Newsletter 6/16: Ambulance companies collect millions by seizing wages, tax refunds
Plus: S.C. shrimpers warn of 'shrimp fraud'; 2 arrests and pepper spray after big uptown protest; 'Squawks' having best year yet; McColl calls out rival; Wells Fargo sign video 🎥
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LEDGER IN-DEPTH
Some ambulance patients are surprised to find their wages or tax refunds seized to settle hefty bills
◼️ EMS leaders say the measures are needed to cover their costs and preserve tax money
◼️ Mecklenburg’s MEDIC led the state in seizing tax refunds and lottery winnings, with $2.5 million last year
After her son was in a car wreck, Christy Owca was shocked that the Gaston County ambulance agency garnished her wages for what it said was an unpaid bill. “When you pull up to this knowing your son was in that vehicle, you don't worry about if the ambulance is in your insurance group. You just want your child to be safe," she said. (Photo courtesy of Christy Owca)
By Michelle Crouch
Co-published with N.C. Health News
When Christy Owca’s 17-year-old son flipped his Jeep in a crash in 2019, she was grateful that an ambulance got him to the hospital quickly and that his injuries turned out to be minor. So when the first bill from Gaston County’s ambulance agency came, she didn’t think twice about paying the $61 fee.
But more bills kept coming. Then came statements from her health insurance company, each showing a different amount she owed just for the ambulance ride.
Confused, Owca began making calls — to Gaston Emergency Medical Services, to her health insurance company, to supervisors at both places. She said she spent hours making calls over several months trying to get the situation sorted out. Each time, a representative assured her the issue would be resolved.
The bills and notices kept coming.
Then, one day while she was at work, something mortifying happened: She was notified by her company’s human resources office that her wages were being garnished for an unpaid medical bill — that ambulance ride.
“It was a total shocker and extremely embarrassing,” said Owca, who got the garnishment removed after she sent a complaint to the N.C. Attorney General’s Office about the incident. “If you need an ambulance, if you have a car accident or another emergency, you shouldn’t have to worry that they’re going to take your wages if you call 911.”
Powerful collection tools
Because most EMS agencies in North Carolina are government entities or government-affiliated, they have access to two powerful debt collection tools:
Wage or bank account garnishment: State law allows EMS agencies to take up to 10% of a person’s paycheck each month or to garnish an unlimited amount from a bank account in their name.
State tax refund seizure: Through the state’s “debt setoff” program, EMS agencies can intercept your state tax refund or lottery winnings. In 2024 alone, Mecklenburg County’s EMS provider, MEDIC, collected about $2.5 million through the program — more than any other public agency in the state. (More than 500 N.C. public agencies made these collections last year, here’s a list of how much was collected by each.)
For ambulance agencies facing budget gaps and rising costs, these tools offer a crucial source of revenue and a way to recoup unpaid bills when costs are rising. EMS leaders say they’re forced to go after patients because insurance companies deny or underpay emergency transport claims.
Patient advocates respond that the practices are out of step with efforts in North Carolina and across the country to reduce the aggressive collection of medical debt. In 2024, the state’s hospitals agreed to a medical debt relief plan that prohibits them from using liens, wage garnishment or tax refund seizure to collect medical debt.
“People should not be pushed to suffer financially because they needed help at a critical time,” said Rebecca Cerese, health policy advocate for the N.C. Justice Center. “These types of punitive policies keep people from calling an ambulance when they need one.”
Two steps to take your paycheck
Unlike other states, North Carolina does not require ambulance agencies to get a court order to garnish wages or seize funds from a bank account, said Christopher McLaughlin, a professor at the UNC Chapel Hill School of Government who has studied policies related to government debt collection.
Instead, he said, N.C. law requires just two pieces of paper:
a letter to the debtor notifying them of the garnishment, and
a notice to the employer or bank directing them to seize the amount owed
It’s the same process that counties and cities can use if you don’t pay your property taxes, he said.
“They don’t need to go to court. They don’t need to get approval from anybody,” McLaughlin said.
The debtor can stop the garnishment only if they can prove that the agency has the wrong person or they can prove they already paid, McLaughlin said.
It’s not clear how many EMS agencies across the state use wage or bank account garnishment or how much they collect, but McLaughlin said he thinks most do.
$21M seized from tax refunds and lottery winnings
As for debt setoff, 469 government entities — including counties, cities and utilities — used it to collect $21.4 million from people’s North Carolina tax refunds and lottery winnings in 2024, according to a clearinghouse that helps agencies use the program.
Representatives for Wake County EMS and MEDIC — which serve the state’s two largest counties — told The Charlotte Ledger/NC Health News they use the debt setoff program, but they do not pursue wage garnishment.
