Confluence Health has refunded more than $1.8 million to patients following an investigation by the Attorney General’s Office. The investigation found that Confluence repeatedly failed to refund patients who paid for hospital care but were eligible for charity care. Today, the AG’s office filed an agreement with Confluence that ends the investigation and ensures the hospital system will follow the law going forward.

“Our charity care laws protect Washingtonians who would otherwise face crippling medical debt or have to choose between financial security and their health,” said Attorney General Nick Brown. “Thanks to the work of our staff and Confluence’s willingness to cooperate we were able to get thousands of people the refunds they deserve without resorting to litigation.”

Washington’s Charity Care Act requires that hospitals make financial assistance available for low-income patients to help with their out-of-pocket medical costs. The act was first passed in 1989, but in 2022, Washington amended it to greatly expand the number of people eligible for financial assistance to an estimated 4 million Washingtonians. Financial assistance varies based on income and the size of a hospital, with the largest hospital systems in the state being responsible for providing more financial assistance than smaller ones. Many hospitals require patients to apply for charity care to verify their eligibility, but some patients make payments toward their bill before they apply for charity care. If a patient pays their bill but the hospital later approves their application for charity care, the hospital is required to refund the money paid.

Confluence operates two hospitals in Central Washington. Though many medical providers offer some form of financial assistance or charity care at their clinics, the Charity Care Act and the AG’s investigation relate only to hospital care. The AG’s office began investigating their billing practices in 2024 and found that since 2021, thousands of patients at these hospitals had made payments toward their bill before they applied for charity care, but Confluence failed to refund them when their application was approved. Confluence found that they had failed to refund 4,729 patients and began issuing refunds with 12% interest, which eventually totaled more than $1.8 million.

The agreement the AG’s office filed today acknowledges Confluence’s work to refund their patients and ends the investigation without litigation. The agreement also ensures that Confluence will follow the Consumer Protection Act in the future and give patients the financial assistance they deserve.

For more information about Washington’s medical financial assistance law, including tools to see if you qualify, visit https://www.atg.wa.gov/charitycare.

Read the agreement here. 

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