(NEW YORK) MintPress — It couldn’t exactly be considered good bedside manner. Installing debt collectors in emergency rooms is just one of the methods used by Accretive Health in hospitals across the country, according to the Minnesota attorney general, Lori Swanson who released hundreds of documents showing that Accretive, one of the nation’s biggest collectors of medical debts, has used myriad strong-arm tactics to recoup payments for major health care institutions.
The Illinois-based company has contracts not only with two hospitals cited in Minnesota but also the Henry Ford Health System in Michigan and Intermountain Healthcare in Utah. And on Tuesday, as the allegations unfolded, Accretive announced it won a new contract with Catholic Health East, which has hospitals in 11 states.
“I have every reason to believe that what they are doing in Minnesota is simply company practice,” said Swanson.
The case highlights not only the increasingly desperate strategies adopted by hospitals as their debts pile up, but also the mounting pervasiveness of unethical practices in the health care industry.
According to the American Hospital Association (AHA), the more than 5,000 community hospitals in the U.S. provided $39.3 billion in uncompensated care in 2010, up 16 percent from 2007. Because of that financial burden, many have started letting debt collectors work in the front offices in jobs such as patient registration and scheduling.
Boiler room culture
Accretive says that it trains its staff to focus on getting payments through “revenue cycle operations.” According to the newly released documents, it created a highly pressurized environment that included mandatory daily meetings at the hospitals in Minnesota. Employees who chalked up a large number of collections were rewarded with gift cards. Those who failed to retrieve a lot of revenue were in danger of losing their jobs.
“The focus was on growth, not protecting patients’ information,” wrote a former Accretive employee in comments to The New York Times. It was all about volume and getting more consultations done – often in incredibly stressful conditions. People were forced to work overtime with no compensation and no breaks. Seven days a week was the norm.”
The documents show that employees were told to delay patients entering the emergency room until they had agreed to pay an outstanding balance. They were also directed to ask patients for “point of service” payments before they received treatment.
One manager at Fairview Health Services in Minnesota, which recently canceled Accretive’s contract, told staffers they should “get cracking on labor and delivery,” as there is a “good chunk to be collected there.”
“Patients are harassed mercilessly,” one Fairview employee told attorney general Swanson. Patients with outstanding balances were tracked and put on “stop lists.”
In 2011, doctors at Fairview complained that Accretive’s procedures were discouraging patients from seeking necessary treatment, but company officials dismissed the complaints as “country club talk.”
Illegal activities
In addition to their tactics being underhanded, according to attorney general Swanson Accretive employees may have broken the law. She maintains that hounding patients violates the Emergency Medical Treatment and Active Labor Act (EMTALA), a federal law requiring hospitals to provide emergency health care regardless of citizenship, legal status or ability to pay.
In addition, by giving its collectors access to patients’ health records, Accretive violated the Health Insurance Portability and Accountability Act (HIPAA). Finally, she contends the company broke state collections laws by failing to identify themselves as debt collectors when dealing with patients.
Swanson is now in talks with state and federal regulators about appropriate action. In January, she filed a civil suit against the company after a laptop with patient information was stolen. That suit is still pending.
In its annual report, the company said it was cooperating with Swanson to resolve the issues in Minnesota. An Accretive spokeswoman said only “We have a great track record of helping hospitals enhance their quality of care.”
Anthony Wright, executive director of consumer advocacy coalition Health Access California, said, “The mission of these companies is in direct opposition to the supposed mission of these hospitals.”