UNITED STATES OF AMERICA 

Federal Trade Commission 

Washington, D.C. 20580 

 James Reilly Dolan 

 Associate Director 

Division of Financial Practices 

 Phone: 202-326-3292 

 Email: jdolan@ftc.gov 

 

 December 31, 2013 

Via Federal Express

Kirkland & Ellis LLP 

Attn: Andrew Clubok 

601 Lexington Avenue 

New York, NY 10022 

Re: Accretive Health, Inc. 

Dear Mr. Clubok: 

As you know, the staff of the Federal Trade Commission’s Division of Financial 

Practices has been conducting a non-public investigation of Accretive Health, Inc. (“Accretive”) 

for possible violations of the Fair Debt Collection Act (“FDCPA”), 15 U.S.C. §§ 1692-1692p, 

and Section 5 of the Federal Trade Commission Act (“FTC Act”), 15 U.S.C. § 41 et seq. 

Specifically, our inquiry has focused on Accretive’s conduct in collecting defaulted debts in 

hospital emergency rooms and other sensitive hospital areas. 

The FDCPA, among other things, prohibits debt collectors from communicating with a 

consumer in connection with the collection of any debt “at any unusual time or place or a time or 

place known or which should be known to be inconvenient to the consumer.” 15 U.S.C. § 

1692c(a)(1). And the FTC Act generally prohibits “unfair or deceptive acts or practices in or 

affecting commerce.” 15 U.S.C. § 45. 

Attempts to collect defaulted debts in emergency rooms or other medical facilities raise 

serious consumer protection concerns. For example, collection attempts in such circumstances 

may have the effect of deterring consumers from seeking necessary medical care, because they 

fear that they will be confronted with debts that they do not have the means to pay. Some 

consumers may even fear that the hospital may withhold necessary treatment unless payments 

are made. Such collection attempts also could interfere with the provision of medical treatment, 

either by delaying treatment while the collection attempt is made, or by adding additional 

emotional stress for the patient. Moreover, consumers are not normally well-positioned in such 

circumstances to evaluate the validity of the alleged debt and their financial ability to make any 

payments. Consumers will not normally have access to their paperwork and records, or the 

status of their financial resources, while awaiting medical treatment in an emergency room. 
Thus, debt collectors or other entities that engage in this activity may violate the FDCPA and/or 

the FTC Act. 

Upon careful review of the matter, including information submitted to FTC staff, we have 

decided not to recommend enforcement action at this time. Staff’s investigation revealed 

indications of unlawful debt collection tactics used by Accretive within the state of Minnesota, 

but revealed very little evidence that such tactics were employed by Accretive in other parts of 

the country. In deciding to not recommend enforcement action against Accretive at this time, 

one of the things staff took into consideration was the fact that Accretive has been banned from 

collection activity in Minnesota pursuant to a $2.5 million settlement with the Attorney General 

of Minnesota. The decision not to recommend enforcement action is based on findings specific 

to this particular investigation. The closing of this investigation is not to be construed as a 

determination that a violation of law did not occur, just as the pendency of an investigation 

should not be construed as a determination that a violation has occurred. The Commission 

reserves the right to take such further action as the public interest may require. 

Sincerely, 

 /S/ 

James Reilly Dolan 

 Associate Director 

 Division of Financial Practices