Despite Chicago mayor's intervention, Minnesota AG says she won't back off Accretive probe

Attorney General Lori Swanson is vowing to press on with her investigation of Accretive Health despite the mayor of Chicago asking her to rein it in until she has met executives to discuss concerns about the company's collection practices.

Meanwhile, Sen. Al Franken, D-Minn., scolded Chicago- based Accretive Health for not yet providing his office with answers to a series of questions he raised last month.

In April, Swanson released the results of her investigation of Accretive Health's relationship with the Fairview health system, saying the parties had engaged in overly aggressive billing tactics that included pressuring patients for payment in emergency rooms and maternity wards.

"I request that the parties cease efforts to publicly prosecute this matter and rather try to resolve the matter privately," wrote Rahm Emanuel, the mayor of Chicago, in a letter to Swanson released Tuesday, May 8. "Please confirm to me that this is the path we are on and let me know the date for which the meeting is scheduled."

Emanuel asked that Swanson back off from interviewing Accretive's clients until that meeting, according to the undated letter. His letter stated that he and Swanson discussed the matter by phone last week and opened by noting that both Democrats share the goal of making health care affordable.

The mayor, who was chief of staff in the Obama administration and helped craft the 2010 legislation to overhaul the nation's health care system, wrote in his letter that Accretive Health does "important work for hospitals" by helping uninsured patients find coverage so their bills can be paid.

The work, in turn, makes hospitals more viable financially, Emanuel wrote, so they can invest in higher-quality care.

POLITICS VS. LAW ENFORCEMENT:

In her statement, Swanson didn't address whether she would meet with company executives in the future, though her agency has met with the firm's attorneys. She said her office has received many calls from witnesses around the country about Accretive Health's relationships with charitable hospitals.

"We will continue to interview witnesses and perform our law enforcement responsibilities over charitable hospitals in Minnesota," Swanson said.

Accretive Health has "retained or contacted numerous heavyweights in the national Democratic Party," Swanson added.

"It has now contacted Mayor Rahm Emanuel of Chicago," she said. "This is a law enforcement matter. Unfortunately, Accretive appears to address it as a political one."

Accretive Health distributed Emanuel's letter on Tuesday and issued a statement from Mary Tolan, the company's chief executive, saying: "As one of Chicago's leading growth companies, we are incredibly grateful for Mayor Emanuel's help in reaching a fair resolution of our issues with the Minnesota Attorney General."

Tolan, who has served as the company's CEO since 2003, serves on the board of trustees at some premier Chicago institutions, including the University of Chicago. Her company offers "quality and total cost of care" services that are designed to help health systems such as Fairview make the transition to becoming "accountable care organizations" -- ACOs, for short.

The federal health care overhaul legislation from 2010 includes incentives for health systems to become ACOs, which are groups of doctors, hospitals and other health care providers who accept financial incentives to improve the coordination and quality of care for Medicare beneficiaries. Accretive Health says it helps hospitals enter into ACO arrangements by helping them predict which patients will incur high costs so hospitals can "focus greater efforts on managing these patients," the company said in a regulatory filing.

PATIENTS 'WILL BE HEARD':

Accretive Health got Swanson's attention after a company employee's laptop computer was stolen from a locked car in Minneapolis in July. A few months later, Fairview and North Memorial Medical Center in Robbinsdale, another Accretive customer, had to notify thousands of patients of the theft because the computer contained unencrypted patient information.

In January, Swanson sued Accretive Health in federal court, alleging violations of state and federal privacy laws, state debt-collection laws and state consumer-protection laws. In April, she followed up with a lengthy report detailing what she called overly aggressive billing and collection techniques, as well as likely violations of an agreement between Fairview and the attorney general on charity care.

The report includes details about how Fairview workers became concerned that the focus on getting emergency room patients to pay their bills would run afoul of a federal law against patient dumping. An unnamed Fairview worker quoted in the report claimed that patients were being "harassed mercilessly" until they were approved for charity care.

Many patients with health insurance complained to Swanson about demands for immediate payment of their deductibles. In her statement Tuesday, Swanson said: "The patients who suffered indignities from Accretive will be heard."

Tom Alexander, a spokesman for the Chicago mayor, said Emanuel knows of Accretive Health's work because of his background in health policy and his interest in supporting new companies in the city.

"He is fully aware of the (Swanson) report's conclusions," Alexander wrote in an email.

Following Swanson's report, Franken issued a letter calling on Accretive Health to answer a series of questions by May 4. The company asked for an extension until Monday, May 6, and then missed that deadline, Franken wrote in a letter released Tuesday.

"I fully expected to receive a response to my letter by the end of the day yesterday," Franken wrote. "Instead, Accretive's representative again contacted my staff to inform them that Accretive's response would not be ready before Friday, May 11, a full week after our initial deadline."