South Carolina hospitals are being accused of charging the highest fees to patients who can least afford the cost — the state’s uninsured.

Lawsuits filed recently in several counties claim three hospital systems — two in Columbia — routinely charge uninsured patients rates that are several times higher than those charged to other categories of patients, such as people covered by Medicare, Medicaid, and private insurance companies.

The lawsuits seek an injunction against the multitiered pricing and cash compensation from:

• Palmetto Health Alliance, which owns three hospitals: Palmetto Baptist-Columbia, Palmetto Richland and Palmetto Baptist-Easley

• Lexington Medical Association, which owns Lexington Medical Center

• Health Management Associates, a Naples, Fla.-based company that runs Gaffney’s Upstate Carolina Medical Center and Hartsville’s Carolina Pines Regional Medical Center.

The lawsuits allege the hospitals charged dramatically different prices for identical health care services.

Palmetto Health spokeswoman Judy Cochett Smith said the hospital system is evaluating the lawsuit.

“We believe our policy and practices are correct,” she said.

Calls to Lexington and Health Management Associates officials were not returned Thursday.

English McCutchen, one of the Columbia attorneys who filed the lawsuits, said up to 10 more suits are likely to be filed next week, following a similar spate of lawsuits filed in more than 20 states.

McCutchen said no dollar amount on the compensation has been set because they are still collecting complaints.

One hospital system — North Mississippi Health Services — recently settled with lawyers out of concern that Mississippi would challenge the hospital’s nonprofit status.

Under the $150 million agreement, the hospital will provide free health care to patients who earn up to twice the federal poverty level, and other patients will receive discounts.

The South Carolina lawsuits claim the hospitals:

• Breached their contractual duty to charge reasonable rates for services and materials

• Breached their duty of good faith and fair dealing

• Unjustly enriched themselves at the expense of the uninsured.

Smith said Palmetto Health considers uninsured individuals as one category of patients, different from insured patients.

“Everybody receives the same charges,” she said. “It’s the payments that are different.”

A lot of negotiation goes into determining the amounts of these payments. Unfortunately for the uninsured, the numbers are not on their side, said Jim Head, interim executive director of the S.C. Hospital Association.

Government-sponsored Medicaid and Medicare programs simply state what will be paid.

“If you decide on sticking with a fixed price for everybody, the insurance company, with its market share, will take its members elsewhere,” Head said.

Palmetto Health’s Smith offered a more succinct answer to why each category of patient — Medicare, Medicaid, insured, uninsured — does not pay the same amount: “That would be called socialized medicine.”

INSTITUTE BLAMES ‘MARKET SYSTEM’

One state, Maryland, sets all hospital rates, and in turn has the lowest costs, according to Don DeMoro, executive director of the Institute for Health and Socio-Economic Policy.

The California-based institute released its annual study of hospital costs nationwide Wednesday, with Maryland lowest on the list. South Carolina ranked among the most expensive states for a variety of health services.

“In Maryland, the rate-setting keeps costs down,” DeMoro said.

DeMoro does not place the high cost of health care solely on the hospitals. “We place the blame on the market system.”

Ten years ago, the largest rollback of federal anti-trust laws was enacted to accommodate increased competition among hospitals. Instead, DeMoro said, the hospital industry has used this freedom to consolidate and raise prices.

“If the market were a viable mechanism, if it were going to work, it would be working,” DeMoro said. “It’s been 10 years.”

Reach Werner at (803) 771-8509 orbwerner@thestate.com.