The office of Minnesota Attorney General Keith Ellison (D) is looking into Mayo Clinic’s billing practices after a local media outlet reported the health system sued low-income patients for unpaid balances.

The Rochester Post Bulletin, which published the investigation last month, interviewed 20 sued patients and found 14 appeared to have been eligible for free or discounted services.

“Mayo’s apparent aggressive bill-collection conduct and apparent failure to inform its patients of charity care that the Post Bulletin reported is alarming. Based solely on that reporting, it may violate the letter and spirit of the Hospital Agreement. We take that very seriously and have asked Mayo for more information,” John Stiles, spokesperson for Ellison’s office, said in a statement.

The Hospital Agreement, which has been renewed until July 1, 2027, is an agreement between Ellison’s office and 128 nonprofit hospitals in Minnesota, plus for-profit system PrairieCare, to protect patients from abusive or deceptive practices in collections. The agreement, established in 2005 and renegotiated every five years, requires hospitals to follow certain standards for assessing whether patients can pay medical bills and implementing payment plans.

In 2020, Ellison reached a settlement with Hutchinson Hospital under the agreement to restore more favorable billing practices, resulting in $184,000 of patients’ medical debt forgiven and a 40% discount on outstanding bills for some patients. 

Rochester, Minnesota-based Mayo Clinic said it is responding to the attorney general’s request for more information and wants to present a clear, accurate picture of its practices. To determine financial hardship, Mayo Clinic reviews services requested by the provider, previous care provided, available insurance coverage and a patient’s financial profile. 

“We are confident that our response will demonstrate that financial assistance is an important part of Mayo Clinic’s relationship with patients and is shared with them at points before, during and after care is provided,” Mayo Clinic said in a statement.