A Brooklyn hospital illegally billed dozens of sexual assault victims for their forensic rape examinations, an investigation by the New York attorney general’s office has revealed.

Between January 2015 and February 2017, the Brooklyn Hospital Center conducted 86 exams, known as rape kits. In all but one of those cases, the hospital charged the patient or the patient’s insurance company for the kit without making it clear the exam could be free, Attorney General Eric T. Schneiderman said Tuesday. The hospital sent at least seven of these bills to collection agencies.

“These kits are used on what is undoubtedly one of the worst days of a survivor’s life,” Schneiderman said in a news conference Tuesday. “The absolute last thing they should have to worry about is how they’ll pay for their care at the hospital. We have found, contrary to law, that way too often they have to worry.”

New York state law requires that hospitals provide free emergency care to people who have been sexually assaulted. Medical providers must either charge the state’s Office of Victim Services directly or give the patient the option to bill a private insurance company. Many rape survivors prefer not to charge their private insurance companies to maintain privacy and confidentiality, Schneiderman said. Survivors pay, on average, more than $900 for emergency care, Schneiderman said.

In a settlement with Schneiderman’s office, the Brooklyn hospital has agreed not to bill sexual assault victims for their forensic examinations. All survivors will be provided with a form explaining that they have the choice to bill the state or their private insurance for the costs. The hospital will also reimburse all patients who already paid out of pocket.

The hospital, as part of the settlement, did not admit or deny that it violated state law. However, it released a statement Tuesday acknowledging “an inadvertent breakdown in our billing processes related to sexual assault victims, which we deeply regret.”

The hospital has now designed processes and protocols to ensure that such billing issues do not happen again, it said in the statement. The hospital, located on Dekalb Avenue in downtown Brooklyn, was Brooklyn’s first hospital and serves a population of more than 1 million people.

The attorney general is also sending letters to 10 other hospitals across the state asking for information about their policies, he said.

Schneiderman’s office began investigating in January, after a sexual assault victim complained that she had been billed seven times for her emergency care, for hundreds of dollars each time.

The patient underwent a forensic examination in the Brooklyn hospital’s emergency room in 2015. Within two months, she received two bills totaling more than $750. She contacted a victim’s assistance organization, which contacted the state Office of Victim’s Services,  which told the hospital not to charge the woman.

“The hospital assured them it would not bill her again,” Schneiderman said. “But it did, again and again and again.”

“This is intolerable conduct,” he added, “and it is hard to imagine the heartbreak and anxiety that would come from having to fight a collection agency over a clearly unlawful, mistakenly charged rape kit.”

The Violence Against Women Act, reauthorized by Congress in 2005, mandates that all out-of-pocket costs of rape kits be covered by a state or other entity, in order to receive federal grants through a program called STOP. Health-care providers must also inform victims that these exams are free.

But studies over the past few years have shown that such policies are not being enforced everywhere, and some women still bear the burden of paying for their rape kits.

In 2013, insurance providers and victims paid more than $9 million for medical care related to sexual assault, according to a study published in the American Journal of Public Health as reported by Reuters. The average cost was $6,737 per case. The study looked at hospital billing records for privately insured women who were raped in 2013.

About 88 percent of the 1,355 sexual assault victims incurred charges on the day of their hospital visit, and 27 percent paid more than 25 percent of those costs.

According to a 2014 study by the Urban Institute funded by the National Institute of Justice, victim compensation funds are by far the largest source of funding for exams nationwide. The study found that survivors generally received free exams without having to report if they didn’t want to.

But providing the exams often costs more than the state victim compensation programs allow for. Because of this, survivors often have to foot the bill for certain services or the exam itself.

For example, states are not required to pay for tests for pregnancy or sexually transmitted diseases as part of the rape kits, although many states do.

“What other crime victims must cover the costs of their own crime investigations?” Sonia Ossorio, president of the National Organization for Women of New York City, said in a statement Tuesday. “This goes to the very heart of blaming the victim.”

Christopher E. Bromson, executive director of the Crime Victims Treatment Center, said in a statement that receiving a notice from a collections agency is a “traumatizing reminder of a devastating event, and completely unnecessary.”

After announcing the agreement with the Brooklyn hospital, Schneiderman said he would be “remiss” if he didn’t acknowledge that these challenges are part of a “larger system of discrimination” and a “culture of male supremacy in our health-care system and in the nation as a whole.”

“In recent months, we’ve begun a long-overdue reckoning with our culture of violence and silence,” he said. “Today’s announcement is really a response to a systemic failure of many American institutions to protect women.”

“We must re-imagine a world where predators are exposed and held to account and survivors are supported and empowered at every level,” he added.

More from Morning Mix: