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I'm familiar with the scenario too. I was the Patient Accounts Manager in a supposedly not-for-profit hospital and it made me sick.

We sued a guy who worked as a dishwasher at the local truck stop and had three kids but when one of the city "elite" would call in and opine that their bill was too high we wrote it off.

As to Charity, that was a joke. Basically, we didn't do up-front charity. Just before people were going to go to collections we LET (not suggested) people fill out charity applications. If they met the poverty guidelines we would write it off to charity. Of course, you might be surprised how many of the "Elite's" college-aged kids fell into that category.

It ended up OK, as I was leaving I turned them in for Medicare fraud and they had to make a settlement.

Good for you! Unfortunately, I doubt that the hospital's malpractice was fully explained to the public -- or even that the local newspaper would have run the story if they had it given them on a silver platter. But sometimes, the curtain parts and the public gets a glimpse.

About a year ago, the Orlando area nearly lost its prime emergency trauma center due to doctor demands for more money, with the largest area nonprofit hospital claiming that it needed a few million more from the taxpayers because it had no money available. After a burst of doctor and hospital contrived publicity, a panel was appointed by the county to find a solution. Contrary to expectations, the panel had a few honest people on it.

It was soon learned that the hospital was flush with cash, with millions in uncommitted reserves, and that the doctors involved were greedy and extortionate in their demands. They were getting more than a thousand dollars a day for simply being on call, and some of them were earning several hundred thousand a year from that and from hospital fees alone, with hundreds of thousands more from private practice. To the extent that the trauma center had suffered losses, it was due to accounting practices and the ever expanding flow of illegal aliens clogging the emergency room.

Why was there a crisis? A handful of doctors were demanding major pay increases. One trauma surgeon who was a leader of the group said that he was entitled to be paid like Michael Eisner and referred to the cost of his new home, his twin engined airplane, and college tuition for his kids. Once the newspaper got the facts out, the doctors settled for much less than they asked for at first and most of that came from the hospital. Absent the news coverage, I have no doubt local and state politicians would have forked over a large chunk of taxpayer cash rather than be blamed for letting the public lose the trauma center.