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Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside. This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.

Having a medical crisis that lands you in the hospital is stressful enough, but there’s a disturbing new trend that’s so bad, it makes the indignity of wearing a hospital gown pale in comparison. Debt collectors are masquerading as hospital workers and demanding that sick people cough up payments for old medical bills before receiving treatment — even in emergency rooms.