August 29, 2012 | Posted By Bruce D. White, DO, JD

The July 31, 2012, issue of the Chicago Tribune carried an article entitled “Chicago-Based Accretive Health Banned from Doing Business in Minnesota for 2 Years.

Facts in the article are sketchy: (1) The Minnesota attorney general’s office began investigating possible privacy breaches when a hospital account collections company laptop was stolen two years ago. The laptop contained the names and protected health information of 23,000 patients treated at two Minnesota hospitals. (2) The company – Accretive Health – manages billing and collections for hospitals. One hospital in Minnesota accounted for 9.9% of Accretive’s first quarter revenue - $25 million out of $253.7 million. (3) Accretive had been accused of pressing patients for payments, sometimes before they received hospital treatment. (4) Since the investigation began at least two senior Accretive executives have left the company, a senior vice president and the principal accounting officer. The company did not disclose the reasons for the departures. (5) Accretive – in discussing the settlement – said that the investigation “failed to identify one patient in Minnesota who had experienced a ‘problematic interaction’ with a company employee.” (6) In reaching a settlement with the state, Accretive agreed to pay a $2.5 million fine, which will be used to compensate patients, and not to do business in Minnesota for two years. (7) In a prepared statement about the settlement, Attorney General Lori Swanson said, “A hospital emergency room is a place of medical trauma and emotional suffering for patients and their families. It should be a solemn place, not a place for a financial shakedown of patients. It is good to close the door on this disturbing chapter in Minnesota health care.”

From this, readers are left to wonder: What was going on here? What on Earth surfaced as investigators began looking into possible privacy breaches when a laptop was stolen? The article hinted at “multiple allegations of improper collections” but no additional details were disclosed.

Ethics teachers typically use casuistry – a case-based analysis approach – when discussing ethical dilemmas as a means of fleshing out right or wrong intents, acts, and consequences. But with cases such as the one reported about Accretive Health, there’s so little information that one cannot really say if what the company was doing was good or bad. With the sanctions – the fine and the agreement not to do business in Minnesota for two years – and with the allegations, there is the suggestion that it was something that society should not tolerate was happening, but it’s unclear. In today’s legal environment too, it’s often the better path to settle a dispute with an agreement rather than to litigate. Here the company president said just that, “Entering into this settlement agreement allows our Company to put this matter behind us and prevents further distraction from the important work that we do for our hospital clients.”

So, for ethics teachers, is there very much value in using a newspaper report like this to teach about good hospital and billing and collection company relations, or what are acceptable practices when asking patients about unpaid hospital bills? Probably not. Ethics dilemmas are contextual. To make good ethical decisions, one needs to understand the factual setting much more than is described in the article. In fact in this article, it may be really difficult for say even to say what the ethical question really is.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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