AG Ellison announces settlement with Mayo Clinic over charity care, debt collection

Minnesota Attorney General Keith Ellison announced Friday morning his office has reached a settlement with the Mayo Clinic investigating financial assistance policies.

Ellison said Mayo violated the Minnesota Hospital Agreement, which protects patients from harmful debt-collection practices, through aggressive debt-collection tactics and policies that blocked eligible patients’ access to free or discounted “charity care.”

The settlement requires Mayo to provide charity care to patients with incomes at or below 200% of federal poverty guidelines and up to a 50% discount for patients at or below 400% of federal guidelines.

Mayo is required to provide patients who are presumed eligible with charity care without requiring them to apply for assistance, according to the settlement. Mayo is also required to streamline the application process to reduce burdens on patients not presumed eligible.

The settlement prohibits Mayo from suing patients for debt collection unless in “exceptional circumstances” and requires lawsuits to be approved by Mayo’s CFO.

In addition to Friday’s agreement, Ellison published a report and legislative changes regarding his investigation into Mayo.

According to the report, Mayo violated legal requirements and its own charitable mission to provide patients access to charity care applications. Mayo staff were instructed to “steer patients away” from charity care options and suggest patients take out bank loans, start fundraisers or borrow from family members to afford treatment.

The report said Mayo’s charity care application process was “burdensome” and “inadequate” for patients. Mayo was also accused of denying and delaying care to patients with medical debt until it was paid in full.

The report also included recommended reforms to the state’s regulatory framework, such as expanding charity care eligibility, establishing an income-based floor for charity care and creating a uniform application for patients.

Ellison said that Mayo has taken positive steps to increase patients’ access to charity care since the start of his investigation.

The following prepared statement was issued regarding Ellison’s settlement:

“While this is disappointing, I am heartened by the substantial improvements Mayo Clinic has made to their charity care program, and I am grateful for their cooperation with our investigation. The settlement I have reached with Mayo Clinic ensures their improved charity care policies and procedures will remain in place.”

Minnesota Attorney General Keith Ellison

In a statement, Andrea Kalmanovitz, Mayo Clinic communications director, said patients are able to apply for financial assistance any time before, during or after treatment has been provided.

Kalmanovitz said Mayo has expanded its presumptive eligibility practices since 2023 to allow patients to receive assistance without applying first.

The following prepared statement was issued regarding Mayo’s response to the settlement:

“After their review, the MN OAG’s factual findings demonstrate that Mayo Clinic adheres to and in many cases exceeds all regulatory guidelines for charity care. As noted in the agreement, Mayo Clinic has offered assurances that it will continue the robust financial assistance policies Mayo Clinic has in place and the ongoing enhancements made in recent years to meet the evolving needs of patients.”

Mayo Clinic Communications Director Andrea Kalmanovitz

Ellison will host a community forum to discuss medical debt and federal overreach in Rochester on Saturday, March 15. The forum’s location and time are available after participants RSVP online.