the great hospital heist: how new york hospitals charge the most to those least able to pay

How New York Hospitals Charge the Most

to Those Least Able to Pay

Pu

Hospital Bill __________________________________

You owe $55,243.00 for appendectomy*

*But HMOs only pay $2,500.00 Wall Street Journal 3/17/03

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March 2006

blic Policy and Education Fund of New York

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The Great Hospital Heist page 1

The Great Hospital Heist: How New York Hospitals Charge the Most

to those Least Able to Pay

Introduction

This report draws on data from the New York State Department of Health to calculate the amount that hospitals in New York overcharge uninsured patients and other patients who are unable to pay their full hospital bills. “Overcharges,” as used in this report, are the amounts that the hospital charges greater than the reasonable cost of providing care, according to the hospitals’ own reporting to the New York State Health Department.

Hospitals in New York and around the country establish a charge rate, comparable to a list price, for hospital services. However, very few of a hospital’s patients ever pay the charge rate. As a spokesperson for the American Hospital Association explained on the CBS news show 60 Minutes on Sunday March 5th, 2006, “Actually, what hospitals charge for a service is the same for everybody, whether they have insurance or not. What’s confusing for everybody is that what a person ends up paying in this country can be very different.”

Medicaid, Medicare, and most private insurance plans actually pay rates that are significant discounts off the charge rate. Insurance companies negotiate the discount with hospitals. Medicare pays hospitals at rates established under federal law and Medicaid pays rates established under New York State law.

The only patients who are expected to pay the charge rate are uninsured patients and the few patients who are covered by insurance plans that have not negotiated a hospital discount. These patients are generally known as “self-pay” patients.

Hospitals in New York are required to report the total amounts they charge for inpatient and outpatient care to the New York State Department of Health (DOH). Hospitals are also required to report the reasonable cost of providing care for purposes of calculating Medicaid rates. Using this information, DOH calculates a conversion factor for each hospital, which is the ratio of cost to charges.

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Hospitals in New York receive $847 million annually from the State to compensate them for bills that have not been paid by patients. These funds are generally referred to as ‘bad-debt and charity care’ funds or BD&CC. Inpatient and outpatient BD&CC charges are accounted for separately. In order to calculate how much each hospital is due from the BD&CC fund, hospitals report to the Department of Health the total amount of hospital charges for which the hospital did not receive payment. Bad debt is defined as amounts that are considered “uncollectible”. If an amount previously written off is later collected, it is reduced from bad-debt in future reports. Charity care, which is called “free care” in the DOH data, is the reduction in charges made because “the patient is indigent or medically indigent.” (Note: “Courtesy” discounts to physicians, employees, hospital board members, etc. cannot be charged to BD&CC.)1

The Department of Health applies the individual hospital conversion ratio to that hospital’s total BD&CC charges to calculate the actual cost to that hospital for providing BD&CC. A complicated formula is then used to distribute the $847 million – the formula and amount are set by legislation – from the BD&CC pool fund to the individual hospitals; the fund does not cover the full cost of BD&CC for most hospitals.

This report uses the DOH data on BD&CC charges and costs to calculate the aggregate amount that hospitals charge in excess of the actual cost of providing care to patients who are uninsured or can’t afford to pay their bills. We call these amounts, ‘overcharges.’

Findings The Public Policy and Education fund of New York (PPEF) analyzed the data reported by

210 hospitals throughout to the New York State Department of Health for 2003, the most recent year for which data were available. Based on these data, there are a number of findings about overcharges to self-pay patients in New York.

I N P A T I E N T O V E R C H A R G E R A T E

! On average, New York State hospitals charge self-pay patients 2.3 times more than the cost of providing inpatient care. The cost of providing care is only 43% of the amount charged for inpatient care.

! The inpatient overcharge rate varies dramatically among hospitals. o Parkway Hospital, one of only two for-profit general hospitals reporting to the

Department of Health, had the highest overcharge rate for inpatient care, charging patients 7.3 times the cost of providing care.

o 9 hospitals charged more than 4 times the cost of providing inpatient care. 1 NYCRR Title 10, Section 86-1.11(g)(1)(i)(a &b)


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o 31 hospitals charged more than 3 times the cost of providing inpatient care.

o 101 hospitals charged 2 or more times the cost of providing inpatient care.

o On the other extreme, there were actually 4 hospitals that charge less than the cost of providing care and an additional 5 hospitals that have charges that closely match, within 10%, the cost of providing inpatient care.

! There are big regional differences in overcharge rates – See Table 1. o Suburban hospitals have the highest overcharge rates, with hospitals on Long Island

charging 2.7 times the cost of inpatient care and hospitals in Westchester County charging 2.5 times the cost of inpatient care.

o Hospitals in New York City and in the Northeast region (north of the NYC suburbs) had an overcharge rate of 2.3 times the cost of inpatient care.

o Upstate hospitals located west of the Hudson River generally did not inflate their charges as much as hospitals downstate. Hospitals in Rochester had the lowest overcharge rate, 1.6 times the cost of providing inpatient care.

