The New York Times on Tuesday published an investigation into the aggressive legal tactics that U.S. Sen. Roger Marshall routinely used to collect on his patients’ medical debts during his decadeslong career as a Kansas OBGYN.

A Times analysis of Kansas court records found that Marshall sued more than 700 patients over unpaid medical bills. In 81 of those cases, patients were arrested for missing court dates, according to the report, which said Marshall’s attorneys sought warrants in at least 13 other lawsuits.

About half of the lawsuits were filed in Marshall’s name and the other half were filed by Heartland Regional OBGYN, the Great Bend practice that Marshall solely owned from 1998 to 2012 and retained co-ownership of until 2019, The Times reported.

The unpaid bills that Marshall sought to collect ranged from several thousand dollars to $101, according to the report. Court records show that former patients had their paychecks and bank accounts garnished.

The Times reported that Marshall and his practice regularly charged patients an 18% annual interest rate on outstanding bills.

How did Marshall respond?

The account of Marshall’s approach to handling patients’ unpaid bills comes as the first-term Republican incumbent seeks re-election in a race against the Rev. Adam Hamilton, a Johnson County Democrat.

Payton Fuller, a spokesperson for Marshall’s Senate office and campaign, defended the aggressive tactics he used to recoup money from patients as a doctor specializing in pregnancy and childbirth.

Fuller told The Times that Marshall spent decades caring for patients regardless of their ability to pay.

“Judges issue warrants when people repeatedly miss court dates, not doctors,” Fuller said in a statement to The Times.

She said Marshall’s practice “provided millions in uncompensated care” and “used the exact same billing and outside collection procedures as every other business or hospital in Kansas.”

Steven Johnson, a lawyer who often represented Marshall in debt cases, also defended the warrants and arrests of patients as necessary.

“If defendants were allowed to appear only when they wanted to without any consequences, the court would get no business done,” Johnson told The Times.

‘On the extreme side’

The Times interviewed eight people Marshall sued between 2003 and 2015. The news story says most described themselves as living from paycheck to paycheck, meaning they often had to choose between paying medical bills or buying groceries.

Two such patients said the bills Marshall pursued in court stemmed from late miscarriages that required surgery.

Marshall, who spent 25 years as a physician, stopped practicing medicine when he was elected to the U.S. House in 2016. But according to The Times investigation, Marshall’s legal collection work continued until 2021 — five years after Kansas voters sent him to Washington.

Barak Richman, the co-director of the health law program at George Washington University, told The Times that there is “a lot of variation” in how doctors across the country handle unpaid bills — from filing lawsuits to hiring debt collectors or forgiving debts for patients who can’t afford to pay.

“There are a lot that do bring lawsuits but also a whole lot that don’t,” Richman is quoted as saying. “It’s not because they’re in a different position; they’ve just decided they’re not going to do it.”

As insurance deductibles have risen in recent years, more hospitals and doctors have turned to litigation. But Richman, who has studied medical debt litigation in three states, told The Times that wage garnishments and arrests of patients are “definitely on the extreme side.”

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