Fall­out from Ac­cre­tive set­tle­ment

... but ques­tions linger over col­lec­tion prac­tices

Modern Healthcare - - FRONT PAGE - Me­lanie Evans

Ac­cre­tive Health set­tled the law­suit that cost the billing and col­lec­tion com­pany clients and mar­ket cap­i­tal­iza­tion, but the set­tle­ment has not ended the ques­tions that the al­le­ga­tions raised about how hos­pi­tals and their con­trac­tors get pa­tients to pay their bills.

Ac­cre­tive, based in Chicago, did not ad­mit wrong­do­ing in the agree­ment with Min­nesota At­tor­ney Gen­eral Lori Swan­son, and the com­pany, in a state­ment as the deal was an­nounced, dis­missed the al­le­ga­tions as “base­less or ex­ag­ger­ated.”

Swan­son al­leged the com­pany broke the law by us­ing med­i­cal records to col­lect bills and pres­sur­ing emer­gency-room pa­tients for money be­fore and dur­ing treat­ment. The set­tle­ment ended a “dis­turb­ing chap­ter in Min- ne­sota health­care,” she said, ac­cord­ing to a state­ment.

Un­der the set­tle­ment, Ac­cre­tive agreed to stop do­ing busi­ness in Min­nesota for two years and pay $2.5 mil­lion. The com­pany must en­ter into a con­sent agree­ment with the at­tor­ney gen­eral for a four-year pro­ba­tion should it wish to re­turn to the state.

Swan­son was not the only of­fi­cial to look into Ac­cre­tive’s ac­tiv­i­ties. U.S. Sen. Al Franken (D-Minn.) held a hear­ing on the al­le­ga­tions in May in St. Paul. “It was clear that our laws don’t go far enough to pro­tect con­sumers from se­ri­ous breaches of trust,” Franken said in a state­ment re­spond­ing to the set­tle­ment.

Af­ter his field hear­ing, Franken in­tro­duced debt-col­lec­tion and pa­tient-pri­vacy bills that would ban col­lec­tors from hospi­tal emer­gency rooms, la­bor and de­liv­ery de­part­ments and in­ten­sive-care units and would ex­pand con­sumer in­for­ma­tion and col­lec­tors’ li­a­bil­ity for vi­o­la­tions un­der the Fair Debt Col­lec­tion Prac­tices Act.

Rep. Pete Stark (D-Calif.) in April called for HHS’ in­spec­tor gen­eral to launch an in­ves­ti­ga­tion into Ac­cre­tive. Reps. Henry Wax­man (D-Calif.) and Diana DeGette (D-Colo.) opened their own in­quiry into hospi­tal billing and Ac­cre­tive.

At Fairview Health Ser­vices, a seven-hospi­tal sys­tem based in Min­neapo­lis, where Ac­cre­tive op­er­ated un­til the at­tor­ney gen­eral’s in­quiry into prac­tices there, of­fi­cials have re­vised col­lec­tion poli­cies and train­ing ma­te­ri­als. Fairview broke off its con­tracts with Ac­cre­tive Health as the at­tor­ney gen­eral pur­sued her in­quiry.

Fairview spokesman Ryan Daven­port said the hospi­tal has since stopped col­lect­ing coin­sur­ance or past-due amounts in its emer­gency rooms, and a push is un­der way to halt sim­i­lar col­lec­tions in its la­bor and de­liv­ery units. The sys­tem re­viewed and re­vised its train­ing ma­te­ri­als and has moved to en­sure com­plaints are han­dled quickly, he said.

Ac­cre­tive’s stock price rose with the news of the set­tle­ment, de­spite the loss of Min­nesota busi­ness.

In ad­di­tion to Fairview, 70-bed Maple Grove (Minn.) Hospi­tal ended its con­tract with Ac­cre­tive in June. And 384-bed North Memo­rial Health Care, Rob­bins­dale, Minn., broke off its busi­ness with Ac­cre­tive ahead of the an­nounced set­tle­ment, ac­cord­ing to a state­ment. North Memo­rial of­fi­cials de­clined an in­ter­view re­quest.

Ac­cre­tive’s Min­nesota troubles ap­par­ently have not dis­rupted the com­pany’s busi­ness out­side of Min­nesota. Ac­cre­tive an­nounced its deal with Catholic Health East in April as it lost its Fairview con­tract. Scott Share, a spokesman for the 23-hospi­tal sys­tem, said the deal tests rev­enue cy­cle co-man­age­ment at one hospi­tal. “To date, we are pleased with our re­la­tion­ship with Ac­cre­tive Health,” Share said.

As­cen­sion Health, the na­tion’s largest not­for-profit health sys­tem and Ac­cre­tive’s largest and first cus­tomer, is also an in­vestor in the com­pany. As­cen­sion is in talks to ex­tend its con­tract with Ac­cre­tive for five years.

“All our ven­dors are con­trac­tu­ally re­quired to com­ply with our poli­cies,” Robert Henkel, pres­i­dent and CEO of the health sys­tem, said in a state­ment. The 76-hospi­tal sys­tem’s poli­cies and prac­tices re­flect com­pas­sion, re­spect for hu­man dig­nity and seek to aid those unin­sured who are el­i­gi­ble for cov­er­age, he said. “If we have in­for­ma­tion that such poli­cies or prac­tices have not been ad­hered to, we take steps to ad­dress and cor­rect that sit­u­a­tion.”

Some Ac­cre­tive clients stressed that their con­tracts with Ac­cre­tive dif­fered from the com­pany’s deal in Min­nesota with Fairview, where Ac­cre­tive as­sumed con­trol of billing and col­lec­tion ef­forts. Henry Ford Health Sys­tem is con­tin­u­ing its con­tract with Ac­cre­tive. “All of our emer­gency de­part­ments pro­vide treat­ment with­out re­gard for abil­ity to pay, and staff who reg­is­ter pa­tients for treat­ment are Henry Ford em­ploy­ees,” the six-hospi­tal Detroit-based sys­tem said in a state­ment.

Beaumont Health en­tered into a con­tract with Ac­cre­tive in July 2011 for ser­vices, but Beaumont con­tin­ues to con­trol its billing and col­lec­tion staff, de­ci­sion-mak­ing and poli­cies, said Co­lette Stimmell, a spokes­woman for the three-hospi­tal sys­tem based in Royal Oak, Mich.

A spokesman for 21-hospi­tal, Salt Lake City, Utah-based In­ter­moun­tain Health­care said the health sys­tem “is a rel­a­tively new client” of the com­pany, which pro­vides in­sur­ance-claim re­views, soft­ware and con­sult­ing.

Ac­cre­tive, while ag­gres­sively dis­put­ing Swan­son’s char­ac­ter­i­za­tions of its prac­tices, cre­ated a panel to de­velop stan­dards for pa­tient col­lec­tions and named for­mer HHS Sec­re­tary Mike Leav­itt to lead it.

The Health­care Fi­nan­cial Man­age­ment As­so­ci­a­tion, which has pub­lished guide­lines for pa­tient-bill col­lec­tion, has been in con­ver­sa­tion with the panel or­ga­niz­ers, said Rick Gundling, the as­so­ci­a­tion’s vice pres­i­dent of health­care fi­nan­cial prac­tice. The HFMA’s guide­lines al­ready ad­dress vi­o­la­tions al­leged by Min­nesota’s at­tor­ney gen­eral, he said.


In the pres­ence of pa­tients who pro­vided

tes­ti­mony against the com­pany, Min­nesota At­tor­ney Gen­eral Lori Swan­son,

left, an­nounces the set­tle­ment July 30.

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