Be careful – that nice nurse over there might actually be a debt collector. Accretive Health, one of the country's largest collectors of medical debt, provides onsite collection services for some of the largest hospital systems in the US. According to an April 24, 2012 story in the New York Times, Minnesota Attorney General Lori Swanson thinks some of the tactics used by Accretive are aggressive and in some cases illegal. These tactics include:
- embedding Accretive employees in hospital emergency rooms and demanding that patients pay before receiving treatment;
- embedding Accretive employees in labor and delivery rooms;
- Accretive employees discouraging patients who have a previous balance from seeking emergency care, or stalling them in the emergency room until they pay;
- Accretive employees giving the appearance of being hospital employees when they were not, in violation of the law; and
- In some cases, Accretive employees had access to health information in addition to billing information, a possible violation of federal privacy laws.
Ms. Swanson has not yet brought action against Accretive, but she said she was in discussions with state and federal regulators across the country about a coordinated response to Accretive's practices.
As noted in the Times article, hospitals have long hired collections companies to pursue patients after they have left the facilities. In 2010, the more than 5,000 community hospitals in the US provided $39.3 billion in uncompensated care. These mounting health care costs have pressured hospitals into more aggressive collection tactics, including allowing collections companies on site.
According to documents from the Minnesota investigation, Accretive fostered a pressurized collection environment that included mandatory daily meetings at Minnesota hospitals. Employees with high collection rates were rewarded with gift cards, and those who were less effective were threatened with termination.