MEDIC considered using wage garnishment in 2019 to address a budget shortfall but dropped the plan after public outcry.
A tactic of last resort
Gaston County spokesman Adam Gaub said he could not comment on a specific patient’s bill, citing privacy laws, and he declined a request for an interview about the county’s ambulance billing policies.
In a written response to questions, Gaub said Gaston’s ambulance service, known as GEMS, uses a sliding fee scale and does not garnish wages or seize refunds from patients who cannot afford to pay.
He emphasized that the agency uses wage garnishment and debt setoff only “as an absolute last course of action” after working with individuals and offering payment plans.
The agency’s policy is to send three bills over 90 days before turning a bill over to collections, which triggers the wage garnishment process. The county also sends certified letters to the patient and their employer notifying them of the garnishment.
GEMS collected $31,757 in wage garnishments and $244,168 from the debt setoff program in 2024.
The agency is already operating in a deficit, Gaub said. In 2024-25, GEMS brought in $16.6 million and spent $23.1 million, with the difference made up by the county’s general fund revenues, which includes property taxes.
“Not collecting for services rendered from those who have the capacity to pay would place an additional burden on Gaston County taxpayers and/or would negatively affect our ability to provide our current level of service,” Gaub wrote.
What happened to my tax refund?
In Charlotte, Mae Cynthia Glover was caught off guard in 2020 when the state tax refund she was expecting never arrived. Instead, she said she received a letter saying MEDIC had seized it to cover an unpaid ambulance bill.
The letter said her refunds would continue to be garnished every year until her full balance was paid, Glover recalled.
“It wasn’t much, but it would have been better than nothing,” she said.
The unpaid bill dated to 2019, when Glover finished a week of double shifts at her job as a catering company dishwasher and began feeling dizzy and nauseous. Her sister urged her to call 911. Moments later, in the back of the ambulance, Glover’s heart stopped. Paramedics revived her with a defibrillator, and doctors later implanted a pacemaker.
Glover doesn’t remember the exact amount of the ambulance bill — only that it was in the thousands and she couldn’t pay it.
She set up a monthly payment plan with MEDIC, but she said she fell behind after her health forced her to stop working. The unpaid bill was sent to collections, triggering the tax refund seizure.
“It’s frustrating because you ain’t got no choice when you call the ambulance,” she said. “It’s usually a life-or-death situation.”
She said she was relieved when she turned 65 last year and got on Medicare, so she doesn’t have to worry anymore about a big bill if she calls 911.
EMS: Insurers leave us no choice
Ambulance providers say they wish they didn’t have to use collection actions like debt setoff and wage garnishment, but they have little choice because of how insurance companies handle emergency transport bills.
Medicare and Medicaid reimbursement rates are so low they don’t even cover the cost to run an ambulance, said Regina Godette-Crawford, a lobbyist for the North Carolina Association of EMS Administrators. And private insurance companies routinely underpay or deny claims because they often treat ambulance transports as out-of-network.
That leaves the patient responsible for the balance, sometimes totaling in the thousands of dollars.
In addition to low reimbursement rates, ambulance services are also grappling with rising costs, workforce shortages and increasing numbers of calls.
John Peterson, executive director of MEDIC, said the agency makes every effort to work with patients, offering financial aid to low-income patients and interest-free payment plans. The agency also sends “multiple letters, multiple correspondences” before taking action, he said.
He said MEDIC uses the debt setoff program only when patients don’t respond to repeated billing attempts.
“If we don’t hear from anybody, then … we have to do what any good agency or business would do, and try to collect those dollars wherever we can,” he said. “We are a safety-net provider, but we’re also a business. We have to be good stewards of taxpayer and patient dollars.”
MEDIC gets an annual subsidy from Mecklenburg County’s general fund, which is supported by property and sales taxes. The subsidy is expected to remain flat for 2025-26 at $22.5 million. The new county budget also includes $7.6 million for one-time capital purchases like new ambulances and equipment.
Other states have protections
In North Carolina, legislation unanimously approved by the state house aims to ease some of the financial pressure on ambulance agencies. House Bill 489 would require health insurers to treat emergency ambulance transports as in-network and reimburse providers at local rates. The proposed legislation says patients should pay no more than $100 per ride.
Nineteen other states have approved similar “surprise ambulance bill” legislation. In some states, such as Massachusetts and California, those laws include provisions that ban EMS agencies from using aggressive collection actions like wage garnishment, said Mona Shah, senior director of policy and strategy at Community Catalyst, a national nonprofit that advocates for medical debt protections.
Other states take different approaches to shield patients from harsh collection practices, Shah said.
In Texas, for example, wage garnishment for medical debt is banned entirely. And in New Jersey, a 2024 law says wages can’t be garnished for medical debt if a person’s income is below 600% of the federal poverty level — currently $192,900 for a family of four. That law specifically names ambulance services as subject to its provisions.
