Hospitals across the state are inappropriately billing rape victims for medical exams — possibly in violation of the law, according to a new report from the Minnesota Coalition Against Sexual Assault.

It was just one troubling finding in this first-of-its-kind study in Minnesota, which illustrates vast inconsistencies in how hospitals treat sexual assault victims.

In Minnesota, counties are obligated to foot the bill for forensic sexual violence exams, and they can only request reimbursement from a victim’s insurance company with consent. Yet out of more than 100 professionals surveyed for the study, more than half said they were aware of victims being billed at some point. Nearly one-third of responders said they didn’t feel confident telling victims they would not be receiving a bill, suggesting they don’t understand the law, according to the study.

“We know for a fact that victims are getting billed for aspects of their exam, which is a big problem,” said Kari Ogrodowski, medical forensic exam access project coordinator for the coalition.

To conduct the study, the coalition surveyed 139 people, ranging from medical practitioners to advocates and law enforcement. Only 42 percent of responders said their medical communities give appropriate care to underserved populations, such as LGBT, American Indian or non-English speaking victims. They attributed the gap to not enough interpreters, poor cultural awareness and lack of “compassionate response” to some victims.

“Educated white females receive more services, get out of there more quickly, and are provided more comforts,” wrote one responder. “Not so with Native, Hispanic, gay, lesbian, bisexual, or trans clients.”

Circumstances of the victim and crime can also play a role in how victims are treated, the study found. One responder reported seeing homeless people getting unequal care. Another witnessed treatment influenced by factors like whether the perpetrator was an ex-partner or stranger, or if the victim was sober, mentally ill or had a history with the medical facility.

Other problems highlighted in the study include victims waiting more than an hour for an exam, hospitals turning people away because the medical staff feel “ill-equipped” and incidents of practitioners insisting victims go to law enforcement even if they don’t want to make a report at the time.

“Our hospital does not follow the law,” said one responder. “They require victims report to law enforcement before they will do an exam.”

‘We need to do something’

Ogrodowski attributes most of the findings in the report to a lack of education about state laws and how to best respond to victims, rather than a malice on part of medical practitioners. She said the study only confirmed problems the coalition has heard anecdotally from community members.

“We’re finally getting to a point where it’s just painfully obvious that we need to do something,” she said. “We need to make our response more streamlined so victims do receive equitable care.”

One way to address the billing problem would be to re-examine where the money comes from, she said. As it stands, the county where a sexual assault occurs is responsible for covering the costs of the medical exam. This could be simplified by creating a statewide fund that would pay for these, she said.

The coalition also wants Minnesota to create a position for a statewide coordinator who would oversee the exam process and ensure hospitals are being consistent in providing care.

“This report is an important step in figuring out where we need to go next,” Ogrodowski said. “But something needs change.”