Table 1: Inpatient Overcharge Rates by Region

! There are substantial differences in overcharge rates by types of hospitals, using a DOH classification2 – see Table 2.

o Hospitals that overcharge at the highest rate – 2.6 times the cost of inpatient care – are non-profit hospitals that do not care for a disproportionate number of low-income

2 There are 5 types of hospitals:

• Voluntary SLIPA (Supplementary Low Income Patient Adjustment) are non-profit hospitals that see a disproportionate number of Medicaid and low-income uninsured patients.

• Voluntary non-SLIPA hospitals are non-profit hospitals that see more low-income patients. • use of the large number

• •

Region Inpatient Overcharge Rate Long Island 2.7 (Charges are 2.7 times higher than costs.) Northern Metropolitan 2.5 New York City 2.3 Northeast 2.3 Western 2.1 Utica/Watertown 1.8 Central 1.7 Rochester 1.6 Statewide 2.3

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Distressed hospitals are considered to be in very bad financial condition, often beca

reat Hospital Heist page 3

of low-income patients they serve. Rural hospitals are a group of hospitals in rural areas. Major public hospitals are public entities controlled by the New York City Health and Hospitals Corporation and state and county run hospitals.

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(Medicaid or self-pay) patients. These are called Voluntary non-SLIPA (Supplementary Low Income Patient Adjustment) hospitals.

o Public hospitals inflate their charges the least, charging on average 1.5 times the cost of inpatient care.

o Rural hospitals also do not inflate their charges as much as others, charging on average 1.7 times the cost of inpatient care.

Table 2: Inpatient Overcharge Rates by Hospital Type

O U T P A T I E N T O V E R C H A R G E R A T E

! On average, New York hospitals charge self-pay patients 1.6 times more than the cost of providing outpatient care. The cost of providing care is only 61% of the amount charged for outpatient care.

! The outpatient overcharge rate varies dramatically among hospitals. o 4 hospitals, including Parkway Hospital, one of only two for-profit general hospitals

in New York, charged 4 times the cost of providing outpatient care.

o 15 hospitals charged more than 3 times the cost of providing outpatient care.

o 66 hospitals charged more than 2 times the cost of providing outpatient care.

o 141 hospitals charged 1.5 or more times the cost of providing outpatient care.

o On the other extreme, 13 hospitals charged less (2% to 28%) than the cost of providing care and an additional 6 hospitals’ charges closely matched, within 10%, the cost of providing outpatient care.

! There are big regional differences in overcharge rates – See Table 3. o Hospitals in the Northeast region of the State have the highest overcharge rates for

outpatient care, 2.4 times.

o Hospitals in New York City had the lowest over charge rate, largely – as data below

Hospital Type Inpatient Overcharge Rate Voluntary non-SLIPA 2.6 Voluntary SLIPA (serve more low-income patients) 2.4 Distressed (hospital in poor financial condition) 2.3 Rural 1.7 Major Public 1.5 Statewide 2.3

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show – due to the large number of public hospitals.

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Table 3: Outpatient Overcharge Rates by Region

! There are also substantial differences in overcharge rates by types of hospitals, using the DOH classification – see Table 4.

o Voluntary non-SLIPA and rural hospitals overcharge the most, followed by voluntary SLIPA and distressed hospitals.

o Public hospitals only charge slightly more than the cost of actually providing care, with their costs at 94% of the charge rate.

Table 4: Outpatient Overcharge Rates by Hospital Type

A M O U N T O F O V E R C H A R G E S

The 210 hospitals in New York State collectively overcharged self-pay patients by $1.1 billion in 2003. That is the patients who were self-pay – patients who are uninsured or did not have an insurance plan that has negotiated a discount with the hospital – were charged $1.1 billion

! Of

Region Outpatient Overcharge Rate Northeast 2.4 (Charges are 2.4 times higher than costs.) Northern Metropolitan 2.1 Long Island 2.0 Utica/Watertown 1.9 Western 1.8 Central 1.7 Rochester 1.6 New York City 1.4 Statewide 1.6

Hospital Type Outpatient Overcharge Rate Voluntary non SLIPA 1.9 Rural 1.8 Voluntary SLIPA (serve more low-income patients) 1.5 Distressed (hospital in poor financial condition) 1.5 Major Public 1.1 Statewide 1.6

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more than the reasonable cost to the hospital of providing services.

those aggregate overcharges:


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o $648 million were inpatient overcharges; o $462 million were outpatient overcharges.

! Two large New York City based academic medical centers had the highest total overcharges.

o St. Lukes Roosevelt - $48 million

o New York Presbyterian - $48 million.

