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[Art Deco]

*The New York Times*
------------------------------
April 24, 2012
Debt Collector Is Faulted for Tough Tactics in Hospitals By JESSICA
SILVER-GREENBERG

Hospital patients waiting in an emergency room or convalescing after
surgery are being confronted by an unexpected visitor: a debt collector at
bedside.

This and other aggressive tactics by one of the nation’s largest collectors
of medical debts, Accretive Health <http://www.accretivehealth.com/>, were
revealed on Tuesday by the Minnesota attorney general, raising concerns
that such practices have become common at hospitals across the country.

The tactics, like embedding debt collectors as employees in emergency rooms
and demanding that patients pay before receiving treatment, were outlined
in hundreds of company documents released by the attorney general. And they
cast a spotlight on the increasingly desperate strategies among hospitals
to recoup payments as their unpaid debts mount.

To patients, the debt collectors may look indistinguishable from hospital
employees, may demand they pay outstanding bills and may discourage them
from seeking emergency care at all, even using scripts like those in
collection boiler rooms, according to the documents and employees
interviewed by The New York Times.

In some cases, the company’s workers had access to health information while
persuading patients to pay overdue bills, possibly in violation of federal
privacy laws, the documents indicate.

The attorney general, Lori Swanson, also said that Accretive employees may
have broken the law by not clearly identifying themselves as debt
collectors.

Accretive Health has contracts not only with two hospitals cited in
Minnesota but also with some of the largest hospital systems in the
country, including Henry Ford Health System in Michigan and Intermountain
Healthcare in Utah. Company executives declined to comment on Tuesday.

Although Ms. Swanson did not bring action against the company on Tuesday,
she said she was in discussions with state and federal regulators about a
coordinated response to Accretive Health’s practices across the country.
Regulators in Illinois, where Accretive is based, are watching the
developments closely, according to Sue Hofer, a spokeswoman with the State
Department of Financial and Professional Regulation.

“I have every reason to believe that what they are doing in Minnesota is
simply company practice,” Ms. Swanson said in an interview, but declined to
provide details.

In January, Ms. Swanson filed a civil suit against Accretive after a laptop
with patient information was stolen, saying that the company had violated
state and federal debt collection laws and patient privacy protections.
That action is still pending.

An Accretive spokeswoman declined to comment on whether other states were
looking into its practices and issued a brief statement, “We have a great
track record of helping hospitals enhance their quality of care.” In its
annual report, the company said it was cooperating with the attorney
general to resolve the issues in Minnesota.

As hospitals struggle under a glut of unpaid bills, they are reaching out
to companies like Accretive that specialize in collecting medical bills.

Hospitals have long hired outside collection agencies to pursue patients
after they have left hospital facilities. But financial pressures are
altering the collection landscape so that they are now letting collection
firms in the front door, according to Don May, the policy adviser for the
American Hospital Association, a trade group.

To achieve promised savings, hospitals turn over the management of their
front-line staffing — like patient registration and scheduling — and their
back-office collection activities.

Concerns are mounting that the cozy working relationships will undercut
patient care and threaten privacy, said Anthony Wright, executive director
of Health Access California, a consumer advocacy coalition. “The mission of
these companies is in direct opposition to the supposed mission of these
hospitals.”

Still, hospitals are in a bind. The more than 5,000 community hospitals in
the United States provided $39.3 billion in uncompensated care —
predominately unpaid patient debts or charity care — in 2010, up 16 percent
from 2007, the hospital association estimated.

Accretive is one of the few companies specializing in hospital debt
collection that is publicly traded. Last year, it reported $29.2 million in
profit, up 130 percent from a year earlier.

Late last month, Fairview Health Services, a Minnesota hospital group that
Accretive provided services to, announced it was canceling its contract
with Accretive for back-office debt collection. After Accretive informed
investors, its stock plunged 19 percent in a day. On Tuesday, the company’s
shares closed at $18.49, down 2.7 percent.

Accretive says that it trains its staff to focus on getting payment through
“revenue cycle operations.” Accretive fostered a pressurized collection
environment that included mandatory daily meetings at the hospitals in
Minnesota, according to employees and the newly released documents.
Employees with high collection tallies were rewarded with gift cards. Those
who fell behind were threatened with termination.

“We’ve started firing people that aren’t getting with the program,” a
member of Accretive’s staff wrote in an e-mail to his bosses in September
2010.

Collection activities extended from obstetrics to the emergency room. In
July 2010, an Accretive manager told staff members at Fairview that they
should “get cracking on labor and delivery,” since there is a “good chunk
to be collected there,” according to company e-mails.

Employees were told to stall patients entering the emergency room until
they had agreed to pay a previous balance, according to the documents.
Employees in the emergency room, for example, were told to ask incoming
patients first for a credit card payment. If that failed, employees were
told to say, “If you have your checkbook in your car I will be happy to
wait for you,” internal documents show.

Employees at Accretive’s client hospitals ask patients to make “point of
service” payments before they receive treatment. Until she went to Fairview
for her son Maxx’s ear tube surgery in November, Marcia Newton, a
stay-at-home mother in Corcoran, Minn., said she had never been asked to
pay for care before receiving it. “They were really aggressive about
getting that money upfront,” she said in an interview.

Ms. Newton was shocked to learn that the employees were debt collectors.
“You really feel hoodwinked,” she said.

While hospital collections at Fairview increased, patient care suffered,
the employees said. “Patients are harassed mercilessly,” a hospital
employee told Ms. Swanson.

Patients with outstanding balances were closely tracked by Accretive staff
members, who listed them on “stop lists,” internal documents show. In March
2011, doctors at Fairview complained that such strong-arm tactics were
discouraging patients from seeking lifesaving treatments, but Accretive
officials dismissed the complaints as “country club talk,” the documents
show.

Ms. Swanson said that the hounding of patients violated the Emergency
Medical Treatment and Active Labor
Act<http://www.acep.org/content.aspx?id=25936>,
a federal law requiring hospitals to provide emergency health care
regardless of citizenship, legal status or ability to pay.

In the January lawsuit, Ms. Swanson said that by giving its collectors
access to health records, Accretive violated the Health Insurance
Portability and Accountability Act <http://www.hhs.gov/ocr/privacy/>, known
as Hipaa (pronounced HIP-ah). For example, an Accretive collection employee
had access to records that showed a patient had bipolar
disorder<http://health.nytimes.com/health/guides/disease/bipolar-disorder/overview.html?inline=nyt-classifier>,
Parkinson’s disease<http://health.nytimes.com/health/guides/disease/parkinsons-disease/overview.html?inline=nyt-classifier>and
a host of other conditions.

In addition, she said, the company broke state collections laws by failing
to identify themselves as debt collectors when dealing with patients.
Late Tuesday afternoon, Accretive announced it won a contract to provide
“revenue cycle operations” for Catholic Health East, which has hospitals in
11 states.

-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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