Between 2005 and 2010, North Carolina hospitals – most of which are tax-exempt nonprofits – filed more than 40,000 lawsuits against patients with overdue bills. Carolinas HealthCare System, a controlling entity, reported annual profits of more than $300 million over the last three years. According to a New York Times article, Accretive Health, which provides revenue cycle management; quality and total cost of care, and physician advisory services to health care providers, has embedded collectors as employees in emergency rooms demanding patients pay before receiving care. The state attorney general for Minnesota said federal laws may have been broken by Accretive employees who accessed protected health information as part of their collection process. In some cases, successful Accretive employees were rewarded with gift cards, while less successful were threatened with termination. 

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