! Three other New York City hospitals had overcharges of $30 million or more:

o Montefiore - $37 million;

o Jamaica Hospital - $33 million;

o Beth Israel – $33 million.

! Each of 17 hospitals had overcharges of $20 million or more.



T H E B I G G E S T B U R G L A R S

Fourteen hospitals ranked in the top 50 for both their overcharge rate and the total amount of overcharges. The list includes several of New York’s largest teaching hospitals that have relatively high overcharge rates and a large number of beds: St. Luke’s Roosevelt, Beth Israel; Staten Island University, Maimonides and Lenox Hill. The list also includes three smaller,

Biggest Burglars: Hospitals Among Top 50 in Inpatient Overcharge Rate and Total Overcharges

Hospital Inpatient

Overcharge Rate

Total Overcharges

PARKWAY HOSPITAL 7.3 $12,059,371 BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER INC 5.2 $24,105,461 LENOX HILL HOSPITAL 5.0 $24,366,359 INTERFAITH MEDICAL CENTER 3.8 $15,198,661 CABRINI MEDICAL CENTER 3.5 $ 8,454,907 ST LUKES-CORNWALL HOSPITAL 3.3 $ 9,017,702 MONTEFIORE HOSPITAL & MEDICAL CENTER 3.2 $37,116,153 GOOD SAMARITAN HOSPITAL OF SUFFERN 3.1 $ 9,604,435 MAIMONIDES MEDICAL CENTER 3.0 $29,647,343 STATEN ISLAND UNIVERSITY HOSPITAL 2.9 $15,313,519 FRANKLORANGEBETH ISRST LUKE

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IN GENERAL HOSPITAL 2.9 $ 8,555,429 REGIONAL MEDICAL CENTER 2.9 $ 8,147,403 AEL MEDICAL CENTER 2.8 $32,772,531

S - ROOSEVELT HOSPITAL CENTER 2.8 $48,440,398



non-teaching hospitals that earn their dubious distinction because of their high overcharge rates: Brookhaven; St. Luke’s Cornwall and Orange Medical Center. As mentioned previously, Parkway tops the list because of its outrageously high overcharge rate which leads to very high total overcharges even though the hospital is only moderately sized. The other hospitals on the list are moderately large teaching hospitals with relatively high overcharge rates: Interfaith; Montefiore; Cabrini; Franklin General; and Good Samaritan.

Discussion More than 5.6 million New Yorkers, one-out-of three people under the age of 65, did not

have health coverage for all or part of 2002-2003, according to a June 2004 report released by Families USA. Most of these New Yorkers, 65%, went without health insurance for six months or longer. According to a report from the National Institutes of Health, 18,000 Americans die prematurely each year due to the lack of health insurance.

High medical bills have severe impact on individual and family finances. Medical debt is the second most frequent cause of personal bankruptcies. Hospital billing practices exacerbate any financial crisis facing New Yorkers. As this report demonstrates, hospitals in New York State charge uninsured patients more than twice the hospitals’ cost of providing health care. Low and moderate-income uninsured patients usually do not get discounts similar to the rates paid by Medicaid, Medicare, or private insurance companies. In New York State, these overcharges statewide amount to about $1 billion annually.

Some hospitals also engage in aggressive debt collection activities, routinely sending uninsured patients vastly inflated bills, using collection agencies to hound patients for payments, and taking steps such as garnishing wages or attaching bank accounts to secure payment. It is these hospital billing and collection practices that are largely responsible for the fact that medical costs are the second leading cause of personal bankruptcy.

Until recently, hospital associations nationally and in New York long maintained that Medicare required them to bill the uninsured at the “full-charge” rate and try to collect the debt. On February 19, 2004, then U.S. Secretary of Health and Human Services Tommy G. Thompson sent a letter to the president of the American Hospital Association disagreeing with the hospital associations’ interpretation of Medicare regulations by writing: “Nothing in the Medicare program rules or regulations prohibit such discounts [for low-income patients].”

In response to negative publicity and a Congressional investigation into hospital billing and collection practices, the American Hospital Association (AHA) issued voluntary guidelines to its member hospitals in December 2003. The Healthcare Association of New York State



(HANYS), the statewide hospital association, approved its own set of guidelines Financial Aid/Charity Care Policy at New York’s Not-for-Profit Hospitals in January 2004.

While the hospital associations’ guidelines are an acknowledgement of the need for hospitals to do better, they are no substitute for legislation. Both the AHA and HANYS guidelines themselves are weak, providing little in actual patient protections. In addition, since they are voluntary – lacking the force of law or an enforcement mechanism – they do not establish accountability for the use of public dollars.

Hospitals individually and collectively often tout the amount of “charity care” they provide. The Preamble to the HANYS guidelines claims that New York hospitals provide “almost $2 billion a year in uncompensated care.”3 It fails to explain if the dollar calculation is based on the full charge rate or the lower, actual cost of care. There is no mention of federal and state governments’ provision of significant amounts of taxpayers’ dollars to hospitals every year to offset some of these costs. The federal government provides $22 billion a year to hospitals nationwide and New York State provides $847 million a year to cover the costs of bad debt and charity care.

