A Wall Street-based medical collection service has been sued by the Minnesota Attorney General after losing a laptop containing sensitive information about 23,500 patients treated by two hospitals which contracted with the company. More significantly, the AG’s complaint alleges that the company, Accretive Health, Inc., was mining, analyzing and using the data for purposes that were not disclosed to patients and which may adversely affect their access to care. The suit is being reported as the first HIPAA enforcement action by a state attorney general against a business associate.


Accretive Health’s parent company, Accretive, LLC, a private equity firm, has run into legal challenges in Minnesota before due to its vertical integration of the debt collection industry under which they took control of the nation’s largest debt collection enterprise, the largest national collection law firm, and the nation’s largest consumer debt collection arbitration company.  


The company’s laptop, which was stolen from a rental car, allegedly contained patient names, addresses, dates of birth, social security numbers, as well as risk factors developed by Accretive to sort patients by likelihood of inpatient admission, the presence of any of 22 costly health conditions, “frailty” and ability to pay.


According to Attorney General Lori Swanson’s press release


“The debt collector found a way to essentially monetize portions of the revenue and health care delivery systems of some nonprofit hospitals for Wall Street investors, without the knowledge or consent of patients who have the right to know how their information is being used and to have it kept confidential.”


Accretive provided comprehensive revenue cycle services to its hospital clients, including patient intake and scheduling, billing and collections. In its contract with one of the hospitals, Fairview Health Services, Accretive offered what it called “Quality and Total Cost of Care” services, allegedly through using “data mining,” “consumer behavior modeling,” and “propensity to pay” algorithms. Under this model, Accretive was paid incentives for cost control and increased revenue.


The AG relied heavily on securities disclosure materials provided by Accretive to its investors, which described its business as including “development of risk scores on individual patients; automated care plans; case management; medical necessity reviews; pharmacy management; length of stay management; discharge planning; population based management; and analytics and reporting of utilization by patient, per patient profit and loss reports, and identification of patient ‘outliers.’” The AG characterizes Accretive’s business model using its own language, which boasted that the company provides risk scoring of patients; focuses on reducing avoidable hospital admissions; identifies the “sickest and most impactable patients” for “proactive management” and identifies “real-time interventions with significant revenue or cost impact.”


In addition to HIPAA violations, the suit alleges violation of state debt collection and consumer protection laws, and asks the court to order Accretive to fully disclose to patients the nature and purpose of the information gathered including to what extent data has been sent to the company’s “Shared Services Blended Shore Center of Excellence” in New Delhi, India. The suit also seeks injunctive relief and damages.


It may be tempting to see this lawsuit as an act of political grandstanding seeking to capitalize on current anti-Wall Street sentiments (and on the widespread resentment of outsourcing of American jobs).  Accretive’s troubled history with Minnesota regulators and its use of impenetrable, Orwellian and vaguely threatening euphemisms for its data analysis services (“impactable patients,” “proactive management,” “real-time interventions”) doesn’t help its case.


However, the case may also validate the maxim “bad cases make bad law.” The type of data allegedly gathered and analyzed by Accretive could potentially be used for nefarious purposes including shunting poorer, sicker patients into a second-class care system, but it could also be used to identify those patients for whom special attention could most effectively improve outcomes. In fact, this is the very type of analytical capability that many providers will need to develop to effectively participate in the emerging post-fee-for-service reimbursement environment typified by Medicare’s ACO Shared Savings Program.  The suit may signify a crackdown on shadowy organizations trafficking in secret health and financial scores for profit without the knowledge of the patients whose data is being bought and sold, but regulators should be cautious not to chill legitimate and transparent use of the multitude of electronic data currently available in ways that may advance cost-effective, high-quality care.