Editor's note: This is the Louisiana analysis in Patients Rising's Medical Bankruptcy in America series — a six-state review of approximately 900 federal bankruptcy filings and the role of 340B-participating hospitals as creditors. State-level analyses for Virginia, Wisconsin, Washington, Louisiana, Colorado, and Maine are publishing on a rolling cadence. Methodology available on request.
Across 130 individual Chapter 7 and Chapter 13 bankruptcy filings from the federal bankruptcy courts of Louisiana, January through May 2024, the data shows the single largest individual hospital balance in our entire six-state series — and a state-level pattern dominated by two nonprofit hospital systems whose Louisiana footprints extend from the Mississippi border to the Gulf Coast.
For context: the previous largest individual balance in our series was Fredericksburg's Mary Washington case at $376,855. The Louisiana data turned up a single balance ten thousand dollars higher, on a household with a fraction of the Virginia household's income.
Across the 130 Louisiana filings, two hospital systems dominate the medical-creditor schedules.
CHRISTUS Health, the Catholic system headquartered in Irving, Texas with substantial Louisiana operations, appears on 10 of the 44 cases with verified 340B debt — a total of $434,421. CHRISTUS Highland Medical Center in Shreveport (a 340B disproportionate-share hospital) is the single largest creditor balance in the dataset; CHRISTUS facilities across northwest and northern Louisiana account for the bulk of the system's appearance.
Ochsner Health, the New Orleans–based nonprofit system that is the largest healthcare provider in Louisiana, appears on 12 cases for a total of $365,332. Ochsner Clinic, Ochsner Lafayette, and Ochsner-affiliated facilities are all 340B participants. Ochsner's Louisiana network — Ochsner Medical Center New Orleans, Ochsner Baton Rouge, Ochsner Lafayette General, Ochsner LSU Shreveport, and dozens of community hospitals across the state — makes it the most geographically distributed hospital creditor in the dataset.
Add the third- and fourth-largest creditors — Willis-Knighton Health System ($52,152 across 6 cases) and Franciscan Missionaries of Our Lady Health System / Our Lady of Lourdes ($51,950 across 6 cases) — and four systems account for $903,855, or 95 percent of all verified 340B debt in the dataset.
The remaining 5 percent is distributed across smaller systems: North Oaks Health in Tangipahoa Parish, Lake Charles Memorial, St. Tammany Health, LSU Health, Tulane Health, LCMC Health, and a handful of rural critical-access hospitals.
The for-profit hospital sector — most notably Rapides Regional Medical Center (HCA) in Alexandria and Glenwood Regional Medical Center in West Monroe — appears on Louisiana bankruptcy schedules but is excluded from the $954,000 total, which counts only 340B-participating nonprofit systems.
Plain Dealing is a small town in Bossier Parish, in the far northwest corner of Louisiana, about thirty miles north of Shreveport and four miles south of the Arkansas border. Its population is approximately a thousand people. The principal hospital serving Plain Dealing residents is CHRISTUS Highland Medical Center in Shreveport — a 340B disproportionate-share hospital owned by CHRISTUS Health.
In May 2024, a household in Plain Dealing filed for Chapter 7 bankruptcy. Their bankruptcy schedule lists $422,121 in total liabilities, of which approximately $387,000 — ninety-two percent — is owed to CHRISTUS Highland Medical Center.
Their monthly income, by Schedule I: $1,800. Their monthly expenses, by Schedule J: $1,800. Their margin, before any payment toward the bankruptcy debt: zero.
The household had no monthly capacity to pay anything toward the CHRISTUS balance. The hospital, the collections agency, and the household all knew it from the first billing notice. The federal Chapter 7 discharge entered approximately three months after the filing. The $387,000 balance became uncollectable as a matter of federal law. CHRISTUS Highland Medical Center wrote the balance off as bad debt expense. Under federal hospital-reporting conventions, the write-off may be aggregated into CHRISTUS's annual "community benefit" disclosure.
CHRISTUS Highland Medical Center is a federally subsidized 340B disproportionate-share hospital. Its eligibility for the program rests on demonstrated service to low-income patients.
The patient on this schedule, with $1,800 a month of household income for the entire household, is — by any measure the federal poverty thresholds apply — exactly the patient population whose existence justifies CHRISTUS's participation.
She was never told what charity-care policy might have applied. She was never told whether she qualified. The bill came. Then the collections letters. Then the bankruptcy.
A household in Lafayette filed for Chapter 7 bankruptcy in February 2024. Their schedule lists $533,094 in total liabilities, of which $313,554 is owed across three separate balances to Ochsner Clinic — Louisiana's largest hospital system.
The principal filer, by Schedule I, is disabled. Combined household monthly income: $4,368. Monthly expenses: $4,368. The margin: zero.
The three Ochsner balances — approximately $263,000, $50,000, and $1,400 — appear as separate entries on Schedule E/F. They represent, almost certainly, multiple care episodes accumulated to a single hospital system over time, the kind of pattern that the Patients Rising series has documented repeatedly across all six states: medical debt accumulating to one regional dominant hospital system in pieces that look separate on the schedule but financially aggregate into a number that no household with that monthly margin can absorb.
