Accretive Health, Inc.'s legal issues continue to evolve as new allegations by Minnesota Attorney General Lori Swanson accuse Accretive of operating without a HIPAA-required business associate agreement (BAA) and then creating a back-dated agreement in response to litigation. 

As we previously reported, Accretive, a Chicago-based health care consulting company and debt collection agency, originally caught the attention of Attorney General Swanson when it was discovered that an unencrypted lap top computer with medical information of over 23,531 Minnesota patients was stolen on or about July 25, 2011.  This led to revelations suggesting that Accretive was engaged in improper collection activities in the emergency rooms of two Minneapolis-area hospitals, Fairview Health Systems and North Memorial Hospital, and engaging in bedside collection visits.  It was then disclosed that one or more officers of Fairview had family connections with employees of Accretive.  In January, Minnesota Attorney General Lori Swanson sued Accretive Health for violation of HIPAA, the HITECH Act, the Minnesota Health Records Act and various Minnesota consumer protection and debt collection statutes. Perhaps the strangest twist occurred in May when Chicago mayor Rahm Emanuel reportedly sent a letter to Swanson asking her to back off the litigation until he could arrange a meeting with Accretive's CEO. Swanson declined the suggestion.

Swanson now seeks to file a second amended and supplemental complaint to add new factual allegations. Specifically, Swanson alleges that at the time she requested documents in October of 2011, Accretive did not have a business associate agreement in place with North Memorial. Following the request, she claims that Accretive created one and made it look as if it had been signed on March 21, 2011. 

The Attorney General acknowledges that it is the covered entity's obligation to have a BAA in place before making protected health information available to a vendor, such as Accretive. However, the Attorney General argues that Accretive's actions with respect to not having the BAA supports her claims that Accretive disregarded its HIPAA obligations. It would be surprising if a sophisticated health care provider like North Memorial had not had implemented such a basic required document with a business associate like Accretive, to say nothing of the alleged "deception" as characterized by Swanson. 

This case is a good example of the growing propensity for state Attorneys General to engage in HIPAA enforcement actions as we have discussed. Regardless of how the legal saga turns out, it is also a good reminder to have compliant business associate agreements in place as required by HIPAA.