Imagine you’ve had some health problems, been mired in bankruptcy court, and owe a substantial amount to a hospital because you have an obscenely high deductible in your health plan or you no coverage at all. Imagine your symptoms get worse, and in spite of everything, you need to go to the emergency room.

Then imagine that when you get there, a debt collector greets you before you see the doctor.

This isn’t some horrific fiction. According to the New York Times, this happens regularly and is a common practice employed by Accretive Health, a medical debt collection company that works with many major hospitals. The Minnesota Attorney General has filed a civil lawsuit against Accretive for allegedly violating state and federal banking laws and federal health care privacy protections.

Accretive CEO Mary Tolan

Accretive CEO Mary Tolan says wringing money out of the sick is a “complex process” that is “end-to-end.”

From a video on Accretive’s web site:

It starts with the time the episode is being scheduled all the way through to cash.

The Times article explains it a little differently:

Accretive debt-collection employees, calling themselves “financial counselors,” are instructed by the upper management ranks to stall patients entering the emergency room until they have agreed to pay a prior balance, according to the documents.

The story also reports that Accretive employees regularly access patient records in clear violation of the Health Insurance Portability and Accountability Act.

According to Accretive’s web site, their sole focus is “generating significant, sustainable improvements in revenue cycle outcomes” for hospitals and other health care providers. This has lead to “stop lists” of patients who Accretive employees, who may often be indistinguishable from hospital staff, prevent from getting emergency health care services until they have signed a deal with the debt collector.

The Affordable Care Act would provide quality, affordable health insurance to many of the people now being hounded to pay their bills before they receive medical treatment. Obamacare just might put companies like Accretive out of business.