An investigation by New York’s attorney general found that the Brooklyn Hospital Center improperly billed dozens of patients for the cost of forensic rape exams.

The exams, known as rape kits, are required by state law to be free of cost to patients. Attorney General Eric Schneiderman’s office said Tuesday that between January 2015 and February 2017, the hospital conducted 86 forensic rape exams. It billed the patient or her insurance plan in 85 of those cases, without revealing that the exam could be free.

Schneiderman said he launched the investigation after one victim complained that she had been billed seven times for a forensic rape exam performed at the hospital’s emergency room. After receiving the initial bill, the patient contacted a victim’s assistance organization, which reached out to the state’s Office of Victim Services, which told the hospital that the state should be billed. A month later, the patient got a bill from a collection agency.

“These kits are used on what is undoubtedly one of the worst days of a survivor’s life,” Schneiderman told The Associated Press. “The absolute last thing they should have to worry about is how they’ll pay for their care at the hospital. But we have found contrary to law that way too often they do have to worry.”

Schneiderman said the state had reached a settlement with the Brooklyn hospital, which dictates that the hospital maintain a Sexual Assault Victim Policy that prevents improper billing and provide full restitution to those who should not have been billed. He said he had also sent letters to 10 other hospitals in the state, seeking information on their policies.

The Violence Against Women Act, reauthorized by Congress in 2005, requires that the full out-of-pocket costs of sexual assault medical forensic exams be covered by a state or other entity, as a condition of receiving federal grants through a program called STOP. That program provides funding for law enforcement and prosecutions in combating violence against women as well as for victim services. Victims cannot be required to file law enforcement reports to receive free exams.

New York is not the only place where victims have been improperly billed. CBS News reported in 2014 that victims in 13 states said they had been billed for medical services related to a sexual assault. A victims’ advocate organization in Chicago told CBS it got as many as six calls a month from rape victims who had been wrongly billed.

In 2014, the Urban Institute published a study on how the funding for sexual assault exams is handled by states. “In practice, each state (or local jurisdiction, in the case of non state-level paying systems) decides what it will cover as part of the free exam,” the report found. “Some states cover only what is required by federal mandate, and other states provide more free services to victims.”

The report’s authors explain that VAWA 2005 dictates that such exams should, at minimum, include:

• Examining physical trauma
• Determining penetration or force
• Interviewing the patient
• Collecting and evaluating evidence

But the victim may require medical services for treatment relating to an injury, pregnancy or sexually transmitted infections. Whether and how those expenses are covered varies by state, and some victims are billed for the additional services.

The Urban Institute study found that crime victim compensation funds were the primary funding sources for the exams in most states, rather than federal STOP grants.

And, the report said, there are issues with using victim compensation funds to pay for rape kits:

“Victim compensation is intended to pay for services that directly benefit victims. … The most common types of expenses compensated are medical and dental services, mental health counseling, lost wages, and funeral or burial expenses. It is clear that the medical services provided in an exam directly benefit victims and are in keeping with the mission of compensation.

“However, some have questioned—through this study and otherwise—whether funds intended to benefit victims should be used to pay for forensic evidence collection intended to build a criminal case. Is forensic evidence collection a benefit to victims, or is it a benefit to the justice system? Victims who have had negative experiences with the justice system might say that it is no benefit to victims at all. No other evidence collection activities (such as autopsies, crime scene processing, and ballistics analysis) are paid for with funds meant for services to victims.”

New York’s Office of Victim Services covers the cost of emergency care for survivors of sexual assault. The attorney general’s office said it did not have details on how the victim services office funded its programs.

Ariel Zwang, CEO of victim assistance organization Safe Horizon, welcomed Schneiderman’s announcement.

“Rape survivors deserve expert and immediate medical care after an assault, including access to a rape kit,” she said in a statement Tuesday. “For so long, survivors and victim advocates fought to change the law so that survivors would not incur the cost of these important exams. We applaud the Attorney General’s office for ensuring enforcement of this law, holding hospitals accountable who have unnecessarily charged for this exam, and standing up for survivors.”

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