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AG report: Fairview embedded debt collectors in hospital

Checking into a hospital, particularly during a medical emergency, can be a confusing and intimidating process.

But should patients who go to the hospital for medical care expect to encounter a debt collector at the registration desk?

Attorney General Lori SwansonAttorney General Lori Swanson

Apparently, some hospitals, desperate to recoup mounting losses associated with unpaid patient bills (which totaled $39.3 billion in 2010), aren’t waiting until patients have been treated and go home to send collection agencies after them. Instead, the hospitals have begun embedding “stealth” debt collectors among their own personnel.

On Tuesday, light was shed on this ugly situation here in Minnesota.

Writes Pioneer Press reporter Christopher Snowbeck:

A Chicago-based consultant hired by the Fairview health system pushed hospital workers to engage in overly aggressive bill collection tactics that included pressuring patients in the emergency room, according to an investigative report released Tuesday, April 24, by Minnesota Attorney General Lori Swanson.

Accretive Health Inc. imposed quotas on hospital personnel to collect money before treatment was provided in some cases, according to Swanson’s report, and ignored concerns from some Fairview workers that the tactics were going too far.

The report described Accretive’s methods as being akin to those “commonly utilized in high-pressure boiler-room-style sales atmospheres.”

And this from Tony Kennedy and Maura Lerner at the Strib:

Swanson’s probe found that Accretive employed collection quotas, cash inducements and in-house competitions using National Football League team names to motivate staff members to squeeze upfront payments from patients. At patient registration desks, for example, employees were told to follow lengthy scripts, written by Accretive, to press patients for payments before they got treatment, according to the six-volume report.

In one case, a child who sought treatment at the University of Minnesota Amplatz Emergency Room reportedly was kept waiting while the parents, who were uninsured, met with an Accretive “financial counselor.” The incident prompted the hospital’s own employees to question whether Accretive was violating federal law, which requires emergency rooms to see patients without such delays.

According to the attorney general’s report, Accretive was derisive of such questions and complaints, even when they came from doctors. “I’m assuming this is a country club conversation that is getting floated around,” an Accretive manager wrote in an e-mail to another employee.

North Memorial

Fairview said on Tuesday that it has stopped using Accretive to collect its debts, although the hospital also said it continues to use the company to help control other costs.

Accretive also contracts with North Memorial Hospital. Swanson told reporters that she’s been trying to investigate that relationship, but North Memorial officials have been uncooperative. The hospital released a statement Tuesday in which it said it was providing information to the attorney general “in a manner that is as timely as possible.”

Accretive has issued a statement as well. “We have a great track record of helping hospitals enhance their quality of care,” it reads. “For example, we have helped over 250,000 patients get insurance coverage.”

A disturbing trend

This story may be new to Minnesota, but it’s not new nationwide. Kaiser Health News ran a related story earlier this year:

Last year, about 80,000 emergency-room patients at hospitals owned by HCA [Hospital Corporation of America], the nation’s largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency.

Led by the Nashville-based HCA, a growing number of hospitals have implemented the pay-first policy in an effort to divert patients with routine illnesses from the ER after they undergo a federally required screening. At least half of all hospitals nationwide now charge upfront ER fees, said Rick Gundling, vice president of the Healthcare Financial Management Association, which represents health-care finance executives.

For patients, this is a disturbing trend. Up to 7 percent of emergency room patients who are found to have “routine” medical issues are admitted to a hospital within 24 hours, according to an emergency room physician interviewed by Kaiser reporter Phil Galewitz.

As Swanson told Minnesota Public Radio reporter Elizabeth Dunbar about the Accretive revelations: “It’s something new and it’s something troubling. This is a case of money and medicine not mixing very well.”

You can read a New York Times story on the subject here and the attorney general’s report here.

Comments (6)

  1. Submitted by Lawrence Lockman on 04/25/2012 - 04:36 pm.


    Even more disturbing than the financial harassment–which is disgusting–are details in the New York Times article indicating that Accretive employees were placed in jobs that patients and families would assume were staffed by hospital personnel. These people may well have violated the patient privacy policies required by the federal government (HIPPA regulations) which is a federal crime.
    When I practiced at Fairview University Hospitals and Clinics the HIPPA regulations were strictly enforced, at least by the doctors and nurses.
    What’s next?

