II 

116TH CONGRESS 

2D SESSION S. 4697 

To amend the Public Health Service Act to provide additional transparency 

and consumer protections relating to medical debt collection practices. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 24, 2020 

Mr. MURPHY (for himself and Mr. VAN HOLLEN) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to provide additional 

transparency and consumer protections relating to medical debt collection practices. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Strengthening Con5 sumer Protections and Medical Debt Transparency Act’’. 

6 SEC. 2. MEDICAL DEBT COLLECTIONS. 

7 (a) IN GENERAL.—Part C of title XXVII of the Pub8 lic Health Service Act (42 U.S.C. 300gg–91 et seq.) is 

9 amended by adding at the end the following: 


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1 ‘‘SEC. 2795. MEDICAL DEBT COLLECTIONS. 

2 ‘‘(a) DEFINITIONS.— 

3 ‘‘(1) IN GENERAL.—In this section: 

4 ‘‘(A) DATABASE.—The term ‘database’ 

5 means the medical debt collection database es6 tablished under subsection (e). 

7 ‘‘(B) DEBT COLLECTOR.—The term ‘debt 

8 collector’ has the meaning as defined under the 

9 Fair Debt Collection Practices Act. 

10 ‘‘(C) EXTRAORDINARY COLLECTION AC11 TION.—The term ‘extraordinary collection ac12 tion’ is as defined for purposes of section 

13 501(r) of the Internal Revenue Code of 1986 

14 (as in effect on the date of enactment of this 

15 section). 

16 ‘‘(D) HEALTH CARE ENTITY.—The term 

17 ‘health care entity’ means an entity defined 

18 pursuant to paragraph (2). 

19 ‘‘(E) MEDICAL DEBT.—The term ‘medical 

20 debt’ means debt arising from a patient’s re21 ceipt of medical services, products, or devices. 

22 ‘‘(2) HEALTH CARE ENTITY.—For purposes of 

23 this section, the Secretary shall develop a definition 

24 of the term ‘health care entity’ that shall include— 


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1 ‘‘(A) nonprofit, for-profit, critical access, 

2 and cancer hospitals, including hospital-owned 

3 facilities; 

4 ‘‘(B) independently licensed outpatient, 

5 ambulatory, behavioral, optical, radiology, lab6 oratory, dental, and emergency departments; 

7 ‘‘(C) physician group practices, with an ex8 emption for small practices, as determined by 

9 the Secretary; 

10 ‘‘(D) physician staffing firms or physician 

11 services companies; 

12 ‘‘(E) any health care agent of an entity de13 scribed in this paragraph; and 

14 ‘‘(F) other entities as specified by the Sec15 retary. 

16 ‘‘(b) REQUIREMENTS AND PROHIBITIONS.— 

17 ‘‘(1) DEBT COLLECTION.—A health care entity, 

18 or its debt collector, shall not commence, or shall 

19 halt, an extraordinary collection action with respect 

20 to a patient if the entity or its designee is notified 

21 by any party that a health insurance appeal is pend22 ing. 

23 ‘‘(2) DETERMINATION OF ELIGIBILITY FOR AS24 SISTANCE.—A health care entity, or its debt col25 lector, shall not commence any extraordinary collecVerDate Sep 11 2014 22:29 Oct 14, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4697.IS S4697

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1 tion actions with respect to a patient until the entity 

2 determines whether the patient qualifies for assist3 ance, either through enrollment in a Federal or 

4 State program or through the entity’s charity care 

5 or financial assistance policy, with respect to such 

6 debt. The entity shall refer such patient to any such 

7 assistance where available. 

8 ‘‘(3) PROHIBITION ON EXTRAORDINARY COL9 LECTION.—With respect to medical debt collection 

10 relating to a patient, a health care entity, or its debt 

11 collector, shall not take any extraordinary collection 

12 actions (including an action described in sections 

13 1.501(r)–6(a)(2) of title 26, Code of Federal Regu14 lations (as in effect on the date of enactment of this 

15 section)) until the expiration of the 180-day period 

16 beginning on the date on which the initial bill is sent 

17 to the patient, or a later date if applicable. 

18 ‘‘(4) PROVIDING INFORMATION TO PATIENTS.— 

19 A health care entity or its debt collector shall pro20 vide a patient with— 

21 ‘‘(A) an easy-to-understand itemized state22 ment of the medical debt owed by the patient 

23 to the health care entity prior to such entity, or 

24 the debt collector acting on behalf of the entity, 


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1 commencing collection activities relating to such 

2 debt; and 

3 ‘‘(B) a copy of the detailed receipts of any 

4 payments made to the entity or its debt col5 lector by the patient relating to the medical 

6 debt involved within 30 days of such payments. 

7 ‘‘(5) LIMITATION ON RECOVERY BY NONPROFIT

8 ENTITIES.—A health care entity that is a nonprofit 

9 entity, or its debt collector, shall not collect amounts 

10 for the medical debt of a patient who is not enrolled 

11 in health insurance coverage, that are in excess of 

12 the amount generally billed, as described in sections 

13 1.501(r)–1(b)(1) and 1.501(r)–5(b) of title 26, Code 

14 of Federal Regulations. 