Ochsner Health is Louisiana's largest healthcare provider. Its 2023 federal Form 990 reports total revenues exceeding $6 billion. It is a 340B disproportionate-share hospital system.
The patient on this schedule will, when the Chapter 7 discharge enters, see the $313,554 balance become uncollectable. Ochsner will write it off. Under hospital-reporting conventions, the write-off may flow into Ochsner's community-benefit reporting.
Louisiana has six congressional districts. The 44 cases with verified 340B hospital debt distribute across all six, with concentration in three:
The pattern echoes our findings in other states: medical-bankruptcy cases concentrate where the dominant 340B-participating hospital systems operate, regardless of district or political map. CHRISTUS dominates northwest Louisiana; Ochsner dominates the I-10 corridor from Lake Charles to Baton Rouge to New Orleans. The bankruptcy schedules trace those market footprints.
Louisiana's hospital systems on these schedules all participate in 340B. CHRISTUS, Ochsner, FMOL, Willis-Knighton, North Oaks, LSU Health, Tulane, LCMC, Lake Charles Memorial, St. Tammany — every major nonprofit acute-care system in the state. All certify their eligibility annually to the federal Health Resources and Services Administration. All capture the program's outpatient drug-pricing discounts.
None of them is required, by federal law, to tell patients at the point of care that the hospital is a 340B participant — or what charity-care policy applies, or how to apply.
There is no federal statutory definition of a "340B patient." The 340B statute, written in 1992, never defined the term. HRSA's 1996 attempt at a guidance-level definition was struck down in Genesis Healthcare v. Becerra in November 2023 as unenforceable. In current practice, Louisiana's 340B-participating hospitals — like 340B hospitals nationally — can classify a patient as 340B-eligible after the fact, by reviewing the patient's records days or weeks after a prescription is filled. The patient is never informed of the classification.
There is no federal statutory definition of "charity care." Ochsner's published charity-care policy, CHRISTUS's, FMOL's, and Willis-Knighton's are each different documents with different eligibility thresholds and different application requirements. Two patients with identical financial circumstances can be charity-care eligible at one Louisiana hospital and not at another, and neither hospital is doing anything wrong under federal law.
There is no federal requirement that any Louisiana hospital tell a patient at the point of care what charity-care policy applies to them. There is no federal requirement that the patient be told the eligibility threshold, the application process, or the documents required.
The Plain Dealing household with $1,800 a month of income — earning, on an annual basis, less than half the federal poverty line for a typical household size — was eligible for charity care at CHRISTUS Highland by virtually any defensible threshold. They were not told. The bill came. Then the collections letters. Then the bankruptcy.
CHRISTUS, Ochsner, and the other Louisiana nonprofit systems on these schedules report annual "community benefit" expenditures on IRS Form 990 Schedule H. The American Hospital Association aggregates those reports into the figure it cites every time the 340B program is questioned: nearly $100 billion in 340B-hospital community benefits in 2023.
That figure is assembled by the trade association of the same hospitals being scrutinized, from data those hospitals self-report under federal definitions that do not exist. The category includes financial assistance to patients, unreimbursed Medicaid, research and education, the Medicare shortfall, "community-building activities," and bad debt — the last of which includes patient bankruptcy write-offs.
When the Chapter 7 discharge enters for the Plain Dealing household, the $386,758 balance to CHRISTUS Highland becomes uncollectable as a matter of federal law. CHRISTUS writes the balance off. Under federal hospital-reporting conventions, the hospital may aggregate that write-off into its annual "community benefit" disclosure.
The same bankruptcy CHRISTUS helped create becomes part of CHRISTUS's reported community contribution.
A note on Louisiana's particular hospital-system history. From the 1730s through 2005, the state's safety-net hospital network was anchored by Charity Hospital New Orleans — operated by the state government, providing free or sliding-scale care to indigent patients across south Louisiana. Hurricane Katrina forced Charity's closure in August 2005. The state's post-Katrina hospital reconstruction, finalized through the 2013 Public-Private Partnership, transferred the indigent-care safety-net function to private nonprofit systems — most notably LCMC Health, which now operates University Medical Center New Orleans on the former Charity site, and the FMOL system in Baton Rouge.
The patient population that Charity Hospital served before 2005 did not disappear. Their care needs migrated to the nonprofit systems that participate in 340B. The financial-assistance policies those nonprofit systems apply are not the open-access, state-funded model Charity Hospital represented. They are private-system charity-care policies, varying by institution, applied by application, with no federal floor.
The Louisiana bankruptcy schedules in this dataset are one snapshot of that transition's patient-side outcome.
The 340B program was created in 1992 to support hospitals serving disproportionate shares of low-income patients. The Louisiana hospitals on these schedules participate in that program, certify their eligibility annually, and receive the federal drug-pricing discounts.
The patients whose existence justifies that participation appeared, in 2024, in federal bankruptcy court. They were not told they were 340B patients. They were not told what charity-care policy might have applied to them. They were not told there was an alternative to bankruptcy.
The hospitals will write the balances off.
The patients had to file bankruptcy to get there.
The schedules are in the federal court file.
The file is public.
We have read it.
Methodology and aggregate data tables available on request.