New York, N.Y. -- The Office of Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued a favorable decision – Advisory Opinion #20-04 – in response to a request filed by RIP Medical Debt (RIP), a national nonprofit. The request was for the OIG to review a proposed expansion of RIP’s mission-driven medical debt forgiveness program.

The OIG’s Advisory Opinion states it will not impose sanctions under federal anti-kickback or civil monetary penalty laws when RIP works with health systems and large physician groups that donate or sell certain unpaid patient accounts (i.e., bad debts) to RIP. After acquiring an account, RIP abolishes the patient’s financial liability and rehabilitates their credit score.  

“We are excited by this development and look forward to growing our ability to provide economic relief to even more families through the removal of medical debt,” says RIP’s Executive Director, Allison Sesso. “Through this transformative opinion, hospitals and health systems can now expand their healing reach to include their patients’ financial health – a known determinant of physical and mental wellbeing.” 

RIP is a national 501(c)(3) organization founded in 2014 for the sole purpose of eliminating the medical debt burdens of low-income individuals with limited capacity to pay their medical bills. The model leverages even small donations from people across the country to abolish outstanding medical debts. To date, RIP has purchased medical debt accounts only from commercial debt buyers on the secondary debt market. These debts originated from hospitals and physician groups which sell their accounts receivable to commercial debt buyers. RIP acquires, and then forgives, these debts.  

RIP provides relief to individuals with incomes at or below two times the federal poverty level, whose medical debts are five percent or more of their gross annual incomes or who are insolvent. (Individuals cannot apply to have their debts abolished.) Until now, RIP has acquired delinquent accounts that meet these criteria for relief only when those debts have been available on the secondary debt market.  

Now that the OIG has issued Advisory Opinion #20-04, RIP Medical Debt will begin obtaining debt directly from health systems and large physician groups, vastly expanding the number of families benefiting from the work of RIP. Over the next several months, RIP will ramp up its direct engagement with providers. To inquire about working with RIP Medical Debt as a hospital, health system or independent physician’s group with more than 50 members, please contact RIP’s Director of Debt Acquisition & Relief, Mike Toth at or 832-717-2879. 

“Partnering directly with providers – especially health systems and hospitals – allows RIP to help resource-challenged individuals sooner than we can now. Our vision of removing hardship for the highest number of people is now in sight,” says Craig Antico, RIP’s co-founder and Director of Debt Operations. “I'm grateful the OIG sees our value and is giving their green light for hospitals and physicians to donate or sell debts owed by the poor and those in hardship directly to RIP.”  

The massive and growing problem of medical debt in America, and RIP’s charitable efforts, were most publicly highlighted on an episode of John Oliver’s HBO show Last Week Tonight when the late-night host worked with RIP to eradicate $15 Million of medical debt. The nonprofit has also collaborated with numerous pro-athletes, WeTransfer, NBC Universal and many others. Its work has been covered by Good Morning America, The New York Times, Associated Press, CNN, Fox News and many other outlets.  

“We believe the Advisory Opinion will provide an important measure of comfort to hospitals and health systems and large group practices,” says RIP Board Member and Nixon Peabody Partner Michele Masucci. “Now they can donate their qualifying medical debts to RIP consistent with compliance considerations and it will clear the path to creating a positive impact on patients challenged by current health care conditions.” 

Medical debt causes wide-ranging damage, from preventing people from seeking the care they need and filling their prescriptions to blocking access to jobs, housing and loans when employers, landlords and banks check credit ratings.   

About RIP Medical Debt

Since being founded in 2014 by two former debt collectors, RIP Medical Debt has acquired, and abolished, more than $2.5 billion of oppressive medical debt, helping over 1.5 million individuals get out from under the burden of crushing medical debt. On average, one dollar donated to RIP forgives $100 of medical debt, empowering every donor to have an outsized impact. To learn more, visit or reach out to Daniel.

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