One of the annual goals for Health Incorporated Syndicated System (HISS), a multihospital for-profit corporation, is to keep their profit margins up and their payments for actual medical care down. The CFO of HISS, Mr. Monet Graber, examines all the financial records of the service lines in HISS and decides the emergency room (ER) at each hospital in HISS could do a better job at keeping the departments in the black. He decides to engage the services of his college roommate, Thomas (Tommy) Gunn. Tommy is the CEO of Bottom Line Recovery, a debt collection agency. After reviewing the situation with Monet, Tommy recommends embedding bill collectors in each ER in the system. The bill collectors will act as admissions clerks and will wear hospital identification badges, even though they are not directly employed by HISS. Tommy also recommends collecting an upfront fee of $200 from patients who arrive in the ER and want service for non-life-threatening health concerns.

Tommy Gunn’s employees are given HISS badges and deployed to every ER in the HISS organization. At the end of a month, the CFO is delighted to see revenues are up in the ERs and bad debt* is down. Two months after bringing in Bottom Line Solutions, the CFO receives a phone call from the Attorney General of the state where HISS is incorporated. The AG’s office has received 500 complaints about aggressive debt collectors in HISS ERs. In addition, a laptop with private health information on over 20,000 patients has been recovered from a rental car. HISS is now being prosecuted for violation of HIPAA and for intentional misrepresentation of debt collectors as HISS employees.

Discussion Questions

1. What are three factors contributing to this dilemma?

2. What are the top three management issues in this case?

3. What kind of impact do you think debt collection in the ER has on access to care for minority populations?

4. Discuss the pros and cons of requiring patients to make a deposit before being seen in an ER for non-emergency care. Provide your reflections and personal opinions as well as your recommendations for addressing these problems.