oppose and that there are doubts about whether he actually founded Greenpeace. Aso, “the donors to Greenpeace are largely a bunch of alt left nut bags” is made up nonsense.

                I actually agree with you that any source, including Greenpeace, should be taken with a healthy dose of skepticism. All I’m pointing out is that just because something pops up as number 1 on a Google search (or even the first few dozen) does not mean that it is factually correct, because Google search ranking can be bought.

                To go back to your first point, it may well be that US hospitals are the best in the world – I don’t know – but I would be skeptical about some of the claims you make because of the source you presented. Now that you know about the Koch brothers, are you quite so sure?




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            • Anonymous says:

              Greenpeace..lol. Why the founder of Greenpeace left Greenpeace…https://www.youtube.com/watch?v=BpBnJq19R60

              Using your argument tactics, no fact from any group is reliable.

              But I digress…

              CNS: You’re missing the point. Your views have been paid for by the filthy rich. It does not benefit you or 99% of the population, only themselves and their fortunes, but they hide their propaganda behind “think-tanks” that they fund and present as independent so that people like you find on the internet. Feel free to do your own research but, if you don’t like Greenpeace, here’s the New Yorker https://www.newyorker.com/news/news-desk/in-the-withdrawal-from-the-paris-climate-agreement-the-koch-brothers-campaign-becomes-overt




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        • anonymous says:

          Please tell that to the tens of millions of poor U.S. citizens who prior to the “evil ObamaCare” could not get access to any type of healthcare other than when they were on their last legs at the emergency room, and were doomed to live unhealthy lives before an early death. Come on, man, quit your foolishness, or pull the other one : it’s got bells on it!




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          • Anonymous says:

            Obamacare is a failure and was from the moment it was passed. It’s collapsing as predicted. Heavily back weighted to try and kill the free market for a few years before the true costs kick in. The chickens are now coming home to roost, it’s doomed….




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    • anonymous says:

      11.34am, you have a lot of enlightenment ahead of you, clearly. Government doesn’t pay for anything. It receives money from the taxes it levies on its people. There is no such thing as “free” healthcare.The reality is that almost all developed countries in the world have adopted universal healthcare as being the most efficient and cost-effective method to provide health car for its citizenry. You must be a brain-washed American, you poor thing, with your head brim full of the belief that “America is the greatest country in the world” (while never having lived anywhere else) and that “communism/socialism” is evil” (without any understanding of the distinction between the two). I can only encourage you and others of your ilk to travel as much as possible in order to become properly educated. Good luck in your quest.




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  8. Anonymous says:

    Far too many Caymanians think that because they are Caymanian they should get health care free. “Gernment will pay”.




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    • Anonymous says:

      Far too many people. Period. This is not just a Caymanian thing.




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      • Anonymous says:

        Mainly but not exclusively Caymanian. But you need to sit at Pharmacy and listen to the uneducated indigents going on about “gernment” and what it owes “we Caymanians who built this place”. Staring at their smart phones, by the way. The place is sick.




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    • Anonymous says:

      Stats or facts ???




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    • Veritas says:

      You must be talking about our 7,000 civil servants plus all their dependents.




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      • Anonymous says:

        7000 is bullshit so you negate your ability to comment sensibly right there. But civil servants whether you like it or not have a contract with government giving them health care benefits as part of their remuneration package. That is TOTALLY different, bozo, from the ignorant insinuations of your comment.




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    • anonymous says:

      You are completely at sea, my friend. Next thing you’ll be saying that providing for the health of a country’s people is nothing to do with government. But here’s something to ponder for starters : where do you imagine government gets its money from?




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  9. Mr. D says:

    I feel that the Health Services is doing a good job now and should continue on this path. Let us encourage not discourage. Be positive Cayman Islands.




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    • Anonymous says:

      The civil servants do not have a sense of urgency in collecting fees due , because their salary at the end of the month gets paid in any event.
      The business end of the hospital should be in the hands of business people from the private sector who will suffer the consequences of unpaid bills.




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      • Anonymous says:

        That is not true. Go see what they have to go through with the insurance companies. These people put their lives into their work.




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        • Anonymous says:

          And yet they have failed spectacularly. And they have been failing for the last ten years with no change. But its OK because they are Caymanian. It’s expected. We understand. Caymanians will run the country into the ground. Bankrupt for all the right reasons and then give it to the UK to save them from their own stupidity.




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      • Anonymous says:

        Most salaries are guaranteed unless one is on a commission basis. However if they could not collect upfront it is hardly likely they will collect after the fact. Also staff at the hospital are encouraging patients to go to financial department to get a system set up to pay. Maybe they are just being kind but they should not be too free with that notion.




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  10. Anonymous says:

    The problem really lies in the accounting methods of the HSA and because it is so bad, much of the debt will simply be written off. If you tell me I owe you money, but can’t tell me what it is for, then why should I pay? It also casts into doubt the amount of the debt they have reported. Any reputable law firm is not going to take anyone to court unless there is a strong case to win, but they are still going to bill government for the time one way or another.




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    • Anonymous says:

      Exactly, their collection agent called me about at bill from 2005. I don’t have records that go back that far and I’m certain I would have paid my bill as I always pay my bills. They couldn’t tell me what it was for or anything really. I told them, don’t call me any more, just take me to court.




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  11. West bay Premier says:

    I think this how the debt collection is going to get collected , is the indigent won’t be able pay so they would go after the one who can pay. Then that money would be eaten up by the Law Firm . Government might get $35. Of every hundred $ collected .




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    • Anonymous says:

      Well that’s $35 more dollars for slot machines Mr Pessimistic, which could be turned into millions!




