Sen. Roger Marshall's obstetrics practice sued more than 700 patients over unpaid bills

Sen. Roger Marshall, M.D. (R-Kansas), and the obstetrics practice he owned filed debt-collection lawsuits against more than 700 former patients over roughly two decades, and 81 of those patients were arrested after missing court dates, according to a New York Times analysis of Kansas court records published Sept. 8.

The contract patients signed at the practice carried an 18% annual interest rate on unpaid balances. The practice's lawyers garnished paychecks and bank accounts, and the balances at issue ran from $101 to several thousand dollars.

About half the suits were filed under Marshall's name and the rest under Heartland Regional OBGYN, which he owned outright from 1998 to 2012 and co-owned through 2019. He stopped practicing after winning a House seat in 2016. Collection work on some accounts continued while he served in the House, and he is on the ballot again in November.

Where the physician's decisions ended and the law firm's began

Payton Fuller, a spokesperson for Marshall's campaign, said in a statement that "judges issue warrants when people repeatedly miss court dates, not doctors," and that Marshall treated every patient who came through the door regardless of ability to pay.

Court records cited by the Times show Marshall's lawyers filed dozens of briefs requesting warrants, arguing that defendants had refused to obey court orders.

Steven Johnson, an attorney who often represented Marshall in the collection cases, said Marshall was not involved in decisions about when to seek warrants, arrests or garnishments, but that Marshall set the 18% rate in the contract patients signed. Marshall's office did not answer a question about who set the rate.

Meischa Zimmerman said she was told the $3,596 bill from her 2009 delivery had grown past $7,000 with interest. She was arrested three times over it, the last in 2016.

The rate that got it there was on the form she signed at the practice; the filings, judgments and warrant requests came from a law firm, some of them years later.

How often do physicians actually sue patients?

Neale Mahoney, a Stanford University economist, said his research in one state found roughly 1.7% of hospital stays ended in litigation against the patient.

Barak Richman, co-director of the health law program at George Washington University, has studied medical debt litigation in three states; he said physicians vary widely in how they handle unpaid balances, and called garnishments and arrests "definitely on the extreme side."

Marshall introduced the Patients Deserve Price Tags Act with Sen. John Hickenlooper (D-Colorado) in July 2025, legislation requiring hospitals, ambulatory surgery centers, imaging centers and clinical labs to publish negotiated rates and cash prices.

The bill would bar hospitals that do not post their prices from suing patients, the Times noted. It advanced out of the Senate Health, Education, Labor and Pensions Committee in July.

The balances practices cannot collect keep growing

Insured patients were responsible for 7.3% of their bills in 2025, up from 6.8% in 2024, while providers collected 42.4% of what those patients owed, down from 45.1% the year before, according to Kodiak Solutions' "State of the healthcare revenue cycle" report.

The median bad debt rate rose from 1.1% to 1.3% over the same period, and the 2,300 hospitals in the analysis lost more than $48 billion to final denials and uncollected patient balances, up from $38.6 billion in 2024.

Matt Seefeld, CEO of revenue cycle technology company MedEvolve, described the arithmetic behind those write-offs in a Q&A with Physicians Practice.

A workup that would once have produced a manageable bill now lands on a patient with a high-deductible plan, he said. "So either I pay you $100 a month for five years, or you write it off, and that's what we're seeing. Bad debt is really accelerating."

Jack Feltz, M.D., president and a founding member of the U.S. Women's Health Alliance, said rising copays and deductibles are pushing patients toward debt they cannot discharge, and that "the leading cause of bankruptcy in America is health care debt."

Feltz, whose group represents about 5,000 private-practice women's health clinicians across 37 states, made the remarks in an Off the Chart episode on the payment gap between office-based and hospital outpatient care.

A practice with payroll, rent and malpractice premiums cannot treat an uncollected balance as community benefit the way a tax-exempt hospital can, Richard Menger, M.D., MPA, a neurosurgeon, wrote in Forbes on Wednesday.

One can question the tactics, he added, "without arguing that physicians must work for free."

Barton County, where most of the suits were filed, has above-average poverty and uninsured rates. Kansas remains one of 10 states that has not expanded Medicaid under the Patient Protection and Affordable Care Act, and the state's income cap for pregnancy coverage has long been among the lowest in the country, according to the Times analysis.

How much interest can a practice charge on an unpaid bill?

Virginia now caps interest on medical debt at 3% a year and bars any charge at all until 90 days after the final invoice comes due. Rhode Island tied its ceiling to the one-year Treasury yield and capped it at 4%, replacing a 12% post-judgment rate. Marshall's contracts charged 18%.

Maryland also moved to limit interest on unpaid medical bills, and it now prohibits lawsuits over balances of $500 or less. Virginia and Rhode Island have banned wage garnishment and liens on primary residences for medical debt, according to a Commonwealth Fund analysis by researchers at Georgetown University's Center on Health Insurance Reforms.

Virginia's statute reaches large health care facilities and medical debt buyers rather than every independent practice, and Rhode Island's cap applies only to debt incurred after the law took effect.

A collection policy written a decade ago in a state that has since capped interest or restricted garnishment is not the policy the practice thinks it has.

Before a bill becomes a debt

In Experian Health's 2026 State of Patient Access Survey, which polled more than 200 providers and 1,000 patients, 93% of practices said patients struggle to pay at least occasionally and 63% of patients said they would feel more confident if offered a tailored payment plan.

Another 73% of providers said patients delay or forfeit care when they cannot get a cost estimate up front.

"That's not a revenue problem; that's a public health problem," Mindy Fortson, chief operating officer at Experian Health, said in an interview with Medical Economics.

On the share of practices reporting patients who cannot pay, Fortson pointed to employers shifting more cost onto employees and to unresolved questions about Medicaid enrollment. "I'm not sure that those headwinds are going to go away."

The Commonwealth Fund expects the pressures that generate medical debt to intensify in 2026 as enhanced ACA premium tax credits expire and Medicaid and marketplace funding contracts.

The balances arriving at practices next year will be larger and harder to collect than the ones arriving now. What happens to them after 90 days is a decision each practice has already made in writing, whether or not anyone has read it lately.