Not only did Accretive Health send collection agents to emergency rooms, the Chicago-based debt collection agency also neglected to file a business associate agreement with North Memorial hospital, as required by HIPAA.

That is one of the many allegations contained in an amended complaint that Minnesota Attorney General Lori Swanson filed in state court on Tuesday. Swanson has been investigating Accretive ever since the company acknowledged that one of its laptops containing sensitive patient data was stolen from a car in Minneapolis in late July.

Swanson alleges that the company essentially lied when she requested a copy of a business associate agreement between North Memorial hospital and Accretive. A business associate agreement is something that is required under HIPAA to make sure that third parties comply with its privacy rules.

Swanson alleges that only when she requested a copy of the business associate agreement did Accretive create one and back date it to March 2011, when the relationship with the hospital began.

In October 2011, Accretive was a licensed debt collection agency in the Stateof Minnesota. Accretive violated this provision by operating without a valid businessassociate agreement with North Memorial (which was required in order for Accretive to obtain protected health information under the revenue cycle agreement with North Memorial) and thereafter colluding with North Memorial to present a backdated businessassociate agreement to the Minnesota Attorney General, which was deceptively made to appear as if it was signed in March 2011, when it was really signed in October 2011.

An email to a North Memorial spokeswoman wasn’t immediately returned.

A spokeswoman for Accretive Health did not address specific questions, but forwarded a prepared statement.

“The state’s proposed Amended Complaint contains no new causes of action and no additional requested relief. The state has merely added selected allegations from its April ‘Compliance Review,’ which contain numerous mischaracterizations and distortions of documents and facts. The company plans to move to dismiss the second amended complaint in its entirety,” it read.

However, on its website, Accretive addresses the issue of backdating the business associate agreement, an allegation that first emerged when Senator Al Franken held a hearing in Minneapolis where both Swanson and Accretive Senior Vice President Greg Kazarian testified. In a letter addressed to Franken, Kazarian explains that Swanson is “mistaken” in alleging the backdating.

He goes on to say:

In October 2011, the parties could not locate the executed copy of the BAA. Accordingly, a replacement BAA was
signed in October 2011. The replacement BAA was not back-dated. The only reference to a past date — consistent with the requirements and execution date of the RCM (revenue cycle management)contract — was making the replacement BAA effective March 21, 2011, so that it would accurately reflect the period during which RCM services were provided.

Fairview Health Services is the health system with which the agency had a contract for collecting debt. The complaint alleges that Accretive employees approached patients in the ER at Fairview Hospital, noting that such a tactic yielded good results.

Accretive called the tactic of extracting money from ER patients the “Accretive Secret Sauce,” saying that it yielded a 15 percent collection rate, according to the complaint.

Further, Swanson alleges that the company violated state and federal privacy laws, did not train its employees properly and failed to properly secure its laptops that were routinely given to employees. Accretive employees also had access to way more information than they needed, the complaint alleged.

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