ACA International Responds to CFPB Report on Medical Debt

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03/01/2022 5:00 P.M.

For Immediate Release

Contact: Anne Rosso May

Communications Director

ACA International

[email protected]

Washington, D.C. – March 1, 2022 – The Consumer Financial Protection Bureau has released a report about medical debt.

The members of ACA International (ACA), the association of credit and collection professionals, work tirelessly to provide solutions and advocate on behalf of patients and medical providers to get insurance companies to pay the benefits that patients have paid for and are entitled to receive.

ACA represents approximately 2,100 members, including credit grantors, third-party collection agencies, asset buyers, attorneys, and vendor affiliates, in an industry that employs more than 125,000 people worldwide. Most ACA member debt collection companies, however, are small businesses.

The CFPB’s report references the No Surprises Act. However, the CFPB’s research misses the mark by not addressing the serious systemic problem of insurance companies not paying claims in some instances. Congress, in the No Surprises Act, focused on the need for insurance companies to do a better job paying claims for medical care provided, and not surprising patients with unjustified out-of-network bills.

“We stand with the CFPB in our desire to not have a consumer’s credit report include bills that should have been paid by insurance companies. However, the report does not focus on the significant problems with insurance companies’ claim payment processes,” said Jack Brown III, an ACA International board member and president of Gulf Coast Collection Bureau Inc. “Instead, the research attempts to place blame on medical providers, who have served on the front lines of the pandemic, and the debt collectors who support their work.”

The bureau’s research unfortunately focuses on the back end of the credit cycle and gives consumers a false impression that the debt collection industry is responsible for billing issues that occurred on the front end, contrary to the explicit goals of the No Surprises Act.

While the CFPB estimates in its report that there is $88 billion in medical bills on consumers’ credit reports, the report lacks attention and context to the stringent processes health care providers and debt collectors have in place to resolve a payment through an open dialogue and ensure it is accurate before it is placed on a consumers’ credit report—all with the goal to help that consumer.

The report cites outdated information, anecdotes, and unquantifiable research that is not peer reviewed.

ACA is committed to finding solutions to problems based on real data and working with all constituents.

“ACA members are committed to helping consumers resolve their legally owed debts in a respectful and responsible way, which in turn helps create a sustainable marketplace where medical care can be provided to those in need,” said ACA CEO Scott Purcell.

“The CFPB’s research does not seem to grasp the existing infrastructure related to medical debt that has strong safeguards for consumers to dispute any amounts that are in question or that they feel they don’t owe. If a consumer disputes a bill, there are procedures in place to ensure credit reporting is paused while the issue is being resolved,” Purcell said. “There are also controls in the communication of the debt well in advance of any credit reporting through Regulation F and its predecessor rules.”

In fact, Purcell said, “credit reports that do not account for financial obligations, including past-due medical bills, increase the chance of future credit grantors extending credit that a consumer cannot afford—and that will drive increases in bankruptcies, stress and additional costs for consumers, and inappropriate losses to credit grantors.”

Credit reporting is also the last tool used after all other efforts are exhausted to help patients, which the CFPB references in the report through its support of recent changes by the U.S. Department of Veterans Affairs “that will reduce financial distress for veterans by requiring all other methods of debt collection to be exhausted before a veteran’s bill is reported to the credit reporting agencies,” according to the CFPB.

The Department of Veterans Affairs’ process aligns with the work of ACA members to wait to use credit reporting procedures until other account resolution options are used.

This is also consistent with the IRS’ Regulation 501(r), which classifies credit reporting as an extraordinary collection activity.

The CFPB’s report describes patients being stuck in the middle of disputes between medical providers and insurance companies.

Notably, ACA member companies that work in medical debt collections are committed to providing valuable account management resources to many health care providers, including in rural and urban communities that would not be able to continue without their support.

As part of that commitment, ACA staff and members were part of the Healthcare Financial Management Association Medical Accounts Receivable Resolution Task Force, which included consumer groups, that reconvened in 2020 to update best practices for the fair resolution of patients’ medical bills and address financial assistance policies in response to the COVID-19 pandemic and potential future public health emergencies.

These best practices put even stronger guardrails around the credit reporting process.

The report from the HFMA and ACA reflects the task force’s consensus on the current state of best practices related to the equitable resolution of the patient portion of medical bills. It includes procedures for credit reporting that ensure compliance with 501(r) and recommends that health care providers and their collection partners have processes in place for consumer accounts tied to uncompensated care.

“With the Affordable Care Act, we as a society enhanced free medical care for lower-income Americans by ensuring the funds that would have been used to pay taxes for nonprofit providers get used to provide free or reduced-cost medical care,” Purcell said. “We’re in agreement there are improvements to make, but the focus should be on better communication to consumers with income typically below 400% of the Federal Poverty Level ($111,000 a year for a family of four in 2022) about the benefits they already have under the Affordable Care Act.”

Lastly, it is worth noting that the CFPB’s report makes some broad assumptions about COVID-19 that ACA members have not seen reflected in the marketplace. ACA members have not reported a significant increase in debt related to care for COVID-19 treatment or testing. ACA is sympathetic to consumers if government programs or policies in the myriad of COVID-19 relief legislation have failed and instead increased joblessness or led to less insurance coverage. However, COVID-19 relief legislation was passed with the stated purpose to limit or eliminate costs for expenses such as COVID-19 testing, and the 2014 501(r) regulation has also ushered in an even stronger safety net for medical care for the uninsured in unexpected situations.

“The CFPB needs to tell the whole story in connection with this report and research the practices of insurance companies just the same as researching the work of health care providers and debt collectors,” Purcell said.


ACA International (ACA), the association of credit and collection professionals, is the largest membership organization in the accounts receivable management industry. Founded in 1939, ACA brings together third-party collection agencies, law firms, asset buying companies, creditors and vendor affiliates representing industry professionals. ACA produces a wide variety of products, services and publications, including educational and compliance-related information; and articulates the value of the accounts receivable management industry to businesses, policymakers and consumers.

If you have executive leadership updates or other member news to share with ACA, contact our communications department at [email protected]. View our publications page for more information and our news submission guidelines here.




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