The Chicago-based firm accused of pressuring Fairview hospital patients to pay as they waited in emergency rooms is once again pushing back against Minnesota Attorney General Lori Swanson, accusing her of rushing to judgment and using confidential documents out of context to create the illusion of illegal, threatening debt-collection practices.

In a 29-page response to a series of questions posed by U.S. Sen. Al Franken, Accretive almost entirely dismissed Swanson's report, but did offer a caveat.

"Several questions ask if Accretive Health is aware of any information suggesting that something occurred. These questions are very broad and could be misread as seeking answers based upon perfect knowledge of the actions of every employee throughout the company," read a footnote in the report.

The debate between Accretive and Swanson has drawn the attention of several other U.S. senators, Chicago Mayor Rahm Emanuel and the federal Center for Medicare & Medicaid Services, which is conducting their own investigation of Accretive's debt-collection policies and practices.

It began with a six-volume report released in late April, where Swanson described in detailed how patients were harassed after Accretive Health introduced sweeping changes at Fairview's seven Twin Cities hospitals and implemented new strategies for collecting payment.

In their response to Franken, Accretive wrote that: ... "employees were never instructed to suggest to patients that they would not receive treatment unless they paid" and reaffirmed that employees were only adhering to all federal guidelines if they discussed prior balances or payment options with patients.

The company did acknowledge "bedside financial counseling" for patients, but stressed that the conversations were optional.

After the public release of Swanson's report, Accretive accused the attorney general of releasing confidential documents, using the content of emails out of context and failing to interview company employees to properly vet her assertions.

Days after Swanson released her report, Fairview cut ties with Accretive and created a link on the hospital website to take complaints or questions from patients about issues raised by Swanson's report or by Accretive's practices in the Twin Cities.

"... it is clear that the Attorney General's report is highly misleading and was not informed by even a single meeting with any current Accretive Health employee," the response sent to Franken Friday indicated.

The mayor of Chicago rushed to the defense of the hometown company this week asking Swanson to back off the investigation until Accretive CEO Mary Tolan was prepared to talk with her. Swanson fired back, telling Emanuel that her probe was a law enforcement matter, not a political one.

Here's a copy of the response below:

2012-05-11 Franken Response