Blog: Bill collections at a Minnesota hospital run afoul of CMS

Hospitals increasingly ask patients to pay a medical bill when they arrive or before they leave. Here's a look at how one Minnesota hospital went too far to collect bills and violated Medicare rules and a law that safeguards access to emergency medical care, regardless of ability to pay.

The University of Minnesota Medical Center, one of seven hospitals owned by Fairview Health Services, is facing a full audit of its compliance with Medicare rules and a follow-up inspection of how well it adheres to the Emergency Medical Treatment and Labor Act, which says hospitals must hold off any talk of payment until a patient has been examined and stabilized.

Collection efforts at Fairview hospitals came under public scrutiny this year after an inquiry by Minnesota's attorney general into Accretive Health, the healthcare billing and collection company Fairview hired. Accretive, based in Chicago, reached a settlement with the attorney general in July that barred the company from Minnesota for at least two years. Accretive denied any wrongdoing.

Nonetheless, an investigation into the University of Minnesota Medical Center found that hospital bill collectors harassed patients and violated EMTALA.

State surveyors deployed on behalf of the CMS said hospital bill collectors harassed the parent of a 7-year-old cancer patient and the father of a 6-year-old with a femur fracture after a playground fall.

In another instance, a woman with chest pain, brought to the emergency room by ambulance, was asked for $627 before a chest X-ray. “She was “angry, scared and appalled” that a hospital employee would ask her for money when she thought she was having a heart attack,” the investigators said. She was later diagnosed with pneumonia and advised to stay the night. Afraid she did not have enough money, she left.

Also, a woman in “agonizing” abdominal pain feared she would not be treated if she did not pay $527 after hospital laboratory staff took blood samples.

The CMS has received and approved a plan from the hospital to correct the violations, said Stella French, director of the Minnesota Department of Health's Office of Health Facility Complaints.

The CMS did not impose civil money penalties for the EMTALA violations, but instead threatened to exclude the hospital from Medicare, the health department said.

“Being in compliance with CMS is critical to our mission,” Carolyn Wilson, president of University of Minnesota Medical Center, said in a statement. “We are very concerned about the issues that came up and are working collaboratively with CMS to get them resolved.”

Fairview has changed registration and collection policies in the emergency room—the system no longer collects past-due amounts, coinsurance and copays in the emergency department, according to the statement.

You can follow Melanie Evans on Twitter: @MHmevans.