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Last week, Minnesota Attorney General Lori Swanson settled her case with Accretive Health, the debt collector that allegedly acts as a gatekeeper to obtaining emergency-room treatment. We've been following this case closely not merely because of the allegations by the Attorney General that "Many of these patients say they were asked to pay money in the hospital emergency room before being treated, often while laying on a gurney, undressed, in pain, or hooked up to tubes or morphine." Why? Well, in addition to its not-so-candy-striper work in hospitals, Accretive Health is affiliated with the same private equity/hedge fund entity, Accretive LLC  (previous blog), that had coordinated a tangled web of debt collectors linked to its own subsidiary, the National Arbitration Forum, the not-so-neutral forced arbitration mill that was the go-to arbiter of consumer disputes and consumer collections for the nation's biggest credit card companies. Several years ago, General Swanson successfully sued the NAF, in a case with national implications that also resulted in the firm leaving the consumer arbitration business.

Last week's settlement bans Accretive Health from doing business in Minnesota for up to six years and imposes a restitution and civil penalty fund of $2.5 million for numerous alleged violations (complaint) of state and federal data privacy, debt collection and other laws. In a legal filing, the Attorney General includes numerous affidavits from victims:

EXCERPT: "At Fairview Southdale Hospital, Maureen was taken to a curtained area in the ER. She was alone and afraid. The first person to come into the curtained area—before she saw a doctor—was a woman with a portable computer cart. The woman told Maureen that she owed $545.20 for the visit. Maureen understood that she wouldn’t get the treatment if she didn’t pay. [...] Before Carol was stabilized, a woman with a mobile computer cart again drifted up to her examination table and asked for money. Carol was having a stroke, and her husband kicked the woman out. [...] As Don lay hooked up to tubes, monitors, and drips, a woman rolled in and told him he needed to pay $50. He tried to resist, but the woman insisted. The woman grabbed his pants and dropped them on his chest. Don got out his debit card, which she swiped. [...] Before Ann saw a doctor, a woman came into her room, noted that Ann was uninsured, and asked for money. After Ann said she was laid off and couldn’t afford to pay anything, the woman kept pestering her, until a doctor finally came in and told the woman to leave. As the doctor attempted a diagnostic spinal tap to see if Ann had meningitis, the woman returned, and the doctor ordered her out."

Yet, in an extremely odd press release of its own, the debt collector makes the curious claim that "the Attorney General did not and could not identify a single patient in Minnesota who experienced a problematic interaction with an Accretive Health employee." Hunh?

The attorney general has referred her consumer cases to federal authorities as well, since states do not have the authority to enforce the federal Emergency Medical Treatment and Active Labor Act, or EMTALA.  "Under EMTALA, a hospital is supposed to examine a patient and, if an emergency exists, treat and stabilize the patient before asking for money."

Hat tip to Bob Lawless over at Credit Slips, the consumer-side bankruptcy law blog. By the way, the Consumer Financial Protection Bureau is completing rules that will give it full supervisory authority over the nation's larger debt collectors.


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