Medical debt is a major issue in the US, with hundreds of hospitals using aggressive tactics such as lawsuits, selling patient accounts to debt buyers, and reporting patients to credit rating agencies to pursue unpaid bills. These practices are common among all types of hospitals, including public university systems, leading academic institutions, small community hospitals, for-profit chains, and nonprofit Catholic systems. Most of the approximately 5,100 hospitals serving the general public in the US have policies to use legal action or other aggressive tactics against patients. These practices can cause financial hardship for patients, including forcing them to cut back on necessities, drain retirement savings, and make other sacrifices. A recent investigation found that over two-thirds of hospitals sue patients or take other legal action against them, a similar number report patients with unpaid bills to credit rating agencies, a quarter sell patient debts to debt collectors, about 20% deny nonemergency care to people with outstanding debt, and almost 40% do not provide information about their collection activities on their websites. These practices can have significant consequences for patients, such as damaging credit scores and making it difficult to rent an apartment, buy a car, or get a job.