August 10, 2022

Rep. Castro and Senator Warren Call on the Department of Defense to Fix Misleading and Confusing Billing Practices at Military Hospitals and Protect Civilian Patients from Crushing Medical Debt

WASHINGTON — Today, Congressman Joaquin Castro (TX-20) and Senator Elizabeth Warren (MA) sent a letter to Secretary of Defense Lloyd Austin expressing concerns that the Department of Defense (DOD) is failing to properly inform civilians about their opportunities for debt relief after receiving emergency medical care at military health care facilities. The letter calls on the DOD to improve billing practices to protect patients from further harm.

Brooke Army Medical Center (BAMC) is one of two Level I Trauma Centers in San Antonio and serves nearly half of civilian patients treated by military Medical Treatment Facilities (MTFs). For years, Congressman Castro’s office has worked to help constituents who faced extraordinarily high medical bills after receiving trauma care at BAMC. In response to these ongoing issues, Congressman Castro secured an amendment in the FY2021 National Defense Authorization Act (NDAA) that provided the DOD with the flexibility to waive civilian medical bills. Despite this flexibility, a July 2022 report from the nonpartisan Government Accountability Office (GAO) found that the DOD has provided very few debt waivers to date. This year, the House passed a Castro-authored amendment to the FY2023 NDAA that would require the DOD to use its flexibility to waive patient bills.

“For years, I’ve worked to help San Antonio families who faced high medical bills after receiving trauma care at Brooke Army Medical Center,” said Congressman Castro. “The GAO's report is damning evidence that this problem goes far beyond San Antonio. It is unacceptable that the Department of Defense is failing to use the flexibility granted under the amendment I passed in 2020 to waive civilian medical bills. These outrageous billing practices need to end. The House recently passed my amendment in the 2023 National Defense Authorization Act to require the Secretary of Defense to waive extraordinary fees for civilians and I urge the Senate to ensure that this amendment is passed into law.”

“No American should struggle to access health care or be forced to take on significant medical debt to get the care they need.” said Senator Warren. “It is essential that the DOD promotes policies to ensure that our nation's health care system provides high-quality, affordable health care that does not lead to debt or bankruptcy or force families to choose between medical care and other necessities.”

The practice of treating civilian patients at military facilities provides significant benefits to the Department of Defense. The July 2022 GAO report noted that “treating civilians is critical for maintaining accreditation for graduate medical education programs,” which is a requirement for Level I Trauma Centers like Brooke Army Medical Center. The report further cited DOD officials who stated that “providing emergency medical care to civilians was beneficial to military readiness because doing so increased MTF case volume and diversity of cases.”

The GAO report found that 67% of the civilian emergency patients who received treatment did not have insurance, leaving them highly vulnerable to massive medical bills. Press and congressional reports of unusually aggressive billing practices by MTFs include more than $28,000 to repair a fractured heel bone, $1.7 million for life-saving treatment for a burn victim, and $210,008.07 plus interest for treatment to repair a ruptured bladder.

The report also found that DOD military treatment facilities were misleading and misinforming the public about their right to seek relief for this debt and revealed that some outstanding debts are likely based on false or incomplete information. Their review found at least 23 percent of patients had been assigned the wrong billing category code. MTFs have tried to establish a patchwork of systems to seek reimbursement through Medicare and Medicaid but have repeatedly encountered billing issues or had claims rejected. 

“These hospitals can be invaluable resources for their communities,” said the lawmakers. “But as the GAO points out, increased financial risk to civilians creates a barrier to further expanding services. MTFs can enhance community relations by clearly communicating available debt relief options to patients and the DOD can help thousands of Americans who have incurred medical debt at these facilities by waiving that debt.”