“While there are broader policies around hospitals not being able to garnish wages, there can be loopholes for ambulance companies,” Shah said.
It’s particularly troubling for a government ambulance agency to be garnishing wages, she said, because it jeopardizes a person’s economic stability for an emergency they couldn’t control.
“You expect your government to be there to help in times of emergency,” she said.
She added that the real problem lies with insurers failing to cover emergency ambulance bills in the first place — shifting the financial burden to local governments and, ultimately, patients.
“We should really be going after insurance companies for denying coverage,” she said, “not patients who call 911 because they have a medical emergency.”
Michelle Crouch covers health care. If you have tips or ideas for her, please shoot her an email at mcrouch@northcarolinahealthnews.org.
This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area.
➡️ You can support this effort with a tax-free donation. This coverage is supported by readers like you who value smart, transparent and independent reporting.
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Think you’re eating local shrimp at the beach this summer? It might actually be cheap Asian knockoffs, S.C. shrimping industry says
For some beachgoers, no summer vacation is complete without a seafood dinner.
But the shrimping industry is warning this year that many restaurants in South Carolina are falsely advertising “local seafood” when they’re actually importing it from Asia.
On Friday, the S.C. Shrimpers Association sued 40 Charleston-area restaurants, alleging that they are falsely claiming to serve local seafood while actually serving shrimp caught in India, China, Vietnam and Ecuador.
The federal lawsuit follows a round of genetic shrimp testing last month by an industry-hired consultant that found that 40 of 44 Charleston-area restaurants were “misleading customers in their branding, menu descriptions or proximity to local docks, with 25 found to be outright fraudulent.”
The lawsuit alleges that the restaurants “have falsely advertised shrimp served in their establishments as ‘local,’ ‘Carolina-caught,’ ‘fresh South Carolina shrimp,’ among other misrepresentations, when in fact Restaurant Defendants knowingly served cheaper shrimp that was farmed or harvested out-of-state.”
The suit and the genetic testing report do not name the restaurants. The Shrimpers Association says the identities of the restaurants can be established as the lawsuit proceeds, with the names added later.
It’s illegal to falsely market the origin of shrimp, the association says.
“Shrimp fraud is not a victimless crime,” said Bryan Jones of the S.C. Shrimpers Association, according to TV station WCSC, at a press conference Friday at Shem Creek, a riverside stretch of seafood restaurants outside Charleston.
The Association has a “fresh shrimp locator” on its website that lists more than 120 restaurants that serve verified South Carolina-caught shrimp. —Tony Mecia
➡️ Read the federal shrimp lawsuit 🍤
Thousands protest Trump uptown; CMPD arrests 2 and releases pepper spray in minor skirmish afterward
Police estimated that nearly 6,000 people showed up Saturday in First Ward Park uptown to participate in Charlotte’s anti-Trump “No Kings” protest, part of nationwide demonstrations. After the rally, several hundred protestors squared off against police on Seventh Street (right) and other spots uptown. Charlotte-Mecklenburg Police said they charged two people with assaulting law enforcement officers and released pepper spray to prevent the crowd from disrupting traffic, WBTV reported. (Photos by Ron Koppelmann, left, and Deborah Goldberg, right)
Ticket sales for ‘Charlotte Squawks’ are the ‘biggest yet’ in 20 years of performances, Blumenthal says
“Charlotte Squawks,” the musical show that parodies politics and life in Charlotte, is having its most successful season ever in ticket sales.
Co-creator Brian Kahn tells The Ledger that in a typical year, shows toward the end of the three-week run at Booth Playhouse in the Bank of America Corporate Center sell out, with the early shows having empty seats. This year, the first Saturday night was virtually sold out, and tickets are more scarce than usual for the remaining shows.
“We’ve never in the history of the show sold that well,” Kahn said.
And it sounds like that “tickets going fast” message isn’t just FOMO-inducing marketing hype. A spokeswoman for Blumenthal Arts, which hosts the show and sells the tickets, told The Ledger: “This year is currently on track to be the biggest yet.”
Kahn, who moonlights as the managing partner of law firm McGuireWoods’ Charlotte office, says he’s not quite sure why this year is so big but suspects momentum has grown over the years. This is the show’s 20th year.
“It’s one of those shows where you always hear people say, ‘I love it! I’m coming back and I’m bringing all of my friends,’” he said. “That’s how we’ve grown.”
Although this year’s performance is heavy on the anti-Trump jokes, he’s unsure if that’s a contributing factor: “Part of me thinks people want to vent and see us vent for them, but I don’t know.”
He says he has been surprised at the positive reception to some of the local numbers, including a spoof of an NSYNC song from 2000 whose title he altered to be about a prominent Charlotte politician.
