University of Minnesota Law Professor

Writes in Chronicle of Higher Education

About Fairview Hospital Shakedown

My esteemed colleague, Professor Michele Goodwin, writes:

In the Chronicle of Higher Education

[Some emphasis mine

Also note: slightly edited - by omission - because some of the matters have been previously covered on this blog.]

This week, Senator Al Franken chaired a field hearing on patient access and privacy.  I blogged previously about the hearings here.  Franken, a member of the U.S. Senate Health Committee, launched the investigation after Lori Swanson, the Minnesota attorney general, filed a law suit (complaint here)  against Accretive Health, an organization that wears many hats, including that of aggressive debt collection.

The detailed six volume report from Swanson’s office highlights alleged misconduct so reprehensible that if found to be true, the company violated numerous federal and state laws.  The company is alleged to have back-dated documents;  shared with random employees the personal medical histories (as well as social security numbers and other personal data) of more than 20,000 patients; harassed patients at the hospital (often at their bedside) for payments; contacted relatives of patients; deceived patients who had credit in their account by demanding payment anyway and not disclosing that the company owed money to the patients; were careless with laptops, which were lost or stolen with unencrypted data; embedded employees among hospital staff so that patients believed they were sharing sensitive information with hospital staff; and that is not all.  Swanson’s office alleges that Accretive developed a patient-restriction strategy, which the company brands in their documents as “Accretive Secret Sauce” to restrict patient care. They then developed a slogan:  “You’ve never seen ASS like ours!” (Volume 2, pages 14-15)

When an attorney contacted Fairview Hospital because a patient was harassed, an Accretive employee is said to have responded in this way:

 “There are some attorneys who aren’t skilled enough for an actual practice that work for these stupid fricken non-profit organizations who help the poor in Detroit. Now we have to waste our time with this low life patient and some dumbass attorney all because the patient didn’t show up to the DHS office to renew her benefits.”

Accretive debt collector: August 16, 2011  (more can be found here)

Employees of the company and the hospital feared for their jobs if they did not comply. In daily “chalk talks,” the company emphasized the importance of collecting money.

At the daily “Chalk Talks” (Ex. 5), [hospital employees]… were required to talk about their collection quotas, tossing a ball around to each speaker as they discussed their collection performance. (Ex. 6.) Accretive’s revenue-cycle work for Fairview was led by an individual Accretive calls “Andrew ‘I Am Not A’ Crook.” (Ex. 7.) As early as September, 2010, Mr. Crook reported to the Accretive home office in Chicago (in preparation for an upcoming presentation to the Fairview CEO), “We’ve started firing people that aren’t getting with the program.” (Ex. 8.) Fairview emergency room workers state that they got the message that if they don’t collect money in the ER, they would be fired. (Ex. 9.)

 ... if gift cards or the opportunity to wear jeans to work didn’t result in more employee stealth at shaking down patients, the company allegedly took stronger action. In an email turned over to Swanson’s office, a management member reminded Fairview:  “I think we’ll need to institute the ‘stick’ as well – can Colin and Colleen start writing folks up for not screening accounts when they’re the registrar.” (Ex. 70).

The documents strongly suggest that the company even engaged in profiling.  According to documents collected by Swanson’s office, Accretive found that going after both emergency rooms patients and targeting pregnant women could bring in a lot of revenue.  Pregnant women are desperate and want to birth healthy babies and emergency room patients are in such pain that they will want relief as soon as possible.

And the angels wept.