The hospitals also fail to mention the dollar value of the significant exemptions they receive for property, school, and sales taxes. These exemptions are taxpayer funding for hospitals to provide community benefits. Under New York State and Federal laws, hospitals may and do include a wide array of activities under the headings “uncompensated care,” “charity care,” and/or “community benefits.” The various activities do, in fact, benefit the community but most hospitals fail to state clearly that care for those unable to pay is only a portion of the total dollar amount they report to the public. At least one hospital was more forthcoming; it reported that “care for the poor” in 2003 accounted for about a third, $8 million, of its “nearly $25 million in community benefits.” The other two-thirds, $17 million, covered “under-reimbursement by Medicare and Medicaid, free lectures and health screenings in the community, and the value of volunteer labor.”4

The Nassau County Department of Health reports that total charges for charity care provided by the 12 hospitals in the county in 2003 were $68.5 million dollars. In contrast, the reported cost of that care was actually one-third lower, $45.3 million.5 There was significant variation from hospital to hospital in the ratio of charges to cost: one hospital reported charges

3 Ibid. 4 St. Peter’s Hospital. 2004. “Celebrating 135 Years of Caring.” Supplement to the Times Union. Albany, New

York. November 1, 2004. p.21. 5 Nassau County Department of Health. 2004. Fiscal Year 2003 Nassau County Hospital Charity Care Report. Nassau

County, NY. October 2004. Table 2. http://www.nassaucountyny.gov/official/resources/file/eb00094f5cd4681/CharityCareFY2003Report_10-25-04.pdf



almost 3 times more than its cost and another reported charges only 8% higher than its costs. Even hospitals in the same health system reported very different cost to charge ratios.

Long before the voluntary guidelines or HHS letter, some states had enacted laws and regulations that require hospitals to provide discounts to patients based on financial need. Two of New York’s neighbors, Massachusetts and New Jersey, require hospitals to comply with statewide eligibility criteria, screening and application process, reporting requirements, and a payment mechanism for charity care. But New York State, which provides hospitals with $847 million a year to compensate hospitals for unpaid bills, has no such requirements.

In both March 2005 and March 2006, the NYS Assembly passed three bills by wide bi-partisan votes (only 10 or 11 negative votes out of 150 Assembly members) – on legislative proposals that would establish statewide standards for providing financial assistance to patients. The package of three bills introduced by the chairs of the Assembly Insurance and Health Committees, Alexander “Pete” Grannis (D-Manhattan) and Richard Gottfried (D- Manhattan) would: (1) set statewide eligibility standards; (2) establish a statewide discounted rate for those with incomes under 200% of the federal poverty level and require sliding scale discounts for patients under 400% of poverty; (3) standardize the application process; (4) define covered services; (5) forbid egregious billing and debt collection practices; (6) specify public disclosure on how taxpayers’ funds were used; (7) require notices to the public about available financial aid; (8) instruct hospitals to bill low to moderate-income uninsured patients at the discounted rate paid by Medicare or other insurers; and (9) create an independent appeals process.

The Governor’s 2005 HCRA proposal included some new procedural requirements for hospitals to qualify for funds from the BD&CC fund pools, procedures. The Governor included similar proposals in his 2006-2007 budget. His Health Commissioner, Antonia Novello, also pledged to advocate enactment of financial assistance protections after news stories reported the death of a young man who was denied treatment due to the lack of health coverage. The NYS Senate included the Governor’s proposal in its March 2006 budget resolution.

The Public Policy and Education Fund conducted surveys of 19 hospitals in four upstate cities in 2005 - 2006 to see whether the hospitals are meeting the standards set forth in the legislation passed by the Assembly. With regard to the specific issue addressed in this study, whether hospitals provide discounts to self-pay patients, our surveys found seven hospitals (37%) that meet the standards set forth in the Assembly legislation: providing free care (other than small co-payments) to patients who earn up to 200% of the federal poverty level and sliding



fee payments based on income to patients who earn up to 400% of the federal poverty level.6 The surveys also found an additional three hospitals that met the first part of the standard (full discount up to 200% of poverty) and two hospitals that met the second part of the standard (a sliding scale discount to 400% of poverty.)7

The findings of these surveys demonstrate that the standards are reasonable, since more than half –12 of 19 – of the hospitals voluntarily are in compliance with at least one of the two standards. The PPEF surveys also demonstrate that voluntary guidelines do not work, since only 37% are in full compliance.

The data presented in this report demonstrate that hospitals routinely charge uninsured New Yorkers more than twice the cost of providing care. These findings underscore the urgency for the Governor and State Senate to join the Assembly to enact strong consumer financial assistance protections for uninsured New Yorkers and other New York hospital patients who are unable to pay their hospital bills.

