Oregon non-profit hospitals can't send you to collections until they consider your financial status

Similar to Washington State's law on sending patients to collections without considering their financial situation, Oregon also has a law. Lets expore it through lawsuit Reiger v. St. Charles Health Sys., 2025 U.S. Dist. LEXIS 112863, 2025 LX 150536, 2025 WL 1676534.

The court recounts how nonprofit hospitals require nonprofit hospitals to limit charges and extraordinary collections activities to low-income patients. The specific of the policies are left to each state, where were enacted in House Bill 3076, and then amended in House Bill 3320.

For low income patients at nonprofit Oregon hospitals, their debt must be adjusted down according to:

• Up to 200% federal poverty guideline - 100% reduction

• 201-300% federal poverty guideline - 75% reduction

• 301-350% federal poverty guideline - 50% reduction

• 351-400% federal poverty guideline - 26% reduction

For a single person, the federal poverty guideline is $15,650, and for a family of four, it is $32,150.

Similar to the Washington State law, before a hospital could transfer an unpaid charge to a debt collector or refer and unpaid charge to collections, it was required to conduct a screening to determine if the patient's income is at or below 200% of the FPG, thereby qualifying the patient for 100% relief, and mail the patient a copy of its financial assistance policy and application.

In 2022, Ms. Riger was injured in a car accident and admitted to St. Charles for emergency care. Eventually they billed her for $1,104. For whatever reason, Ms. Riger says she never got bills or communications from St. Charles. Consistent with the law, St. Charles did look at Ms. Riger's income, saw that they was eligible for a 100% reduction, and sent her a letter informing her of it along with a financial assistance application. The letter did not inform Ms. Riger was eligible for the 100% reduction. Again, for whatever reason, Ms. Riger did not respond.

St. Charles used the services of an Emeri EBO to call Ms. Riger about the $1,104, but on the phone Emeri EBO's agents represent themselves as calling for St. Charles.

Eventually St. Charles outsourced the debt to debt collector Ray Klein, who sued Ms. Riger in small claims court for $1,217, including some interest. Ray Klein got a judgment against her, including a 9% interest. Ms. Riger paid at least $1,339, but then came back at St. Charles and Ray Klein with a lawsuit, claiming they both violated Oregon's laws governing debt collection.

Ms. Riger ended up arguing that St. Charles should not send any debt to collections that they know is eligible for a 100% reduction, and that by doing so, Ray Klein and St. Charles misrepresented the collectability of the debt and the amount owed.

Ray Klein and St. Charles moved to dismiss each claim, or for summary judgment on them.

Reiger v. St. Charles Health Sys._2025 U.S. Dist. LEXIS 112863.Pdf

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Loss #1 for Ms. Riger

Ms. Riger contended that Emeri EBO's calls were prohibited referrals to a debt collector before Ms. Riger's income was screened. Recall, the income screening only need come before an unpaid charge is sent to a debt collector. The court ruled that Emeri EBO's calls were still in house to St. Charles, not referrals to a debt collector.

Loss #2 for Ms. Riger

Ms. Riger contended St. Charles violated ORS 646A.677(4) by transferring the debt to a collection agency after determining that she was eligible for a 100% reduction in the bill.

Under ORS 646A.677(4), hospitals must do two things before sending unpaid charges to collections: "(a) [c]onduct a screening to determine if the patient qualifies for financial assistance as described in ORS 442.614(1)(a)(A), if applicable; and (b) [p]rovide a copy of its financial assistance policy to the patient along with an application for financial assistance." ORS 646A.677(4). As referenced in step (a), ORS 442.614(1)(a)(A) describes that a hospital's financial assistance policy must provide a means of adjusting 100% of the costs of patients whose income is at or below 200% of the FPG. ORS 442.614(1)(a)(A). Plaintiff reads this language as prohibiting a hospital from sending unpaid charges to collections "[i]f the hospital determines from its screening that the patient qualifies for 100% bill forgiveness." She argues that the legislature's use of the word "qualifies" "confirms that it intended a patient's entitlement to 100% bill forgiveness be established by a hospital's screening." And further, that nothing in the statute "requires a patient who the hospital has determined qualifies for 100% bill forgiveness to submit an application before forgiving their debt." Id. For a few reasons, Plaintiff's argument fails.

The court noted that "qualified" for a 100% reduction didn't mean Ms. Riger was guaranteed to receive a 100% reduction. ORS 442.614(1)(a)(A) does not state that hospitals "must adjust" the patient's bill. It states that the policy "must provide for adjusting" the bill, but did not state just qualifying was sufficient to receive it.

Win #1 for Ms. Riger

Ms. Riger's sole win was on the interest Ray Klein charged Ms. Riger. Ms. Riger's claim under Oregon's UDCPA (Unlawful Debt Collection Practices Act) was that St. Charles violated ORS 646A.677(7) by charging interest:

If a patient qualifies for financial assistance under ORS 442.614 (Requirements for financial assistance policies) (1)(a)(A), a hospital, nonprofit hospital-affiliated clinic or other debt collector may not charge interest on the patient’s medical debt.

St. Charles tried the argument that worked above, saying that it was only bound to ORS 646A.677(7) if Ms. Riger had sent in the application for debt reduction, but the court noted that had Ms. Riger done that, there would not be a debt to charge interest to. [Note that the court did not find it sufficient to point to the plain text of the law but felt it had to justify it another way].

ORS 646A.677(7) must be read as applying to the debt of patients who are eligible for 100% assistance because their income is at or below 200% of the FPG. Not only is this understanding consistent internally and with the underlying purpose of the Bill, but it also gives meaning to the screening provision in ORS 646A.677(4) which directs hospitals to search specifically for the lowest income level.

Loss #3 for Ms. Riger

Ms. Riger argued that St. Charles violated Oregon's UTPA (Unlawful Trade Practices Act) by claiming it screens patients "as early as possible" when in practice it attempted to collect payment from Plaintiff before screening her and (b) by not disclosing to Plaintiff that she was eligible for 100% assistance under ORS 442.614(1)(a)(A) when it transferred her unpaid charges to Ray Klein.

For a loss of money to be "a result of" an unlawful practice, the loss must be "occasioned by" the practice. See Gemignani v. Pete, 187 Or. App. 584, 591, 71 P.3d 87 (2003). Here, Plaintiff alleges that her "ascertainable loss" is the money she paid Ray Klein, but she fails to causally connect that loss to St. Charles's "misleading impression" that it screens patients "as early as possible." Whether the screening occurred on day one or day one hundred, the screening alone would not have eliminated Plaintiff's obligation to pay because she was required to comply with the policy and complete an application. The loss therefore precipitated from circumstances other than St. Charles's alleged misrepresentation.

The court dismissed this count but gave Ms. Riger leave to amend her complaint in case she could make a better argument.

The results of this case show that while the law provides debt relief to low income patients at Oregon's nonprofit hospitals, the debt reduction is not automatic, but must be applied for. However protection of added interest is automatic for those identified as meeting criterial to apply for debt reduction.

Got a Case Like This?

If you’ve had similar problems with telemarketers, debt collectors, or bankruptcy-related harassment, we might feature your story in a future blog post. Email your situation or legal filing to peter@nwdebtresolution.com or nathen@nwdebtresolution.com.

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Note: The opinions in this blog are mine (Peter Schneider) and do not count as legal advice. If you're thinking of suing over illegal robocalls or Do Not Call list violations, contact me for a legal consultation.

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