In 2018, senior executives at one of the country's largest nonprofit hospital chains, Providence, were frustrated. They were spending hundreds of millions of dollars providing free health care to patients. It was eating into their bottom line. The executives, led by Providence's chief financial officer at the time, devised a solution: a program called Rev-Up. Rev-Up provided Providence's employees with a detailed playbook for wringing money out of patients even those who were supposed to receive free care because of their low incomes, a New York Times investigation found. If patients did not pay, Providence sent debt collectors to pursue them. More than half the nation's roughly 5,000 hospitals are nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate. But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions. And, as Providence illustrates, some hospital systems have not only reduced their emphasis on providing free care to the poor but also developed elaborate systems to convert needy patients into sources of revenue. The result ... is that thousands of poor patients were saddled with debts that they never should have owed.