Pressure builds on Accretive

Congress amps up inquiry amid new allegations

Accretive Health faces additional scrutiny from Congress and fresh allegations that the company illegally and aggressively sought to collect money from patients. The Chicago-based healthcare billing and collection company could see allegations that its workers violated debt collection and consumer protection laws as they pressured patients for money inside the hospital added to a lawsuit previously filed by Minnesota Attorney General Lori Swanson. Her inquiry has drawn new scrutiny to the practices of hospitals and their contractors looking for ways to collect more of what they’re owed (April 30, p. 6).

Swanson asked a federal judge to allow her to expand a lawsuit filed in January against Accretive Health. A hearing on the request is scheduled for July 6.

Swanson’s latest action also brought a renewed request from Reps. Henry Waxman (D-Calif.) and Diana DeGette (D-Colo.) for information on patient complaints against Accretive and the company’s policies and client list. Accretive did not comply with a scheduled request, canceled a meeting and “ignored repeated efforts” to reschedule, the representatives said in a letter to Accretive Health CEO Mary Tolan.

The attorney general’s action follows a sixvolume report on the company’s business practices that her office released in April. Accretive Health lost a major customer— Fairview Health Services, a seven-hospital system based in Minneapolis—and saw its share price drop during the Minnesota attorney general’s inquiry.

Fairview, which employed Accretive Health during the period when the alleged violations occurred, later announced it would not renew a five-year contract with its own CEO, Mark Eustis.

Accretive Health declined an interview request. A spokeswoman provided a prepared statement that downplayed the legal development.

“The state’s proposed amended complaint contains no new causes of action and no additional requested relief. The state has merely added selected allegations from its April ‘compliance review,’ which contains numerous mischaracterizations and distortions of docu- ments and facts. The company plans to move to dismiss the seconded amended complaint in its entirety.”

Court documents Swanson’s office filed last week detail allegations that emergency room patients saw Accretive Health workers before seeing a doctor. Federal law requires emergency room patients to be screened and stabilized before they can be asked to pay.

The company “implied, suggested, and created the impression to many patients, in the emergency room and elsewhere in the hospital, that the patients would not receive healthcare services if they did not make on-the-spot payments in advance of treatment,” the proposed complaint said.

A part-time sheriff’s deputy, later diagnosed with a ministroke, encountered an Accretive Health bill collector before seeing a doctor in a Twin Cities hospital emergency room, for example, and a 51-year-old teacher with a dangerous infection was met first by a bill collector in the emergency room, according to court papers.

The company’s aggressive collection efforts inside Fairview hospitals violated a prior consent agreement between the attorney general and Fairview that required a “zero-tolerance policy for abusive, harassing, oppressive, false, deceptive or misleading language or collections conduct by its debt collection attorney and agency, and their agents and employees, and hospital employees responsible for collecting medical debt from patients,” the complaint said.

The complaint also alleges that the company failed to follow state law and register as a debt collection agency for a period and failed to identify itself to patients as a debt collection agency.

Earlier this month Accretive lost another client, 70-bed Maple Grove (Minn.) Hospital, according to North Memorial Health Care, which jointly owns the hospital with Fairview. Fairview requested Maple Grove terminate the contract, which began in December 2011, Wendy Jerde, a North Memorial spokeswoman, said in an e-mail. North Memorial, meanwhile, is evaluating its own contract with Accretive Health, which gives the Robbinsdale, Minn., hospital oversight of its billing and collection management, employees and policies, the spokeswoman said.