Private Equity’s Revenue Cycle: Creating and Collecting U.S. Medical Debt

The report details the role of private equity in the U.S. medical debt crisis, specifically through the acquisition and consolidation of revenue cycle management (RCM) companies. It argues that private equity firms create 'end-to-end' service providers that facilitate medical debt through high-interest payment products and then collect that debt using aggressive tactics. The document highlights specific case studies of unlawful collection practices and the use of AI to optimize debt recovery, while calling for increased transparency and legislative protections for patients.

• Medical debt in the United States is a widespread crisis, affecting 14 million people and totaling at least $220 billion.
• Private equity firms have consolidated various functions—including debt collection and medical payment products—into "end-to-end" revenue cycle management (RCM) companies that manage the process from initial patient contact to the collection of delinquent payments.
• Private equity investment in RCM has remained high even during a general downturn in private equity dealmaking, as RCM provides predictable, recurring revenue and opportunities to reduce labor costs through automation.
• Private equity-owned RCM companies facilitate the creation of debt through medical credit cards and installment plans, which can inflate medical bills by nearly 25% due to interest payments.
• Some private equity-owned debt collectors explicitly market themselves as being more aggressive than non-private equity competitors to achieve higher return rates.
• A case study of Providence Health revealed that private equity-owned collectors Optimum Outcomes and Harris & Harris unlawfully collected medical debts from patients who may have qualified for charity care by failing to provide mandatory disclosures.
• Analysis of the CFPB consumer complaint database shows that several private equity-owned collectors, including Receivables Management Partners and CMRE Financial Services, have received hundreds of complaints regarding attempts to collect debts that were not owed or were for the wrong amount.
• The report identifies a trend of using artificial intelligence and machine learning in RCM to predict a patient's propensity to pay and prioritize collection efforts.
• Existing federal and state protections against medical debt are described as inadequate, leading to proposals such as the Medical Debt Cancellation Act and CFPB rules to remove medical debt from credit reports.

APA

Fenne, M. (2024). Private Equity’s Revenue Cycle: Creating and Collecting U.S. Medical Debt. Private Equity Stakeholder Project. https://pestakeholder.org/wp-content/uploads/2024/09/PESP_Report_PE-Revenue-Cycle_2024-compressed.pdf

Chicago

Fenne, Michael. Private Equity’s Revenue Cycle: Creating and Collecting U.S. Medical Debt. Private Equity Stakeholder Project, 2024. https://pestakeholder.org/wp-content/uploads/2024/09/PESP_Report_PE-Revenue-Cycle_2024-compressed.pdf.

Wikipedia

{{cite report |last1=Fenne |first1=Michael |title=Private Equity’s Revenue Cycle: Creating and Collecting U.S. Medical Debt |publisher=Private Equity Stakeholder Project |date=September 2024 |url=https://pestakeholder.org/wp-content/uploads/2024/09/PESP_Report_PE-Revenue-Cycle_2024-compressed.pdf |access-date=23 October 2026 |via=Climate Insights Directory}}

BibTeX

@techreport{fenne2024private, author = {Fenne, Michael}, title = {{Private Equity’s Revenue Cycle: Creating and Collecting U.S. Medical Debt}}, institution = {Private Equity Stakeholder Project}, year = {2024}, month = sep, url = {https://pestakeholder.org/wp-content/uploads/2024/09/PESP_Report_PE-Revenue-Cycle_2024-compressed.pdf}, urldate = {2026-10-23}, note = {Indexed by Climate Insights Directory} }