> Can I assume that the author of this ransomware is American or at least is very immersed in American culture?
No, they sound like someone who learned about the US from internet memes, but doesn’t have firsthand experience. For example, hospitals in the US do not generally collect payment at the time of treatment so it wouldn’t really make much sense to show up to one and try to pay for someone needing urgent medical care
Urgent Care facilities do. One time I badly needed a minor surgery. I went to an urgent care and was told they could see me immediately, but didn't accept my insurance and would charge $450. My other option was to go to the hospital across the street which did take my insurance, but I had to wait 8 hours and be treated like I was an opiate addict with a self inflicted or imaginary condition. So, that would have been great if someone somehow showed up and paid the first clinic.
No, they sound like someone who learned about the US from internet memes, but doesn’t have firsthand experience. For example, hospitals in the US do not generally collect payment at the time of treatment so it wouldn’t really make much sense to show up to one and try to pay for someone needing urgent medical care