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."