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Debt Collectors in Your Hospital Room
Yet another reason this country's healthcare system is seriously f***ed up.
Debt Collector Is Faulted for Tough Tactics in Hospitals
By JESSICA SILVER-GREENBERGHospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.
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 tactics, like embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment, were outlined in hundreds of company documents released by the attorney general. And they cast a spotlight on the increasingly desperate strategies among hospitals to recoup payments as their unpaid debts mount.
To patients, the debt collectors may look indistinguishable from hospital employees, may demand they pay outstanding bills and may discourage them from seeking emergency care at all, even using scripts like those in collection boiler rooms, according to the documents and employees interviewed by The New York Times.
In some cases, the company?s workers had access to health information while persuading patients to pay overdue bills, possibly in violation of federal privacy laws, the documents indicate.
The attorney general, Lori Swanson, also said that Accretive employees may have broken the law by not clearly identifying themselves as debt collectors.
Accretive Health has contracts not only with two hospitals cited in Minnesota but also with some of the largest hospital systems in the country, including Henry Ford Health System in Michigan and Intermountain Healthcare in Utah. Company executives declined to comment on Tuesday.
Although Ms. Swanson did not bring action against the company on Tuesday, she said she was in discussions with state and federal regulators about a coordinated response to Accretive Health?s practices across the country. Regulators in Illinois, where Accretive is based, are watching the developments closely, according to Sue Hofer, a spokeswoman with the State Department of Financial and Professional Regulation.
?I have every reason to believe that what they are doing in Minnesota is simply company practice,? Ms. Swanson said in an interview, but declined to provide details.
In January, Ms. Swanson filed a civil suit against Accretive after a laptop with patient information was stolen, saying that the company had violated state and federal debt collection laws and patient privacy protections. That action is still pending.
An Accretive spokeswoman declined to comment on whether other states were looking into its practices and issued a brief statement, ?We have a great track record of helping hospitals enhance their quality of care.? In its annual report, the company said it was cooperating with the attorney general to resolve the issues in Minnesota.
As hospitals struggle under a glut of unpaid bills, they are reaching out to companies like Accretive that specialize in collecting medical bills.
Hospitals have long hired outside collection agencies to pursue patients after they have left hospital facilities. But financial pressures are altering the collection landscape so that they are now letting collection firms in the front door, according to Don May, the policy adviser for the American Hospital Association, a trade group.
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.
Concerns are mounting that the cozy working relationships will undercut patient care and threaten privacy, said Anthony Wright, executive director of Health Access California, a consumer advocacy coalition. ?The mission of these companies is in direct opposition to the supposed mission of these hospitals.?
Still, hospitals are in a bind. The more than 5,000 community hospitals in the United States provided $39.3 billion in uncompensated care ? predominately unpaid patient debts or charity care ? in 2010, up 16 percent from 2007, the hospital association estimated.
Accretive is one of the few companies specializing in hospital debt collection that is publicly traded. Last year, it reported $29.2 million in profit, up 130 percent from a year earlier.
Late last month, Fairview Health Services, a Minnesota hospital group that Accretive provided services to, announced it was canceling its contract with Accretive for back-office debt collection. After Accretive informed investors, its stock plunged 19 percent in a day. On Tuesday, the company?s shares closed at $18.49, down 2.7 percent.
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.
?We?ve started firing people that aren?t getting with the program,? a member of Accretive?s staff wrote in an e-mail to his bosses in September 2010.
Collection activities extended from obstetrics to the emergency room. In July 2010, an Accretive manager told staff members at Fairview that they should ?get cracking on labor and delivery,? since there is a ?good chunk to be collected there,? according to company e-mails.
Employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance, according to the documents. Employees in the emergency room, for example, were told to ask incoming patients first for a credit card payment. If that failed, employees were told to say, ?If you have your checkbook in your car I will be happy to wait for you,? internal documents show.
Employees at Accretive?s client hospitals ask patients to make ?point of service? payments before they receive treatment. Until she went to Fairview for her son Maxx?s ear tube surgery in November, Marcia Newton, a stay-at-home mother in Corcoran, Minn., said she had never been asked to pay for care before receiving it. ?They were really aggressive about getting that money upfront,? she said in an interview.
