HL20: Lori Swanson—Taking a Stand on Bill Collection Efforts

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Lori Swanson.

This profile was published in the December, 2012 issue of HealthLeaders magazine.

 "There is a time a place and a way for a hospital to collect money but the ER isn't it."

For Minnesota Attorney General Lori Swanson, the case against Accretive Health Inc. started out as a straight-forward HIPAA violation investigation.

An employee at the Chicago-based revenue cycle management and debt collection firm lost his company laptop in a smash-and-grab while his car was parked at a Minneapolis restaurant. The unencrypted computer contained health records for more than 23,500 people.

As prosecutors began investigating the theft they also began to hear troubling reports from patients and Accretive employees about the company's business practices at three hospitals it had contracted with in Minnesota.

"I personally met with over 60 patients who were asked to pay money in the hospital. It was just unbelievable what was being asked of them," Swanson says. "There was a lady who just had her baby and she was literally told before you can take your baby home you have to put $800 on your credit card. She did.

"Another woman, we call her Jane Doe No. 3 in the papers, she was having a miscarriage. Pregnant with her first child, she went to the ER and they demanded right there in the middle of the miscarriage that she pay on a credit card. She did lose her baby that night. That kind of conduct has no place in an American hospital," Swanson says.

"In one case a child had swallowed a bottle of pills, didn't want to live anymore. The mother whisked her child to the ER in the middle of the night. They administered a charcoal solution to start absorbing the overdose," Swanson says. "Mom was literally taken from her daughter's side at that point even though the doctors needed to talk to the mom to get information about the daughter's mental state. She didn't know if she was going to live or die. The mom was asked to pay $500 on a credit card so she could return to her daughter's bedside."

Oddly, in almost every case, the patients did have health insurance. "The hospital would get paid eventually," Swanson says. "There is a time a place and a way for a hospital to collect money but the ER isn't it," she says.  "When you go to the ER you don't have a wallet with you. You are fleeing your home for emergency treatment. It just was unconscionable what these patients were put through."

Swanson says she understands the financial constraints that hospitals are under and that they have the right to pursue outstanding debts. But she says there is no excuse for Accretive's tactics.

In July, Accretive agreed to pay the state of Minnesota $2.5 million, which will be put in a restitution fund to compensate patients. Also as part of the settlement, Accretive is banned from doing business in the state of Minnesota for at least two years and cannot re-enter the state for six years without the consent of the attorney general. The attorney general had alleged violations of state and federal health privacy laws, and of state debt collection laws. The settlement contains no admission of liability or wrongdoing, Accretive noted in a statement.

Swanson says she believes the investigation and the widespread publicity it received struck a nerve with the public, and that the settlement sent a message to other hospitals and debt collectors.

"When you go to the ER you want to enter a sanctuary where they are going to care about treating your medical condition and stabilizing your emotional suffering," she says. "Anybody can have a heart attack or be in a car accident and have to go to the ER. It is people's worst nightmare that it would happen to them or a family member, and at the worse time in your life a bill collector comes at you as a number on a balance sheet instead of a patient who needs care. There is a consensus that there is a time, a way, and a place for hospitals to collect money but this was the wrong place, time, and way to go about it."