Swanson was not the only official to look into Accretive's activities. U.S. Sen. Al Franken (D-Minn.) held a hearing on the allegations in May in St. Paul. “It was clear that our laws don't go far enough to protect consumers from serious breaches of trust,” Franken said in a statement responding to the settlement.
After his field hearing, Franken introduced debt-collection and patient-privacy bills that would ban collectors from hospital emergency rooms, labor and delivery departments and intensive-care units and would expand consumer information and collectors' liability for violations under the Fair Debt Collection Practices Act.
Rep. Pete Stark (D-Calif.) in April called for HHS' inspector general to launch an investigation into Accretive. Reps. Henry Waxman (D-Calif.) and Diana DeGette (D-Colo.) opened their own inquiry into hospital billing and Accretive.
At Fairview Health Services, a seven-hospital system based in Minneapolis, where Accretive operated until the attorney general's inquiry into practices there, officials have revised collection policies and training materials. Fairview broke off its contracts with Accretive Health as the attorney general pursued her inquiry.
Fairview spokesman Ryan Davenport said the hospital has since stopped collecting coinsurance or past-due amounts in its emergency rooms, and a push is under way to halt similar collections in its labor and delivery units. The system reviewed and revised its training materials and has moved to ensure complaints are handled quickly, he said.
Accretive's stock price rose with the news of the settlement, despite the loss of Minnesota business.
In addition to Fairview, 70-bed Maple Grove (Minn.) Hospital ended its contract with Accretive in June. And 384-bed North Memorial Health Care, Robbinsdale, Minn., broke off its business with Accretive ahead of the announced settlement, according to a statement. North Memorial officials declined an interview request.
Accretive's Minnesota troubles apparently have not disrupted the company's business outside of Minnesota. Accretive announced its deal with Catholic Health East in April as it lost its Fairview contract. Scott Share, a spokesman for the 23-hospital system, said the deal tests revenue cycle co-management at one hospital. “To date, we are pleased with our relationship with Accretive Health,” Share said.
Ascension Health, the nation's largest not-for-profit health system and Accretive's largest and first customer, is also an investor in the company. Ascension is in talks to extend its contract with Accretive for five years.
“All our vendors are contractually required to comply with our policies,” Robert Henkel, president and CEO of the health system, said in a statement. The 76-hospital system's policies and practices reflect compassion, respect for human dignity and seek to aid those uninsured who are eligible for coverage, he said. “If we have information that such policies or practices have not been adhered to, we take steps to address and correct that situation.”
Some Accretive clients stressed that their contracts with Accretive differed from the company's deal in Minnesota with Fairview, where Accretive assumed control of billing and collection efforts. Henry Ford Health System is continuing its contract with Accretive. “All of our emergency departments provide treatment without regard for ability to pay, and staff who register patients for treatment are Henry Ford employees,” the six-hospital Detroit-based system said in a statement.
Beaumont Health entered into a contract with Accretive in July 2011 for services, but Beaumont continues to control its billing and collection staff, decision-making and policies, said Colette Stimmell, a spokeswoman for the three-hospital system based in Royal Oak, Mich.
A spokesman for 21-hospital, Salt Lake City, Utah-based Intermountain Healthcare said the health system “is a relatively new client” of the company, which provides insurance-claim reviews, software and consulting.
Accretive, while aggressively disputing Swanson's characterizations of its practices, created a panel to develop standards for patient collections and named former HHS Secretary Mike Leavitt to lead it.
The Healthcare Financial Management Association, which has published guidelines for patient-bill collection, has been in conversation with the panel organizers, said Rick Gundling, the association's vice president of healthcare financial practice. The HFMA's guidelines already address violations alleged by Minnesota's attorney general, he said.