Two years ago, the president of Credit Management Services, a collection agency in Grand Island, Nebraska, presented a struggling local family with the keys to a used 2007 Mercury Grand Marquis. To commemorate the donation, the company held a ceremony that concluded outside its offices, where the couple and their two young girls could try out their new car.   

But CMS played another role in the family’s life, one the article didn’t mention. The company had previously sued the couple eight times over unpaid medical bills and garnished both of their wages. As recently as two weeks earlier, CMS had seized $156, a quarter of the girl’s father’s paycheck.

Shortly after the ceremony, CMS released the family from further garnishment, court records show.  But just four months later, the company filed a motion to start up again. The couple, who did not respond to attempts by ProPublica to contact them, has since declared bankruptcy.

In almost any other state, such a barrage of lawsuits against a family in desperate financial straits would be remarkable. Not in Nebraska. There, debt collectors frequently sue over medical debts as small as $60 and a simple missed doctor’s bill can quickly land you in court.

Filing suit is one of the most aggressive ways to collect debt, but no one tracks how frequently it happens or to whom. An examination of Nebraska’s courts, however, shows that where debtors live can have an enormous, and unexpected, impact on the quantity and types of lawsuits.

Nebraska’s flood of suits isn’t merely a reflection of residents’ inability to pay their bills. About 79,000 debt collection lawsuits were filed in Nebraska courts in 2013 alone, according to a ProPublica analysis. In New Mexico, a state with a population, like Nebraska’s, of around 2 million, about 30,000 suits were filed. Yet by virtually any measure, households in Nebraska are significantly better off than those in New Mexico: Income is higher. Poverty is lower. And fewer families fall behind on their bills.

The cost to file a lawsuit in Nebraska is $45. In New Mexico, where suits are filed at about one-third the rate as in Nebraska, the fee for smaller debts starts at $77.

Nebraska lawmakers, of course, didn’t set out to turn the Cornhusker State into the Lawsuit State. Instead, it appears no one understood the consequences of having cheap court fees: Suing became an irresistible bargain for debt collectors. It’s a deal collectors have fought to keep, opposing even the slightest increase.

“I resent the stereotype that these are not hard-working people,” said Katherine Owen, managing attorney in Legal Aid of Nebraska’s Omaha office. “Truly the majority of them simply cannot afford it. That’s it.”

Lawsuits over medical debts are, of course, filed in other states, usually by hospitals. What makes Nebraska unusual is that almost all the suits are brought by locally owned collection agencies that pursue debts on behalf of medical providers. Although ProPublica found collection agencies filing suits in large numbers in other states, particularly Indiana and Washington, none could match the sheer volume in Nebraska.

“There’s very little information, period” on the number of collection lawsuits in different states, said April Kuehnhoff, an attorney with the National Consumer Law Center. Policymakers in Nebraska and other states should pay attention, she said. “Being sued on a debt has very serious negative consequences for consumers.”

In a statement, the Nebraska Collectors Association said collection agencies file suits as “a last resort,” after attempts by the original provider and the agency to resolve the debt have failed. “Cooperatively working with the consumer is always the preferred approach to the collection process,” it said.

Local businessman Michael Morledge has owned the company since 1995. His son serves as president and his daughter as vice president of customer relations. CMS, with about 200 employees, boasts of having “the industry’s highest recovery rates” on its website and counts two-thirds of Nebraska hospitals among its clients. In addition to other medical clients like doctor’s offices and clinics, CMS also handles non-medical debts such as overdrawn bank accounts, utility bills and payday loans.

Like other collection agencies in the state, CMS employs collectors to persuade debtors to make voluntary payments. And like those other agencies, CMS routinely sues those who don’t. But it’s here that CMS sets itself apart.

In 2013, CMS filed almost 30,000 lawsuits in Nebraska, more than the rest of the collection agencies in Nebraska combined. That would be a staggering number of suits in any state. In New Jersey, with a population nearly five times larger, only one company, the nation’s largest debt buyer, filed more than 30,000 lawsuits that year.

To file those suits—about 120 per working day—CMS has its own staff of six attorneys. The complaints are prepped by support staff and then presented to the attorneys for review, CMS’s general counsel Tessa Hermanson said in a 2012 deposition from a class action lawsuit against the company.  

Debtors aren’t sued unless “the individual has a means to pay,” she said. But when pressed about how CMS determines this, Hermanson, who supervises the company’s lawyers, said she didn’t know if it was done by “one person or a department.”  

A review of CMS’s lawsuits shows the company is routinely aggressive even when it’s obvious the debtor is poor. In one case, CMS emptied a debtor’s bank account 11 times over the course of two years, even though in all but three instances the debtor had under $100. One garnishment netted the company $6.50.

Competition for clients can encourage this sort of approach, said Judge Craig McDermott, former counsel at a CMS rival and current presiding judge of the Douglas County Court in Omaha. Companies may sue even when it’s apparent the debtor can’t pay just to prove to the original creditor that they are making an effort: “Otherwise they’ll go to another agency down the street,” he told ProPublica in a 2014 interview.

CMS’s frequent use of the courts has brought millions back to the company, which retains a percentage of what it collects, and its clients. From 2008 through 2014, CMS seized at least $88 million from Nebraskans’ wages and bank accounts, according to court data analyzed by ProPublica.

In a brief response to a list of questions from ProPublica, CMS wrote that it “plays an active and important role in assisting creditors in Nebraska with recovering money owed for goods and services” and that it “strives to comply with all applicable laws and regulations” and only files suit after other collection attempts fail. The company declined to discuss any individual debtor case.

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