WASHINGTON (By Reed Abelson and Jonathan D, Glater, NYTimes) June 17, 2004 - A group of plaintiffs' lawyers filed civil lawsuits against more than a dozen nonprofit hospitals across the country yesterday, contending that the hospitals violated their obligation as charities by overcharging people without insurance and then hounding them for the money.

The complaints name some of the largest hospitals in the Chicago, Atlanta and Minneapolis metropolitan areas. More lawsuits are expected to be filed, said Don Barrett, one of the lawyers involved in the cases. "It is part of a coordinated attack on this reprehensible practice," he said.

The lawyers, some of whom were involved in litigation against the tobacco companies in the 1990's, are calling for the creation of a trust that would be financed by the hospitals and would provide affordable medical care for those without insurance. Because the hospitals have tax-exempt status and other benefits as nonprofit organizations, the lawyers argue that they have an obligation to provide affordable care to the uninsured.

Hospitals' billing and collection practices have emerged as a controversial issue over the last 18 months as many hospitals have come under sharp criticism for charging people without insurance significantly more than they charge those insured, and then aggressively seeking to collect payments from those people.

"It has brought on them the wrath of the community over their tax exemption," said Dr. Uwe E. Reinhardt, a professor of economics and public affairs at Princeton University.

The suits were filed in federal courts perhaps because they cite federal laws that govern health insurance. The lawyers are seeking class-action status on behalf of uninsured patients who they say should have received affordable care but did not.

The lawyers also say the hospitals are sitting on large, untaxed sums that should help pay for care for the uninsured. Some hospitals are described in the suits as being among the most profitable hospital systems in the nation with hundreds of millions, even billions, in assets and revenue.

But the hospitals say they are not responsible for the plight of the uninsured. And they say that in seeking repayment by people without insurance, they are not charging unfairly high rates but are simply charging prices that do not reflect the negotiated discounts obtained by insurance companies and health maintenance organizations. Many say they are reviewing their billing and collection practices.

The lawsuits are "baseless and misdirected, diverting focus away from the real issue of how we as a nation are going to extend health coverage to all Americans," said Alicia Mitchell, a spokeswoman for the American Hospital Association, a trade group in Washington.

There is little doubt that people without insurance are frequently charged the highest prices for care. The uninsured do not benefit from the ability of an insurer, health plan or large employer to negotiate low prices for care, and hospitals have typically charged their list price to people without insurance.

One suit filed in Chicago named Provena Health. "While Provena gives private insurance companies and governmental third-party payers like Medicare and Medicaid large discounts off this gross or 'sticker price,' '' the suit said, "all of its uninsured patients are charged 100 percent of the full sticker price, which is two to three times more than Provena charges its insured patients for the same service."

The lawsuit claims that Provena each year charges uninsured patients at least $50 million more than its insured patients. The suit does not indicate, though, what portion of the hospital's patients are insured.

"In reality, Provena is anything but charitable," the lawsuit said. "While it promises to provide affordable care to the uninsured poor, Provena has and continues to engage in a practice and pattern of charging inordinate, unreasonable and inflated prices for medical care to its uninsured patients."

No one from Provena could be reached late yesterday for comment.

Provena, like some other hospital chains around the country, is already facing scrutiny from regulators. Earlier this year, Illinois revoked the tax-exempt status of one of its hospitals for, among other reasons, not providing enough charitable care.

Other state attorneys general have cited similar practices in bringing lawsuits against some nonprofit providers. In Connecticut, the attorney general, Richard Blumenthal, brought a suit against Yale-New Haven Hospital. In New York, hospitals' handling of uninsured patients is an issue of concern to Eliot Spitzer, the state's attorney general, said Christine Pritchard, a spokeswoman for his office.

"The office has received complaints from uninsured individuals related to debt collection for their hospital care," Ms. Pritchard said. "It is of concern to our office, and we would encourage any individual in a similar situation to contact our consumer help line."

The lawsuits filed yesterday describe aggressive efforts by the hospitals to obtain payment from uninsured individuals without the means to pay.

The suit filed against Advocate Health Care Network of Oak Brook, Ill., for example, asserts that Jannie Watts, one of the plaintiffs, "received numerous threatening and harassing phone calls" seeking payment of $48,008.47 for treatment of her uninsured teenage son, a bystander to a shooting who was hit by multiple gunshots in 1998.

Similarly, in a suit brought against Allina Health System in Minneapolis, the plaintiff, Paul Kern, argues that he had no insurance and thought his care was free. Instead, the suit says, he was billed the full cost of the care and he turned to a credit counseling service, which was unsuccessful in its attempts to negotiate with the hospital on his behalf for better terms.

A spokeswoman for Allina said the hospital had not seen the lawsuit and could not comment.

Hospitals say they can ill afford to finance free health care. Many say that they are struggling financially and that whatever assets they have they need to invest in improving the quality of care. These lawsuits would drain already limited resources, said Ms. Mitchell of the hospital association.

The issue of hospitals' treatment of the uninsured is likely to continue drawing attention from lawyers and policy makers, said Eugene E. Elder, a lawyer in the Washington office of Akin Gump Strauss Hauer & Feld who has represented hospitals. As more people have direct experience with the high price of hospital care, he said, they are sympathetic to those with medical bills they cannot pay. "More and more people have become sensitized to that," he said, "and it's easy to get outraged."

It is unclear how strong the new legal cases will prove to be, said Samuel Issacharoff, a professor at Columbia Law School who has worked with both plaintiff and defense lawyers. "There are a couple of moving parts that are hard to define," Mr. Issacharoff said. "What is the legal obligation to provide charity care?"

Determining exactly who should have been charged less or received treatment free may be difficult, he said, and deciding how much money they should have been charged for treatment may be equally complex. "This is a terribly complicated issue," Mr. Issachroff said.