If Accretive Health thought it had a chance to change the narrative regarding its alleged debt collection practices, Wednesday morning’s special hearing at the Minnesota State Capitol called by Sen. Al Franken proved otherwise.

Other than the Accretive Health witness, eight other witnesses essentially made it clear that hitting up patients by their bed side or at the emergency room to collect past due payment or prepayment was at best unethical, at worst a breach of the law.

The hearing was prompted by Minnesota State Attorney General Lori Swanson’s investigation into Accretive Health’s debt collection methods. It has resulted in Fairview Health Services, a Minnesota health provider to sever its contracts with the company, and a national uproar over how patients are treated.

On Wednesday, Accretive Health’s Greg Kazarian,a senior vice president, tried to redeem the company’s image by asserting that debt collection is “less than 1 percent of what we do.” Kazarian noted that in the vast majority of cases, employees help patients find health insurance coverage either from their own insurers or from the federal government.

And in his letter to Franken, Kazarian stated how “revenue cycle employees wish to communicate with patients with the greatest compassion.”

However, the actual practices appear to tell a different story.

At the hearing, Franken read aloud an email that a debt collector wrote to a co-worker where he calls a patient with an overdue payment, “deadbeats” and a “schmuck,” and added that he is quite “stern” in his communication with such people.

“That doesn’t square with the compassion” in Kazarian’s letter, Franken said.

Kazarian responded that the employee has been fired. He added that he knows that this attitude is not entrenched within employees because the email response from the co-worker shows that the person “didn’t want to engage in that exchange.”

Patient witnesses Tom Fuller who had undergone a lung transplant with many complications at a Fairview hospital admitted to feeling “furious” and was “shaking” when he was asked to pay a $500 bill in a back room after being separated from his wife. That occurred when he was being registered at the hospital.

Another patient, Deb Waldin, said she was writhing in pain and was in a fetal position from what turned out to be a kidney stone when she was approached by a man saying that she had an outstanding balance. Waldin said she had insurance and did not owe Fairview anything and ended up shooing the man out of the room as she lay on a gurney inside the emergency room. At the time, she hadn’t seen a doctor and had received no pain medication, Waldin recalled.

In his testimony, Fairview’s chairman of the board Charles Mooty personally apologized to patients and said that the company has brought debt collection work in-house after terminating its relationship with Accretive.

While attempting to get to the bottom of the company’s practices, Franken also acknowledged repeatedly that hospitals are operating under tight budgets with shrinking margins, so they too need to find a way to get paid for their services.

“Hospitals need a way to collect. … Where do we strike that right balance” of recouping costs while not compromising the quality of care? Franken asked.

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