Thursday, April 26, 2012

Debt Collectors Find Their Way Into Hospitals

The New York Times reports that “Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.”  Go to to find the article, "Debt Collector is Faulted for Tough Tactics in Hospitals," in the NYT Business Day (April 24, 2012).

The online article, by Jessica Silver-Greenberg , continues: “This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.”

The article also indicates tactics of embedding debt collectors as employees in emergency rooms who would be expected to demand that patients pay before receiving treatment.

To patients, the debt collectors may look indistinguishable from hospital employees.  They may demand that the patient pay outstanding bills and may discourage the patient from seeking emergency care at all.  According to reported allegations, Accretive Health employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance. 

The report indicates that in some cases these workers would have access to health information while asking patients to pay overdue bills, what the Minnesota attorney general speculates may be a violation of federal privacy laws.  The Minnesota general asserts that “the hounding of patients 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,” and that “by giving its collectors access to health records, Accretive violated the Health Insurance Portability and Accountability Act.” In addition, the attorney general says that the company broke state collections laws by failing to identify themselves as debt collectors when dealing with patients.

It is noted that hospitals “have long hired outside collection agencies to pursue patients after they have left hospital facilities,” and “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.”

According to the New York Times report, “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.”

The Minnesota attorney general is currently in discussions with state and federal regulators about a coordinated response to Accretive Health’s practices across the country.

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