.

6 A family of four earns $39,900 at 200% of the FPL and $79,800 at 400% of FPL. An individual earns $20,100 at 200% of FPL and $40,200 at 400% of FPL. 7 The cities were Rochester; Utica; Syracuse and Buffalo. The hospitals that were in full compliance were Faxton-St.Luke’s in Utica; St. Joseph’s in Syracuse; and five hospitals run by Kaleida in Buffalo. In addition: Highland in Rochester, Community General in Syracuse and St. Elizabeth’s in Utica provided a full discount up to 200% of FPL; Parkridge in Rochester and Crouse in Syracuse provided a sliding discount up to 400% of FPL.



Appendix: Hospitals’ Inpatient Overcharge Rate

and Total Amount of Overcharges

Hospital

Inpatient Overcharge

Rate Total Overcharges ADIRONDACK MEDICAL CENTER 1.7 $ 439,243 ALBANY MEDICAL CENTER HOSPITAL 2.2 $ 7,308,966 ALBANY MEDICAL CENTER HOSPITAL - SOUTH CAMPUS 1.8 $ 121,568 ALBERT LINDLEY LEE MEMORIAL HOSPITAL 1.7 $ 273,870 ALICE HYDE MEMORIAL HOSPITAL 1.7 $ 496,089 AMSTERDAM MEMORIAL HOSPITAL 1.7 $ 144,288 ARNOT-OGDEN MEMORIAL HOSPITAL 2.0 $ 2,008,717 AUBURN MEMORIAL HOSPITAL 2.0 $ 951,912 AURELIA OSBORN FOX MEMORIAL HOSPITAL 1.7 $ 935,564 BASSETT HOSPITAL OF SCHOHARIE 1.4 $ 157,623 BELLEVUE HOSPITAL CENTER 1.5 $ 16,840,005 BELLEVUE MATERNITY HOSPITAL INC 1.8 $ 219,174 BENEDICTINE HOSPITAL 2.9 $ 2,596,302 BERTRAND CHAFFEE HOSPITAL 1.3 $ 75,248 BETH ISRAEL HOSPITAL - KINGS HIGHWAY DIVISION 4.5 $ 2,637,666 BETH ISRAEL MEDICAL CENTER 2.8 $ 32,772,531 BLYTHEDALE CHILDRENS HOSPITAL 2.1 $ 865,736 BON SECOURS HOSPITAL 3.1 $ 4,988,501 BRONX-LEBANON HOSPITAL CENTER-FULTON DIVISION 2.7 $ 29,128,188 BROOKDALE HOSPITAL MEDICAL CENTER 1.9 $ 21,638,009 BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER INC 5.2 $ 24,105,461 BROOKLYN HOSPITAL 1.7 $ 9,452,238 BROOKS MEMORIAL HOSPITAL 1.6 $ 311,703 BRUNSWICK HOSPITAL CENTER INC 2.4 $ 3,783,932 BURKE REHABILITATION CENTER 1.3 $ (53,610) CABRINI MEDICAL CENTER 3.5 $ 8,454,907 CALVARY HOSPITAL 1.2 $ 203,618 CANTON-POTSDAM HOSPITAL 1.4 $ 368,858 CARTHAGE AREA HOSPITAL INC 1.5 $ 443,757 CATHOLIC MEDICAL CENTER OF BROOKLYN & QUEENS, INC 2.3 $ 23,234,619 CATSKILL REGIONAL HOSPITAL - HARRIS 2.1 $ 7,066,064 CATSKILL REGIONAL HOSPITAL - HERMAN 0.9 $ 52,831 CAYUGA MEDICAL CENTER AT ITHACA 1.5 $ 546,864 CENTRAL SUFFOLK HOSPITAL 3.9 $ 5,394,032 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CTR 2.1 $ 2,698,022 CHENANGO MEMORIAL HOSPITAL INC 1.8 $ 1,172,936 CITY HOSPITAL CENTER AT ELMHURST 1.8 $ 11,089,143 CLIFTON SPRINGS HOSPITAL AND CLINIC 1.9 $ 355,279 CLIFTON-FINE HOSPITAL 1.1 $ 42,063 COLER MEMORIAL HOSPITAL 2.0 $ 647,642 COLUMBIA-GREENE MEDICAL CENTER 2.1 $ 2,224,374



