(ABC 6 News) – Minnesota attorney general Keith Ellison announced Friday that he settled with Mayo Clinic over charity care and debt-collection procedures that allegedly violated its responsibilities as a nonprofit hospital.

As a nonprofit hospital, Mayo Clinic receives tax breaks in exchange for, presumably, contributing to the community.

According to the AGO’s findings, Mayo Clinic put up barriers for patients who were eligible for charity care, making it difficult to access.

Patients like Roger Daniel, from Mabel in Fillmore County, who had to seek emergency care last year for high blood pressure.

Homeless and uninsured at the time, Daniel was able to sign up for the state health insurance program, MNSure.

That covered the cost of the emergency trip, and was supposed to cover the cost of a follow up appointment with a cardiologist the doctors wanted him to schedule.

Daniel did just that, but within 24 hours, he says he received a phone call from Mayo’s billing office.

“They looked it up and said I don’t have insurance,” he said. “So I told them that there’s a number that they’re supposed to call and all they wanted was a $2000 deposit for me to be able to see the cardiologist.”

Daniel decided then to not follow up with the Mayo cardiologist, and got help from a doctor through the Olmsted Medical Center instead.

He says the experience has left him distrustful of doctors, particularly those at Mayo Clinic.

Mayo also sued patients who were unable to pay their bills, according to the AGO’s report which was ” in contravention of the Minnesota Hospital Agreement and its charitable mission and values,” according to the AGO’s office.

“The Attorney General’s investigation found that Mayo failed to live up to its obligations under the Hospital Agreement and its charitable purpose by steering patients away from charity care, in some cases instructing its staff to avoid discussing charity care and instead ask patients to take out a loan or borrow from a family member to pay their medical bills,” a statement from the AGO’s office reads. “Mayo also maintained a burdensome charity care application that deterred otherwise eligible patients from seeking such care, engaged in overly aggressive debt collection practices, and delayed or denied medical care to patients with outstanding medical debt.”

Ellison claimed Friday that as a result of the office’s investigation, Mayo Clinic provides more charity care in 2024 than in the last 5 years.

“Our investigation also revealed shortcomings in the charity care system generally, and I hope lawmakers will consider my office’s recommendations to address those shortcomings and help more Minnesotans get the care they need to be well,” Ellison wrote in a statement.

Attorney General Ellison will attend community forum in Rochester on Saturday, March 15.

Anyone interested in attending is encouraged to RSVP online.

Ellison’s full report is embedded below.

Mayo Clinic released the following statement:

Mayo Clinic reached an agreement with the Minnesota Office of Attorney General (MN OAG) validating our longstanding commitment to ensuring all patients have access to the care they need, regardless of financial circumstances. 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. The settlement does not require Mayo Clinic to change any current policies or practices. As part of the settlement, Mayo Clinic agreed to continue policies and practices that it began long before the settlement was reached. The agreement also does not include any financial restitution or penalty by the MN OAG, which they have imposed in other cases. As noted by the MN AOG, its public report “does not constitute a legal opinion or reflect a formal determination by the Attorney General.” Mayo contests many of the findings reflected in the report, and Mayo did not agree to include them in the settlement agreement that is formally filed with the court, because those findings are inaccurate, speculative, or are irrelevant to applicable legal requirements.

Mayo Clinic offers financial assistance programs for patients who are unable to pay, and patients may apply for financial assistance at any point prior to services, during care, and after care has been provided. Mayo Clinic communicates the availability of financial assistance on its website, when patients first register for care, and in all billing statements and related letters and offers free financial counseling to uninsured or underinsured patients.

The agreement also reflects that Mayo Clinic has voluntarily adopted practices that support patients who are facing financial challenges. For example, since 2023 Mayo Clinic has expanded the practice of “presumptive eligibility,” in which qualifying patients receive financial assistance without needing to complete a financial assistance application. Since 2019, Mayo Clinic locations in Minnesota have provided over $600 million in financial assistance to patients.

Mayo Clinic continuously evaluates and updates its practices to best serve patients and the community.