"Only a small number of people not eligible for publicly funded healthcare do not settle their debt. We also have people who are paying off their debt by instalment," Northland
DHB's general manager finance, funding and commercial services Meng Cheong said.
He said it would not refuse care to acutely unwell patients.
"Northland DHB has a clear strategy with regard to the recovery of overseas patient debt including the use of overseas debt collectors, this has been the case for many years."
Cheong said most of the patients first presented at the emergency department and, if they were not admitted, were expected to pay at the time.
He said if any of the demographic data indicated the patient was not a New Zealand citizen, further documentation was requested to determine eligibility.
Cheong said debts were not written off until all collection options have been exhausted.
"When a debt is written off the patient details are lodged with Immigration NZ, on the odd
occasion Immigration NZ have been in contact where they have stopped a patient, but this
has not resulted in the recovery of any debt."
The ACC figures exclude the cost of emergency treatment at public hospitals, which is bulk-funded under Public Health Acute Services.
ACC paid out $97,270 in 2014, $35,771 in 2015, $90,301 the following year and $126,712 last year.
Spokesman James Funnell said tourists and visitors made a significant contribution to the New Zealand economy.
"They also contribute to the cost of ACC in a number of ways. For example, people who hire a rental car pay a levy on petrol purchases, and car rental prices include the cost of vehicle registration, which incorporates an ACC levy.
"In addition, overseas visitors who work in New Zealand pay an earners' levy, as well as paying income tax."
He said because ACC was a no-fault scheme that removed the right to sue for personal injury suffered in New Zealand, all overseas visitors who injured themselves were eligible for cover for their treatment and rehabilitation.
Northland tourism leader Jeroen Jongejans said only a small number of overseas tourists ended up with unpaid medical bills that were not huge amounts of money considering their contribution to New Zealand's economy.
"GST tourists pay amounts to billions of dollars each year and that money goes to general funds and helps pay for medical services. When one looks at big scheme of things, the amount owed is significant for Northland but it's not crippling," he said.