“I think I underestimated the love that my generation has for that song and the dance, and how awesome the cast is at that dance performance and the choreography,” he said.
“Squawks” opened June 5 and runs through June 28. —Tony Mecia
Quotable: Hugh McColl calls out an old banking rival for its lack of local philanthropy
From a wide-ranging June 12 Charlotte Observer interview with former Bank of America CEO Hugh McColl Jr.:
Q. Wells Fargo’s nearly $2 trillion asset cap was lifted this month. What do you think that could do for Wells Fargo and Bank of America’s rivalry?
McColl: I don’t see it affecting the Bank of America at all. I don’t know their company well. I wish that they were more interested in our city in terms of philanthropy. I hope that this new freedom will allow them to do that.
🎥 WATCH: Cool time-lapse video of a helicopter hanging ‘WELLS FARGO’ letters on an uptown Charlotte skyscraper
Wells Fargo added its name to Charlotte’s skyline on Sunday, installing 14-foot-tall red letters transported via helicopter on the “handlebar” portion of the 48-story 550 South Tryon office tower, which was formerly the Duke Energy Center. (Video courtesy of Wells Fargo)
➡️ Watch the full 1 minute, 46 second video with additional footage
You might be interested in these Charlotte events
Events submitted by readers to The Ledger’s events board:
WEDNESDAY: “Empower Your Journey: Navigating Career Pivots and Transitions,” 9-11 a.m., Hawthorne at Whitehall, 9105 Bowling Green Lane. Join the Charlotte Area Chamber Women In Business for a transformational workshop designed exclusively for high-performing women with 15+ years of professional experience who are ready to take bold next steps in their careers or businesses, without sacrificing personal balance. Registration required. $25.
THURSDAY: “Juneteenth Art Fest,” 4-8 p.m., at Shoppes at University Place, 8931 J.M. Keynes Drive. University City Partners is hosting its second annual Juneteenth Art Fest, celebrating art, activism and African American emancipation. The afternoon will feature minority-owned businesses, local artists, live music and dance performances along University City’s scenic lakefront. Free.
JUNE 25: “Power Up Charlotte,” 11:30 a.m. to 1 p.m., at Per Scholas Charlotte, 129 W. Trade St., Suite 1210. The Power Up Series is a no-cost event series hosted by Per Scholas in collaboration with Urban Institute, Interstate Renewable Energy Council (IREC) and CareerEquity, created to bring together leaders across the energy and utility sectors to explore the powerful intersection of technology, innovation, and workforce development. Registration requested. Free.
JUNE 26: “June Breakfast Club: Exploring the State of Residential Real Estate in the Region,” 8-9:30 a.m., at AC Hotel Charlotte Ballantyne, 14819 Ballantyne Village Way. South Charlotte Partners is excited to host a breakfast where local experts will explore key trends shaping the residential real estate market in South Charlotte. Topics may include housing affordability, supply and demand challenges, migration patterns, interest rate impacts, innovative housing products, development trends and what’s next for buyers, sellers and builders. $25 in advance. $35 at the door.
➡️ List your event on the Ledger events board.
In brief:
Central Piedmont suit moved to federal court: A lawsuit against Central Piedmont Community College has been moved to federal court. The suit alleges the college violated North Carolina open meetings and public records laws, as well as the First Amendment, by restricting access to public meetings and withholding information about a controversial public safety training facility in Matthews that activists call “Cop City.” (Carolina Public Press)
Neighbors oppose airport’s demolition spree: Some residents south of Charlotte’s airport say they oppose the airport’s efforts to demolish historic buildings such as the William Grier House, a historic landmark that dates to 1828. “It just seems the airport is ripping apart history and the neighborhood for the sake of development,” one neighbor told The Charlotte Observer. The airport received a demolition permit for the Grier House this month and envisions the area as a warehousing and logistics hub. The Ledger reported on the issue last week.
Petition to keep Lansdowne assistant principal: More than 500 people have signed a Change.org petition asking Charlotte-Mecklenburg Schools to keep Assistant Principal Miesha Gadsden at Lansdowne Elementary, after she was reassigned elsewhere. It’s the latest parent objection to CMS staffing moves.
Well-known name as interim Matthews leader: Former Charlotte City Manager Curt Walton has been named the interim town manager of Matthews, the town said in a news release. He retired as Charlotte’s city manager in 2012 after five years on the job.
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I can empathize with Ms Owca and her problems with ambulance billings and trying to get help. I had a similar issue with my Mother and trying to resolve her bill. There has to be a better solution than harassing people struggling with health issues and trying to care for sick and injured loved ones. 90 days is not enough time for people in the midst of crisis to have time to deal with the financial side of the issue.