Hospital


Rate Total Overcharges COMMUNITY HOSPITAL @ DOBBS FERRY 2.1 $ 302,479 COMMUNITY MEMORIAL HOSPITAL INC 1.9 $ 357,971 COMMUNITY-GENERAL HOSPITAL OF GREATER SYRACUSE 1.8 $ 1,249,260 CONEY ISLAND HOSPITAL 1.5 $ 2,653,040 CORNING HOSPITAL 1.3 $ 1,098,532 CORTLAND MEMORIAL HOSPITAL INC 1.6 $ 1,095,454 CROUSE-IRVING MEMORIAL HOSPITAL 1.8 $ 4,035,508 CUBA MEMORIAL HOSPITAL INC 1.2 $ 55,426 DELAWARE VALLEY HOSPITAL INC 1.8 $ 333,408 EASTERN LONG ISLAND HOSPITAL 2.0 $ 679,969 EDDY COHOES REHAB CENTER 1.4 $ 2,847 EDWARD JOHN NOBLE HOSPITAL OF GOUVERNEUR 1.6 $ 167,956 ELIZABETHTOWN COMMUNITY HOSPITAL 1.0 $ 53,500 ELLENVILLE COMMUNITY HOSPITAL 1.1 $ 182,289 ELLIS HOSPITAL 3.3 $ 5,183,432 EPISCOPAL HEALTH SERVICES 2.1 $ 1,797,496 ERIE COUNTY MEDICAL CENTER 1.4 $ 2,288,856 F F THOMPSON HOSPITAL 1.4 $ 465,187 FAXTON - ST LUKES HEALTH CARE 2.2 $ 3,025,972 FLUSHING HOSPITAL AND MEDICAL CENTER 2.0 $ 9,572,943 FRANKLIN GENERAL HOSPITAL 2.9 $ 8,555,429 GENEVA GENERAL HOSPITAL 1.6 $ 1,238,417 GLENS FALLS HOSPITAL 2.1 $ 4,613,982 GOLDWATER MEMORIAL HOSPITAL 2.0 $ 2,067,714 GOOD SAMARITAN HOSPITAL OF SUFFERN 3.1 $ 9,604,435 GOOD SAMARITAN HOSPITAL OF WEST ISLIP 3.3 $ 15,007,726 HARLEM HOSPITAL CENTER 1.1 $ (2,792,098) HELEN HAYES HOSPITAL 1.3 $ 8,381 HEPBURN MEDICAL CENTER 1.6 $ 1,283,414 HIGHLAND HOSPITAL OF ROCHESTER 1.3 $ 641,075 HOSPITAL FOR JOINT DISEASE - ORTHOPEDIC INSTITUTE 2.2 $ 1,262,643 HOSPITAL FOR SPECIAL SURGERY 2.4 $ 723,152 HUDSON VALLEY HOSPITAL CENTER 3.2 $ 1,872,634 HUNTINGTON HOSPITAL 2.4 $ 5,968,029 INTER-COMMUNITY MEMORIAL HOSPITAL AT NEWFANE INC 1.7 $ 200,742 INTERFAITH MEDICAL CENTER 3.8 $ 15,198,661 IRA DAVENPORT MEMORIAL HOSPITAL INC 1.5 $ 203,039 JACOBI MEDICAL CENTER 1.5 $ 467,980 JAMAICA HOSPITAL 2.0 $ 33,375,239 JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON NEW YORK INC 3.1 $ 3,319,350 KALEIDA HEALTH 2.2 $ 13,187,911 KENMORE MERCY HOSPITAL 3.0 $ 1,264,586 KINGS COUNTY HOSPITAL CENTER 1.6 $ 9,519,641 KINGSBROOK JEWISH MEDICAL CENTER 3.5 $ 2,302,414