Ms. Newton was shocked to learn that the employees were debt collectors. ?You really feel hoodwinked,? she said.
While hospital collections at Fairview increased, patient care suffered, the employees said. ?Patients are harassed mercilessly,? a hospital employee told Ms. Swanson.
Patients with outstanding balances were closely tracked by Accretive staff members, who listed them on ?stop lists,? internal documents show. In March 2011, doctors at Fairview complained that such strong-arm tactics were discouraging patients from seeking lifesaving treatments, but Accretive officials dismissed the complaints as ?country club talk,? the documents show.
Ms. Swanson said 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.
In the January lawsuit, Ms. Swanson said that by giving its collectors access to health records, Accretive violated the Health Insurance Portability and Accountability Act, known as Hipaa (pronounced HIP-ah). For example, an Accretive collection employee had access to records that showed a patient had bipolar disorder, Parkinson?s disease and a host of other conditions.
In addition, she said, the company broke state collections laws by failing to identify themselves as debt collectors when dealing with patients.
Late Tuesday afternoon, Accretive announced it won a contract to provide ?revenue cycle operations? for Catholic Health East, which has hospitals in 11 states.
Re: Debt Collectors in Your Hospital Room
I have been sitting here trying to formulate some sort of response but I've got nothing. I seriously cannot believe this happens. I think calling the police would be a good response her for harassment but I'm just not sure.
ETA: In November my allergist sent me across the street to the ER because he was concerned there was something seriously wrong with me. There wasn't but I digress. For this idiotic visit, I received bills from four different sources for this one visit. I thought I paid them all but apparently I missed one for $15. Last month I got a debt collection letter...for $15. I called the hospital and gave them an ear full.
my read shelf:
My first thought at someone rolling into my mom's emergency room demanding payment was that I would want to violently attack them. I could not imagine. I could never ever ever do that job.
This right here is a damned shame.
We have the best medical system in the world!
We're #1. We're #1.
As a nurse, I am unbelievably appalled by this behavior. Anything that gets in the way of a patient's access to care should be stopped.
The idea of pre-paying is wrong anyway. There is no way to know what the bill will actually be until after the services have been rendered.
(To be fair, I have a hate on for debt collectors in general because they have been know to have a clear disregard for the law. Like in this example where they don't identify themselves.)
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.
WTF has this country become, that this happens?
This is one of many reasons I'm all for patient empowerment - you know, the freedom to ask people "Who are you" among other things without getting crap about it.
*fondly remembers when mother was admitted to ortho rehab, saying "You're allowed to read that consent form before you sign it" , staring down the employee mentally daring her to roll her eyes*
Something similar happened when I delivered Kirklette's. It wasn't a debt collector, but right after my OB finished sewing my 2nd degree torn vag, someone from Cedars Finance Department came in and asked how we'd be paying for the delivery - cash, check, or payment plan. The drugs hadn't even worn off yet, so I was delirious. DH was pissed!
Seriously.
I believe my first act as a new mom would be bailing my husband out from jail because I have a feeling he would end up arrested for assault if someone did this.
Someone on MM just posted about her experience.
http://community.thenest.com/cs/ks/forums/thread/65472149.aspx
OMG, I just read that and I am seeing red. I cannot imagine going in for a D&C and being asked to put a down payment on that. I have no words. No words.
seeing that i am still working through the billing for ds's birth and nicu stay (he will be 1 on monday)- maybe hospitals should work on billing insurance properly the first time, getting people's addresses and other necessary info right, and otherwise adding some efficiency to their incompetent billing departments before farming it out to collection agencies that will stand guard before you can get to triage.
just a thought.
DH had surgery in January and we paid everything promptly. The surgical center asked for a down payment and I refused. Other than failing to record our payment, the surgical center got the bills right. His surgeon's office is a complete clusterfuck. Their office got pissed at me for pointing out billing errors and I still don't have a final bill from them. They'd actually billed us for less than our insurance says we owe, but it was for the wrong stuff. He got a boot from them in January and we still don't have a bill. I'm going to have to call them to follow up and know its going to be a pita.