Can collection agencies still report on a medical bill that is four years old and has never been paid?

Yes, but it can only stay on your credit report for a total of 7 years. The easy part for you, if you don't plan on paying or settling the claim ever, is to tell the credit collection agency to not call you anymore on this matter. Legally, once you tell them on the phone to quit calling you about this, they cannot call you anymore. Hpwever, they can still send you a bill in the mail every month, and continue to place it on your credit report each month. In the end, it is gone after 7 years. Execption: If after the above, and even if its been 6 years or more, and you send them even a dollar in sympathy payment, or whatever, Start the 7 years over again. Remember, some people will lie, cheat, steal, or generally harass the world, if you don't understand your rights in any given situation.