Hospital


Rate Total Overcharges KINGSTON HOSPITAL 1.7 $ 1,560,504 LAKESIDE MEMORIAL HOSPITAL 1.8 $ 326,936 LAWRENCE HOSPITAL 2.3 $ 1,878,936 LENOX HILL HOSPITAL 5.0 $ 24,366,359 LEWIS COUNTY GENERAL HOSPITAL 1.6 $ 324,474 LINCOLN MEDICAL & MENTAL HEALTH CENTER 1.3 $ (3,141,558) LITTLE FALLS HOSPITAL 2.0 $ 562,399 LOCKPORT MEMORIAL HOSPITAL 1.6 $ 424,285 LONG BEACH MEDICAL CENTER 5.9 $ 4,236,016 LONG ISLAND COLLEGE HOSPITAL 3.3 $ 20,440,888 LONG ISLAND JEWISH-HILLSIDE MED CTR 2.6 $ 28,275,543 LUTHERAN MEDICAL CENTER 1.5 $ 12,319,231 MAIMONIDES MEDICAL CENTER 3.0 $ 29,647,343 MANHATTAN EYE EAR AND THROAT HOSPITAL 2.4 $ 3,685,945 MARGARETVILLE MEMORIAL HOSPITAL 1.5 $ 917,998 MARY IMOGENE BASSETT HOSPITAL 1.7 $ 1,751,667 MASSENA MEMORIAL HOSPITAL 1.7 $ 727,629 MEDINA MEMORIAL HOSPITAL 1.2 $ 130,949 MEMORIAL HOSPITAL FOR CANCER AND ALLIED DISEASES 1.5 $ 4,701,086 MEMORIAL HOSPITAL OF ALBANY 1.9 $ 1,526,325 MEMORIAL HOSPITAL OF WM F & GERTRUDE F JONES A/K/A JONES MEMORIAL HOS 1.5 $ 135,178 MERCY HOSPITAL OF BUFFALO 2.7 $ 3,301,700 MERCY MEDICAL CENTER 2.8 $ 3,758,859 METROPOLITAN HOSPITAL CENTER 1.4 $ 302,793 MONTEFIORE HOSPITAL & MEDICAL CENTER 3.2 $ 37,116,153 MOSES-LUDINGTON HOSPITAL 1.0 $ 4,420 MOUNT SINAI HOSPITAL 2.1 $ 23,843,140 MOUNT SINAI HOSPITAL OF QUEENS 2.2 $ 4,068,237 MOUNT ST MARYS HOSPITAL OF NIAGARA FALLS 2.3 $ 426,453 MOUNT VERNON HOSPITAL 1.9 $ 4,506,641 NASSAU MEDICAL CENTER 1.8 $ 16,602,959 NATHAN LITTAUER HOSPITAL 1.6 $ 881,191 NEW ISLAND HOSPITAL 3.5 $ 2,344,611 NEW YORK DOWNTOWN HOSPITAL 1.7 $ 1,625,711 NIAGARA FALLS MEMORIAL MEDICAL CENTER 2.1 $ 931,088 NICHOLAS H NOYES MEMORIAL HOSPITAL 2.1 $ 591,502 NORTH CENTRAL BRONX HOSPITAL 1.4 $ (1,163,899) NORTH GENERAL HOSPITAL 1.4 $ 4,486,716 NORTH SHORE UNIV @ FOREST HILLS 2.4 $ 6,957,065 NORTH SHORE UNIV HOSP @ PLAINVIEW 2.7 $ 3,189,748 NORTH SHORE UNIVERSITY HOSPITAL 2.4 $ 26,058,641 NORTH SHORE UNIVERSITY HOSPITAL @ GLEN COVE 2.8 $ 4,891,841 NORTHERN DUTCHESS HOSPITAL 3.8 $ 1,608,315 NORTHERN WESTCHESTER HOSPITAL 1.8 $ 1,348,039



Hospital


Rate Total Overcharges NY COMMUNITY - BROOKLYN 2.3 $ 625,075 NY EYE AND EAR INFIRMARY 2.8 $ 4,270,827 NY MED CTR OF QUEENS 2.2 $ 9,567,314 NY METHODIST HOSPITAL OF BROOKLYN 2.7 $ 25,035,663 NY PRESBYTERIAN 2.4 $ 48,422,220 NY WESTCHESTER SQUARE MEDICAL CENTER 2.0 $ 894,274 NYACK HOSPITAL 4.2 $ 7,047,207 NYU MEDICAL CENTER 2.3 $ 5,082,077 O'CONNOR HOSPITAL 0.8 $ 53,707 OLEAN GENERAL HOSPITAL 1.9 $ 1,057,032 ONEIDA HEALTHCARE CENTER 1.7 $ 627,366 ORANGE REGIONAL MEDICAL CENTER 2.9 $ 8,147,403 OSWEGO HOSPITAL 1.5 $ 1,057,522 OUR LADY OF LOURDES MEMORIAL HOSPITAL 1.9 $ 2,263,052 OUR LADY OF MERCY MEDICAL CTR 2.0 $ 9,095,695 PARK RIDGE HOSPITAL 1.6 $ 1,436,115 PARKWAY HOSPITAL 7.3 $ 12,059,371 PENINSULA HOSPITAL CENTER 1.8 $ 465,646 PHELPS MEMORIAL HOSPITAL ASSOCIATION 2.5 $ 2,416,764 PUTNAM COMMUNITY HOSPITAL 4.0 $ 4,660,832 QUEENS HOSPITAL CENTER 1.2 $ (2,545,238) RIVER HOSPITAL 0.8 $ 52,188 ROCHESTER GENERAL HOSPITAL 1.6 $ 5,936,266 ROME MEMORIAL HOSPITAL 2.1 $ 1,786,589 ROSWELL PARK MEMORIAL INSTITUTE 1.6 $ 372,612 SAMARITAN HOSPITAL OF TROY 2.2 $ 2,724,841 SAMARITAN MEDICAL CENTER 1.7 $ 1,546,436 SARATOGA HOSPITAL 2.4 $ 2,302,939 SCHUYLER HOSPITAL 2.0 $ 365,553 SETON HEALTH SYSTEM 2.2 $ 1,497,710 SISTERS OF CHARITY HOSPITAL 2.5 $ 2,705,549 SISTERS OF CHARITY MEDICAL CTR 2.1 $ 6,752,440 SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES COUNTY INC 1.7 $ 317,044 SOUND SHORE MED CTR OF WESTCHESTER 1.5 $ 7,214,444 SOUTH NASSAU COMMUNITIES HOSPITAL 3.4 $ 5,371,569 SOUTHAMPTON HOSPITAL 2.6 $ 4,524,839 SOUTHSIDE HOSPITAL 3.5 $ 13,106,315 ST ANTHONY COMMUNITY HOSPITAL 3.5 $ 2,549,653 ST BARNABAS HOSPITAL 2.0 $ 8,954,294 ST CATHERINE OF SIENA 3.0 $ 2,670,045 ST CHARLES HOSPITAL 2.7 $ 2,927,269 ST CLARES HOSPITAL AND HEALTH CENTER 1.6 $ 1,182,046 ST CLARES HOSPITAL OF SCHENECTADY 1.6 $ 1,829,342 ST ELIZABETH HOSPITAL 2.0 $ 1,925,417