15 ‘‘(6) REQUIREMENT OF HEALTH CARE ENTITY

16 OR ITS DEBT COLLECTOR.—Prior to commencing 

17 any debt collection activity with respect to a medical 

18 debt, the health care entity or its debt collector shall 

19 make all reasonable efforts to confirm the identity of 

20 the debtor. 

21 ‘‘(7) LIMIT ON MEDICAL DEBT INTEREST.—The 

22 interest rate growth applied with respect to any 

23 medical debt collected under this section shall be set 

24 forth on the initial medical bill, but shall not exceed 

25 5 percent annually or the annual rate set forth 


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1 under section 1961 of title 28, United States Code, 

2 for the calendar week preceding the date of the ini3 tial medical bill plus 2 percent, whichever is lower. 

4 This subsection shall not be construed to limit as5 sistance or a lower interest rate for a patient who 

6 is otherwise eligible for financial assistance. 

7 ‘‘(c) PENALTIES.—Except as provided in this section, 

8 a health care entity, or its debt collector, that fails to com9 ply with any provision of this section with respect to a 

10 patient shall be liable to such patient for damages in an 

11 amount equal to the sum of— 

12 ‘‘(1) any actual damages sustained by such pa13 tient as a result of such failure to comply; 

14 ‘‘(2) in the case of an action commenced— 

15 ‘‘(A) by an individual, any additional dam16 ages as the court may permit, but not to exceed 

17 $1,000 for each failure to comply; or 

18 ‘‘(B) by a class of patients— 

19 ‘‘(i) such amount for each named 

20 plaintiff as could be recovered under para21 graph (1) and subparagraph (A); and 

22 ‘‘(ii) such amount as the court may 

23 allow for all other class members, without 

24 regard to a minimum individual recovery, 

25 not to exceed the lesser of $2,000,000 or 


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1 1 percent of the annual net income of the 

2 covered provider; and 

3 ‘‘(3) in the case of any successful action under 

4 this section, the costs of the action, together with a 

5 reasonable attorney’s fee as determined appropriate 

6 by the court. 

7 ‘‘(d) ESTABLISHMENT OF DATABASE.— 

8 ‘‘(1) IN GENERAL.—The Secretary shall estab9 lish and regularly update a medical debt collection 

10 public database. 

11 ‘‘(2) REQUIRED INFORMATION.—Not later than 

12 12 months after the date of enactment of this sec13 tion, and annually thereafter, a health care entity 

14 shall submit to the database a debt collection report 

15 that shall include— 

16 ‘‘(A) the name and contact information of 

17 any debt collector owned, utilized, or retained 

18 by the entity or to which the entity assigned or 

19 sold medical debt during the year; 

20 ‘‘(B) a description, or link to such descrip21 tion, of the processes and policies of the entity 

22 for assigning a medical debt to the debt col23 lector and for compensating such collector for 

24 services provided to the entity; 


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1 ‘‘(C) the type and number of extraordinary 

2 collection practices the entity, or debt collector 

3 reported by the entity pursuant to subpara4 graph (A), undertakes or seeks to undertake, 

5 such as wage garnishment, bank account at6 tachments, liens, arrest warrants, reporting to a 

7 consumer reporting agency, and lawsuits; 

8 ‘‘(D) the breakdown, by zip code, of med9 ical debt collection accounts referred to a debt 

10 collector; 

11 ‘‘(E) the recovery rate on medical debt col12 lection cases assigned to the debt collector, as 

13 defined by the Secretary; 

14 ‘‘(F) the number of bills paid using a cred15 it card; and 

16 ‘‘(G) any other information determined ap17 propriate by the Secretary. 

18 ‘‘(3) AVAILABILITY OF INFORMATION.—The in19 formation contained in the database shall be avail20 able on a public, searchable internet website regu21 larly updated by the Secretary. The Secretary shall 

22 annually publish a public list on HHS.gov of any 

23 health care entity that fails to submit such required 

24 information. 


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1 ‘‘(4) CFPB REPORT.—Not later than 12 

2 months after the expiration of two annual reporting 

3 periods under paragraph (2), the Director of the 

4 Consumer Financial Protection Bureau shall submit 

5 to Congress a report containing an analysis of the 

6 reports submitted under that paragraph and an ex7 planation of whether the findings based on the data8 base under this subsection are a useful tool for the 

9 agency’s Supervision of Nondepository Covered Per10 sons, including the Risk-Based Supervision Program 

11 (under section 1024 of Public Law 111–203). Such 

12 report shall include recommendations to improve the 

13 disclosures by health care entities for the purposes 

14 of supervising the medical debt industry, including 

15 for predictive analytics, machine learning, or other 

16 analysis techniques used in its Risk-Based Super17 vision Program.’’. 

18 (b) CFPB REPORT.—Not later than 12 months after 

19 the date of enactment of this Act, and every 2 years there20 after, the Consumer Financial Protection Bureau shall 

21 publicly report on medical debt collections, incorporating 

22 data from the medical debt collection public database es23 tablished pursuant to section 2795(a) of the Public Health 

24 Service Act, anonymized data from the three largest credit 

25 bureaus, the Consumer Financial Protection Bureau dataVerDate Sep 11 2014 22:29 Oct 14, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4697.IS S4697

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1 base of consumer complaints, information from the Con2 sumer Financial Protection Bureau’s Supervision of Non3 depository Covered Persons program including the Risk4 Based Supervision Program, and relevant complaints and 

5 information from other sources as available. 

Æ 


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