Care Over Collections traces its origins to a patient encounter at a nonprofit health clinic in St. Louis in early 2020. Mary Shannon met a patient facing a lawsuit over unpaid medical bills. The plaintiff named on the summons was Saint Louis University, Mary’s undergraduate alma mater. 

Curious whether this was an isolated instance or a routine practice, Mary began reviewing Missouri court records on Case.net. A single inquiry grew into a multi-year effort documenting nearly 1,000 medical debt lawsuits filed by physician groups across the St. Louis region. Conducted entirely on a volunteer basis, without funding or formal institutional support, the research was published in JAMA Network Open in July 2025.

Initially funded by the Missouri Foundation for Health, the project expanded its scope statewide. What began as an independent, grassroots investigation has since evolved into Care Over Collections, a research and advocacy initiative dedicated to exposing and challenging harmful medical debt practices across Missouri.

Today, we provide free assistance to people navigating medical bills, collections, and lawsuits while working alongside community partners and advocates to advance a healthcare system that puts care over collections.