Feds seek review of ER billing incident

  • Article by: MAURA LERNER , Star Tribune
  • Updated: May 12, 2012 - 6:48 AM

Fairview's consultant Accretive says its employees were there to help patients and never denied care.

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Minnesota Attorney General Lori Swanson

Photo: Jim Mone, Associated Press

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Federal regulators have sent inspectors to the University of Minnesota Medical Center, Fairview, in the wake of an attorney general's report suggesting that financial counselors may have improperly delayed a child from getting treatment in the emergency room.

Inspectors from the Minnesota Department of Health conducted an "onsite review" last week at the request of the U.S. Center for Medicare and Medicaid Services (CMS), the hospital confirmed Friday.

"We understand the visit was prompted by concerns raised in the attorney general's report and in recent news coverage," said Ryan Davenport, a Fairview spokesman. "We have not yet received any information from CMS about the results."

But, he said, Fairview had conducted its own review, and "did not identify any cases where a patient's treatment was delayed."

Meanwhile, Fairview's Chicago-based consulting firm, Accretive Health, denied in writing that its employees ever delayed treatment or led patients to think they would be denied care without paying their bills.

In a 29-page response to questions from U.S. Sen. Al Franken, Accretive acknowledged that employees known as financial counselors would call Fairview patients at home before scheduled procedures and approach patients in the emergency room and other hospital wards.

But it said the purpose was to clarify insurance coverage and the patient's portion of a bill -- often a murky item in hospital accounting. Many times, the document said, these conversations resulted in Accretive getting insurance companies to pay a bill or helping patients obtain insurance coverage. Accretive also said the ER conversations took place only with permission of medical staff and during treatment "down times'' and that the "bedside financial counseling'' was entirely optional.

"All Revenue Cycle employees were instructed never to insist that patients pay residual or prior balances or suggest that [patients] would not receive treatment unless they paid,'' the document said. Attached was an excerpt from a script for Accretive employees making the same point in capital letters.

Elsewhere in the document, responding to a question from Franken, Accretive acknowledged that nine of its employee laptop computers containing patient data were lost or stolen during 2011, but said that two were recovered within hours and only one contained unencrypted patient records.

"We take very seriously the allegations by the Minnesota Attorney General and ... appreciate this opportunity to set the record straight,'' the document said.

On April 24, Minnesota Attorney General Lori Swanson released a six-volume report alleging harsh debt-collection practices at Fairview hospitals.

Among other cases, Swanson cited a report about a child who arrived at the emergency room at the university's Amplatz Children's Hospital in December, but wasn't examined until after the parents met with a financial counselor.

Under federal law, emergency rooms must assess and stabilize patients without regard to their ability to pay.

Patti Unruh, a CMS spokeswoman, said the federal agency had asked for the inspection.

Accretive officials have cited the emergency-room story as an example of Swanson distorting the facts. They said the child's parents, who did not have insurance, had asked for information about the cost of the visit.

Swanson reported that hospital employees raised concerns that the incident may have violated the law, and that the parents should have been told that the child could be seen for free.

Also Friday, Franken announced that he plans to chair a Senate hearing in St. Paul on May 30 to investigate concerns raised by Swanson's report.

Maura Lerner • 612-673-7384

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