Study Reveals St. Louis Universities Sued Nearly 1,000 Patients Over Medical Debt
St. Louis, MO — July 10, 2025 — For Immediate Release
A new study published today in JAMA Network Open finds that Saint Louis University (SLU) and Washington University in St. Louis (WashU) filed nearly 1,000 lawsuits against patients over unpaid medical bills from January 2020 to May 2023.
The research, led by Mary Shannon, MSW, shows these lawsuits were disproportionately filed in Black and low-income communities, often resulting in wage garnishments that deepened families’ financial hardship.
“This study confirms what many community advocates already knew: that medical debt lawsuits are harming Black and the low-income communities even in cities with academic medical centers working towards health equity,” said Shannon. “The data speaks volumes about the unequal burden of medical debt collection.”
Key Findings:
- 973 lawsuits were filed by SLU- and WashU-affiliated physician groups or their assignees. Most cases end in default judgments.
- Majority-Black ZIP codes, home to just 22% of the region’s population, accounted for 41% of lawsuits and 48% of garnishments.
- Wage garnishments were issued against employees of the universities and local health systems.
- Over $1 million in judgments were pursued, a surprisingly modest figure for institutions with large financial reserves. The smallest debt pursued was $104.
Broader Implications
The study highlights how even nonprofit institutions, despite tax exemptions for charitable missions, contribute to economic and health disparities through aggressive debt collection. It raises questions about physician billing practices and how universities shape the medical debt landscape.
“We hope this work encourages transparency, reflection and accountability, and policy reforms that protect patients,” said co-author Kathryn Koch, JD, MSW.
The study was conducted independently and without funding, with support from the Center for Social Development at WashU and Consumers Council of Missouri. Both researchers are alumnae of SLU and WashU.
Read the full article in JAMA Network Open here.
Contact:
Mary Shannon
314-297-7775
maryshannon414@gmail.com