Hospital


Rate Total Overcharges ST FRANCIS HOSPITAL OF POUGHKEEPSIE 3.2 $ 5,355,919 ST FRANCIS HOSPITAL OF ROSLYN 2.7 $ 2,383,569 ST JAMES MERCY HOSPITAL 1.8 $ 1,586,241 ST JOHNS RIVERSIDE-YONKERS 2.0 $ 4,034,955 ST JOSEPH INTERCOMMUNITY HOSPITAL 3.1 $ 1,402,258 ST JOSEPHS HOSPITAL HEALTH CENTER 1.9 $ 3,850,932 ST JOSEPHS HOSPITAL OF ELMIRA 2.1 $ 1,429,289 ST JOSEPHS HOSPITAL YONKERS 1.7 $ 1,652,854 ST LUKES - ROOSEVELT HOSPITAL CENTER 2.8 $ 48,440,398 ST LUKES-CORNWALL HOSPITAL 3.3 $ 9,017,702 ST MARYS HOSPITAL AT AMSTERDAM 1.8 $ 1,277,787 ST MARYS HOSPITAL OF BROOKLYN 2.0 $ 7,626,873 ST PETERS HOSPITAL 2.8 $ 3,558,850 ST VINCENTS HOSPITAL AND MEDICAL CENTER OF NY 2.1 $ 19,820,926 STATE UNIVERSITY HOSPITAL DOWNSTATE MEDICAL CENTER 1.0 $ 5,216,292 STATEN ISLAND UNIVERSITY HOSPITAL 2.9 $ 15,313,519 STRONG MEMORIAL HOSPITAL 1.7 $ 7,050,102 SUMMIT PARK HOSPITAL-ROCKLAND COUNTY INFIRMARY 1.6 $ 859,378 SUNNYVIEW HOSPITAL AND REHABILITATION CENTER 1.7 $ 32,516 SUNY HEALTH SCIENCE CENTER AT SYRACUSE 1.2 $ 575,025 THE HOSPITAL 1.9 $ 225,208 TLC HEALTH CARE NETWORK 1.7 $ 298,918 UNITED HEALTH SERVICES, INC 1.8 $ 5,162,296 UNITED HOSPITAL 1.9 $ 1,946,363 UNITED MEMORIAL 2.1 $ 1,219,680 UNIVERSITY HOSPITAL AT STONY BROOK 1.8 $ 21,722,895 VASSAR BROTHERS HOSPITAL 5.0 $ 10,702,271 VIA HEALTH OF WAYNE 2.2 $ 1,975,437 VICTORY MEMORIAL HOSPITAL 5.8 $ 6,742,451 WESTCHESTER MEDICAL CENTER 1.8 $ 4,354,311 WESTFIELD MEMORIAL HOSPITAL INC 1.5 $ 144,074 WHITE PLAINS HOSPITAL MEDICAL CENTER 2.1 $ 3,325,393 WINTHROP UNIVERSITY HOSPITAL 2.9 $ 7,142,987 WOMANS CHRISTIAN ASSOCIATION 1.8 $ 1,425,749 WOODHULL MEDICAL AND MENTAL HEALTH CENTER 1.2 $ 681,798 WYCKOFF HEIGHTS HOSPITAL 2.1 $ 9,566,153 WYOMING COUNTY COMMUNITY HOSPITAL 1.4 $ 290,889 Statewide 2.3 $1,110,137,594


The Great Hospital Heist: How New York Hospitals Charge the Most to those Least Able to Pay was authored by Richard Kirsch. © 2006 Public Policy and Education Fund of New York, 94 Central Avenue, Albany, New York 12206; 518-465-4600. http://www.citizenactionny.org/. Support for the Public Policy and Education Fund’s research on health coverage issues comes from the Robert Sterling Clark Foundation.


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the great hospital heist: how new york hospitals charge the most to those least able to pay

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