    Also, why did our local papers publish this story a day after the Times?

  2. Submitted by Joe Musich on 04/25/2012 - 09:41 pm.

    bought and paid for ?

    Maybe the local papers are bought and paid for ? Ya think. So the head of the non profit insurance company United Healthcare gets48 million dollars last year. Is everyone biought and paid for ?
    I just had surgery at a unFairview facility and my insurance is through UnitedHealtcare. How will I ever know I was dealt with the proper way ? I remember getting a call almost a month before my surgery saying that my copay option would put me short of the full price and I should give them some money now. Not liking any debt I cough up some money. I definitely remember it feeling real ishy. A message was left at the phone. The person identified themselves as a fairview emplyee in a message. I returned the call expecting the message to be a reminder about pre surgery protocol, or other health concerns. but no it’s a money call.

    • Submitted by mark wallek on 04/28/2012 - 10:55 am.


      We are what is in our pocketbook, nothing more. That is EXACTLY how Fairview makes a person feel. So, if you are wealthy you probably will really be coddled and schmoozed. Not so if you are just a regular human. I remember my doctor stating that he was thinking of getting out of Fairview because his patients were complaining about how Fairview behaved. They like their money up front. That way the CEO and CFO are asured their cut. And don’t forget that after surgery trip to the emergency when the followup will cost another grand or so.

  3. Submitted by Bill Gleason on 04/27/2012 - 06:20 pm.

    I want to point out

    that the cost PER bed for building the Fairview University of Minnesota children’s hospital was THREE MILLION DOLLARS.

    “The new 96-bed children’s hospital will consolidate pediatric care that formerly was scattered in several campus facilities into one specialized building, said Ryan Davenport, a spokesman for Fairview Health Services. In all, the new hospital is expected to cost $275 million with $175 million secured in bonds and the remainder from donations.”

    MinnPost, link:

    We have lost our values when such a facility turns away or hinders care at the emergency room for children with insurance “problems.”

    Simply pathetic.

    William B. Gleason
    University of Minnesota faculty member and alum.

  4. Submitted by mark wallek on 04/28/2012 - 10:45 am.

    Fairview: Appalling dedication to Capital

    Fairview is a totally disgusting entity. During my adventure with them (which started with a negotiated meeting with the CFO in the coffee shop-“my office is too hard to find”-where I handed over about 3500 doillars and got a tiny little hand written recipt which gave me “the right” to have surgery) I did not hear a single doctor or nurse say anything flattering about Fairview. NOT ONE THING. And I talked to every one. In the clinic in the Waagenstein (sp?) building, the cleaning budget had clearly been reduced as the place was dirty. When an entire staff criticizes Fairview, it should be obvious that the public is NOT being served. The CFO was full of platitudes for why things are this way, but in the end my medical dollars are paying her over large salary. I am sure that whatever she drives cost more than the value of my deflated northside home, AND SHE HAS NOTHING TO DO WITH MY HEALTH OR WELL BEING. If I need their services again I will be flat broke, and hence will not be able to acquire their services. So I guess that problem is solved. The nursing staff was exceptional during my time in the hospital. It was sad to see these caring people so poorly treated by Fairview, whose bureaucrats look to be making out like bandits. Usuary used to be illegal in this nation.

  5. Submitted by Robert Gauthier on 05/03/2012 - 02:15 pm.

    Fairview culture

    The corporate culture at Fairview was inept and arrogant from day one with the University. They presumed everyone was a fool but themselves and made mistake after mistake without acknowledgement. They basically gypped the Univ. of Minnesota faculty out of 40M in the self insurance pool, taking money out of the medical school. The University administration was just inept, Fairview was crooked. The leadership culture has continued this to this day. Not a good place to get sick. They only worry about the bottom line. The issues with Accretive were known for at least a year before this story, management looked the other way. The stat should investigate their non-profit status.

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