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Attorney General Lori Swanson wants Minnesota hospitals to refund sexual violence victims who have been unlawfully charged for physical exams.

On Friday, Swanson sent a letter to health care providers across the state reminding them that billing rape victims for exams violates the law. She also asked hospital administrators to respond to a list of questions about their billing and treatment practices, which her office will use to identify hospitals that have been inappropriately billing and help the victims seek repayment.

Swanson's letter follows the publication of a state report that found major inconsistencies in how Minnesota hospitals treat sexual assault victims.

State and federal laws mandate that counties are responsible for picking up the charges for sexual assault exams, and hospitals can only bill a victim's insurance provider with consent. But more than half of professionals interviewed for the study, conducted by the Minnesota Coalition Against Sexual Assault, said they knew of patients being charged for exams. Many responders also said they've seen underserved populations — such as LGBT, Native American or non-English speakers — receive inadequate care when seeking health services for sexual abuse.

"Victims of sexual assault have already suffered a heinous act, and the reason we have these state and federal laws is to protect victims from having to finance treatment," Swanson said. "I was very troubled with the thought that we have these laws out there to protect victims and that hospitals might not be complying with them."

The survey, which included interviews with 139 people, such as medical practitioners and law enforcement, concluded there's a vast misunderstanding of procedures among some health care practitioners. For example, about one-third of survey respondents said they don't know the law well enough to definitively tell victims they will not be charged for an exam, according to the study.

Swanson said she hopes her letter will clarify proper practices. Laws around billing exist both to shield these victims from spendy hospital costs and to encourage them to assist in the arrest and prosecution of sexual assault perpetrators, she said.

"To do that, you need victims to come forward in the first place," said Swanson. "And anything that can be a chilling impact on victims from coming forward is troubling."

'We can do better'

After the coalition released its report, the Minnesota Hospital Association, which represents health care providers across the state, sent an alert to its members urging them to read the study, and reminded them of laws regarding billing patients, said association spokeswoman Wendy Burt.

"We're disappointed that we're falling short on some of the areas that the report highlighted," said Burt.

The hospital association also reiterated to health care practitioners that victims are not required to report an attack to law enforcement before they can conduct an exam — another bad practice highlighted in the report.

Burt said the hospital association helped the sexual assault coalition conduct the study, and it will continue to work with the organization on how best to improve practices, including providing better training to nurses who conduct the exams.

"We're appreciative to MNCASA for highlighting the disparities, and we do need to provide consistent and compassionate care to victims of sexual assault," she said. "They're vulnerable patients and we take this very seriously. We can do better and we need to better."

Andy Mannix • 612-673-4036