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Debt Collectors In The ER

Jun 01, 2012

This story is part of a reporting partnership that includes Minnesota Public Radio, NPR and Kaiser Health News.

ST. PAUL, Minn. — A former patient of embattled Fairview Health Services testified that a billing employee approached her for payment while she was writhing in pain from a kidney stone in the emergency room.

U.S. Sen. Al Franken led a hearing regarding the debt-collection practices of Fairview Hospital and Accretive Health in St. Paul, Minn. Wednesday, May 30, 2012. (Photo by Jeffrey Thompson/MPR)

Former patients as well as top executives from Fairview and its former debt collector, Accretive Health, testified before a U.S. Senate hearing Wednesday in St. Paul, called by Sen. Al Franken.

Franken, D-Minn., sits on the Senate Health, Education, Labor and Pensions Committee, and wanted to examine whether federal laws protecting patient privacy should be tougher.

The hearing follows a probe by Minnesota Attorney General Lori Swanson that alleges that Accretive used strong-arm tactics to pressure patients into paying for their care up front.

Deb Waldin of Edina testified that while curled up in a fetal position on a Fairview Southdale emergency room gurney last July, alone and waiting for a doctor, a billing agent came in and asked her to pay $750.

"I couldn't believe he was asking me this at the foot of my bed as I'm laying there," Waldin said. "I said, 'I've got insurance, I don't know what you're talking about.' And to be clear, I didn't have any debt with Fairview. And he was asking for this money right then. And I just ultimately told him to get out of the room and go away, and he did."

Another patient, Tom Fuller of New Brighton, told the committee about visiting a Fairview hospital for a procedure a couple of months after a lung transplant. Unlike other visits, he was escorted into a small room, where a man checked him in and put a bill for $500 in front of him.

"I just felt badgered, extremely upset," said Fuller. "Finally he said, 'I'll take a check or a credit card, however you want to pay it.' And I said, 'I have no intention of paying you anything right now; I'm going in for a procedure.'"

The federal health law contains several provisions that apply to nonprofit hospitals like Fairview regarding charity care and collection practices. Nonprofit hospitals are required to attempt to make sure patients don’t qualify for charity care before "extraordinary collection practices" are taken against them.

The Fairview story dates back to July 2011, when an unencrypted laptop containing the personal information of more than 20,000 patients was stolen from an Accretive employee's car, where it was in plain sight. That prompted an investigation and subsequent lawsuit against Accretive by the AG Swanson. She has also accused Accretive of various legal violations due to its bill collection practices.

In the wake of the attorney general's damaging findings, Fairview has ended its contract with Accretive. In addition, Fairview's board of directors announced last week that it would not renew its contract with CEO Mark Eustis.

Fairview's soon-to-be interim CEO Charles Mooty issued an apology at the hearing, as well as a commitment to regain the community's trust.

"We've stopped collecting past-due balances and co-insurance payments in the emergency departments, and we're reviewing emergency department and registration work flow processes," said Mooty.

Chicago-based Accretive has gone on the attack. A company statement last month said extensive inaccuracies, innuendo and unfounded speculation have been part of the attorney general's recent allegations.

Greg Kazarian, senior vice president of operations, said at the hearing that he had worked at the company for more than seven years and that the public portrayal of company's operations is distorted.

But he also said he takes the attorney general's allegations seriously, and if they're true, the company sincerely apologizes.

During a question-and-answer period, Franken read aloud part of a letter in which Kazarian said Accretive employees "worked to communicate with patients with the greatest possible compassion."

Franken then read an internal Accretive email written by an employee who described patients as "deadbeats."

"That he 'really takes the approach of really being stern and calling people out for being stupid, because if they keep hearing it, they may eventually realize their stupidity and possibly feel just a hint of guilt for being such a schmuck,' " Franken read.

Kazarian tried to explain.

"That language, that attitude, does not square with our values, not consistent with our values," Kazarian responded. "And that employee was terminated within 24 hours of us discovering that email. So let me just say for everybody here, make it clear that is not who we are and that's not what we do."

Franken wrapped up the hearing saying this was just the beginning of his investigation, and said he'd hold the record open for a week to accept more questions and comments.

This story is part of a reporting partnership that includes Minnesota Public Radio, NPR and Kaiser Health News.

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