A debt collection agency is facing scrutiny for the heavy handed tactics it employs at some hospitals around the country. According to a report from The New York Times, Accretive Health, the nation’s largest collectors of medical debt, is facing criticism for its practice of stationing representatives at its client hospitals, including in emergency rooms, so that they can pressure patients for payment before care is rendered.
According to the Times, Accretive Health has contracts with some 50 hospitals throughout the U.S., including some of the largest hospital systems in the country, such as Henry Ford Health System in Michigan and Intermountain Healthcare in Utah.
Hospitals have always turned to outside collection agencies to help them obtain payment of overdue bills. But according to the Times, hospitals that contract with Accretive Health have, in some cases, turned over the management of their front-line staffing — like patient registration and scheduling – to the company. Last Tuesday, the Minnesota Attorney General released results of an investigation that revealed some of the company’s disturbing practices:
“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. “
According to the Times, the Minnesota investigation also revealed that:
- Accretive fostered a pressurized collection environment that included mandatory daily meetings at the hospitals in Minnesota.
- Employees with high collection tallies were rewarded with gift cards. Those who fell behind were threatened with termination.
- Employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance.
- Employees at Accretive’s client hospitals ask patients to make “point of service” payments before they receive treatment.
- In March 2011, doctors at one Minnesota hospital group, Fairview Health Services, complained that the company’s strong-arm tactics were discouraging patients from seeking lifesaving treatments, but Accretive officials dismissed the complaints as “country club talk.”
Lori Swanson, the Minnesota Attorney General, has charged that Accretive’s tactics violated the Emergency Medical Treatment and Active Labor Act, a federal law requiring hospitals to provide emergency health care regardless of citizenship, legal status or ability to pay. Swanson also said the company broke state collections laws by failing to identify themselves as debt collectors when dealing with patients.
In January, Swanson sued 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. In that suit, Swanson alleges violated the Health Insurance Portability and Accountability Act, known as Hipaa, by giving collectors access to patient health records, according to the Times.
Since the Minnesota report was made public, several lawmakers have called for a broader investigation into the company’s tactics. According to the Times, California Representative Pete Stark, a Democrat and the highest ranking member of the subcommittee that oversees Medicare and other health programs, on Thursday asked the acting administrator for the Medicare and Medicaid agency to investigate the company’s practices.
Minnesota Senator Al Franken, also a Democrat, has written to the company’s CEO regarding his own plans to investigate Accretive.
“If these allegations are true — and I do want to hear all sides of this story — they would be an affront to the health, privacy and dignity of Minnesotans,” Franken said in a statement.