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  12. Anonymous says:

    I was sent a bill for 2015 (“cough” we are in 2017) but H.S.A. cannot advise what exactly it is for or if I truly owe it. Hmmm they can send all the lawyers they want but until there are checks and balances no one is getting a dime.




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    • Anonymous says:

      Same here. It’s BS through and through.




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      • Anonymous says:

        Tons of local places f up on claims etc and then expect you to turn around and pay. On top of this many businesses render services based on trust and is that what pays Cuc accepts for their bills!?




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  13. Anonymous says:

    Go ahead and send me my bill. I will dispute it the same way I have the last two years. HSA sends me bills showing what I owe but it misses out payments I have made to them. Despite inquiries to HSA, I don’t get answers, just the same bill over and over.




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    • Anonymous says:

      Or they send it so many months later that you don’t remember what was done or what should have been charged. We just got a bill for January, when my daughter broke her leg. They kept her waiting in the ER for 4 hours, and when they finally saw her they set her leg wrong. Based on what they told my husband I took her for a second opinion and they had to re-set her leg. I should have to pay for their mistake. But here they are contacting me 9 months later to settle the balance of their effff up. I should sue them to recover the money they have charged my insurance co. and are now wanting to collect after all this time.




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  14. Anonymous says:

    HSA is just pouring more public money down the drain. Did this hiring even go out to tender?




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  15. Sick and Tired says:

    The HSA is the biggest liability and utter embarrassment of this island! Fire all department heads now.




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  16. Icona Pop says:

    I crashed my car into a liquor store and I dont care, I love it…




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    • Anonymous says:

      Awwww, still upset because you and your friends didn’t get into power? At least someone is doing something and not staying in the same position they’ve been in for a couple years and can’t climb their way out of a wet paper bag.




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    • Anonymous says:

      Got a new Mustang the world is great again.




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  17. Anonymous says:

    Wipe the debt of the books like the Gov does with Cayman Airways and the Turtle Prison.
    Just saying……




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  18. MM says:

    The HSA is more than willing to work out minimal payment plans with its patients; from $25 a month to a $1000; they are happy and willing to take whatever a patient can bring forward and consistently place on their outstanding bills.

    With that said, I cannot see how anyone can assume that patients will be placed in to bankruptcy or homelessness due to the HSA’s efforts to collect debts.

    Regardless of the negativity that many on-island like to spread about our public hospital – compared to others worldwide we run a modernized, equipped and well-run facility with trained, experienced and qualified doctors and many caring, self-sacrificing nurses.

    As a recent patient who underwent surgery, I was blessed with excellent and caring doctors who saved my life a little over a year ago even though I was uninsured at the time. The nurses were attentive and willing to do all they could to keep me and other patients comfortable – these women work 12 hr shifts, are on their feet all the time and walk in to your room and care you like a baby.

    I am grateful to the HSA and they are more than happy to take whatever payment can be given to them – they are really asking people to make an effort!




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  19. Anonymous says:

    Now this is going to be interesting…in some cases late billing by the HSA meant people couldn’t file insurance claims because of cut off deadlines…In other words, their incompetence and inefficiency is going to mean people have a financial liability that they should not have…I see a class action coming against the HSA for incompetence and for the amounts of bills over 6 months old that need to be paid…




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  20. Anonymous says:

    Taxing Cayman with Lawyers fees.




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  21. Veritas says:

    It is ironic that Govt is hounding the poor who cannot afford to pay, yet providing completely free medical care to a vast number of civil servants most of whom can afford to pay.




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    • Anonymous says:

      Take it a step further, government bend backwards to give concessions to multimillion dollar projects that never benefit locals but wants to collect every penny from the average citizen.




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    • Anonymous says:

      ….and now throwing money at lawyers.




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    • Anonymous says:

      How do you know who the people are? This is incredible. You assume so many things yet all you are doing is making a completely unfounded statement.




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  22. Anonymous says:

    Problem is, as the lawyers will find out, a large portion of the debt is not a actually legitimate. Sending me a bill for something which has already been paid by the insurance company does not constitute actual debt, for example.




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  23. annonymous says:

    incredible!




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  24. anonymous says:

    About time too…..the amount of people in the GT pharmacy getting their meds without producing any card or payment is ridiculous. On any day there are people “collecting meds for relative and forgot card” – will bring next time – then in specialist clinic. Lady could not pay for a treatment and held up whole queue of people. Dont treat until paid…what the problem with that approach??? Get on and get back as much as you can and stop anyone getting anything until paid.




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    • Nunya says:

      The problem with that approach is then they bung up the ER with their runny noses, so people with real emergencies have to wait behind them….because the ER can’t turn ppl away and they are not required to pay up front for emergencies. As usual it’s the normal case of the good suffering for the bad.

      I love how we have become the society that have legislated our way right into lawlessness.




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  25. Anonymous says:

    I have excellent insurance, who preautgorised a procedure and so used the HSA recently, last week I was sent a bill for one cent, yes, they printed a bill, put a stamp on it and sent it to me. What a waste……




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    • Anonymous says:

      Just pay up, Mr. Cheap.




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    • Anonymous says:

      I had a bill for 3 cents 2 months ago, and 1 cent this month. I’m going to give them a nickel, when it adds up.

      I do care that they are wasting money and vital resources doing this kind of economically damaging nonsense, but if they are going to do it, they should at least make some attempt to seal the envelopes, as the details set out in the statements are confidential and sensitive information about my health. In neither case had any attempt been made to seal the envelope. The glue was untouched.




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