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Hospital visits are bad enough – first, because you are afflicted with some condition that prompted the visit, and then you have to worry about getting a massive infection while there – and now you have to worry about being harassed by bill collectors. Hospital patients waiting in the emergency room or convalescing after surgery are awaking to a debt collector at bedside.

One of the nation's largest medical debt-collection companies placed its employees in emergency rooms and other departments at two Minnesota hospitals, demanding that patients pay before receiving treatment, according to documents released Tuesday by the Minnesota attorney general. The documents say the company also used patient health records to coerce more money on overdue bills.

The company, Accretive Health, has contracts with dozens of hospitals around the country. Last January Attorney General Lori Swanson of Minnesota filed a civil lawsuit against the company alleging that it violated state and federal debt-collection laws and patient-privacy protections. Swanson has said that she was in discussions with state and federal regulators to prompt a widespread crackdown on Accretive Health's practices in other states.

Hundreds of internal company documents released by the attorney general's office demonstrate how increasingly aggressive medical-collection techniques have become when used against patients at hospitals across the country. As a growing number of hospitals struggle because of unpaid bills, they are turning to companies such as Accretive. To gain better collection numbers, the hospitals allow the collection service access to management of patient registration, scheduling and billing. Accretive says it has such arrangements with some of the country's largest hospital systems to help reduce their costs.

Indistinguishable from medical staff members, Accretive employees register patients, take down sensitive health information and champion aggressive bill-collection goals with incentives such as gift cards for staff members, the company records show.

Accretive boasts that it coaches its staff to focus on getting payment. Employees in the emergency room were told to ask incoming patients first for a credit-card payment. If that fails, employees are told to say, "If you have your checkbook in your car, I will be happy to wait for you," internal documents show.

Accretive is one of a group of debt-collection companies specializing in health-care collection. Last year, the publicly traded company reported $29.2 million in net income, up 130 percent from a year earlier.

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