Thread: Hospitals seek limited reimbursement from feds

http://www.nashvillecitypaper.com/index ... s_id=52485

Hospitals seek limited reimbursement from feds
By Bill Harless, bharless@nashvillecitypaper.com
October 04, 2006

The returns may be relatively small, but several local hospitals have begun submitting invoices to the federal government to recover money they spend providing emergency care to illegal immigrants.

And although some of the data contains information that could identify patients — raising medical ethics concerns — the federal Centers for Medicare and Medicaid (CMS) has said the data will not be provided to the Department of Homeland Security or used to enforce immigration laws.

The money available to Tennessee from a $1 billion money pot that Congress filled in 2003 for the purpose is miniscule: between 2005-2008, CMS will disburse $250 million of the $1 billion to states annually, but for both the 2005 and 2006 fiscal years, the agency allocated Tennessee only about $1.1 million of the total amount, to be distributed among hospitals statewide.

So for the Vanderbilt University Medical Center, the effort was not worth it, officials said.

“Billing for these services and getting the documentation to support the bill would be much too costly, considering the limited amount of funds that are available,” John Howser, VUMC director of media relations, said in an interview this week.

“…It would be cost prohibitive from our standpoint. It would end up costing us more money to try to get this money.”

Still, three local HCA hospitals, including Centennial Medical Center, have submitted claims to CMS, totaling $63,000 for the first quarter of 2006 — HCA has not heard back yet how much of the request will be reimbursed — and Nashville General Hospital, the city’s money-losing public hospital, has begun preparing data to send to CMS for the reimbursement for care provided to undocumented immigrants.

Judy Peek-Lee, financial director for General, said the hospital has not yet tabulated the cost for which it will bill CMS.

Unlike similar organizations in other states, the Tennessee Hospital Association does not keep estimates of how much state hospitals spend on treating illegal immigrants.

The difficulty hospitals have faced in deciding whether to accept the federal money is the question of whether patients will shirk from seeking medical care out of fear of being deported.

“It puts a health care provider in somewhat a position of being an INS officer instead of a health care provider,” Howser said.

And, said Shaunelle Bynum, chief operating officer for HCA’s Patient Account Service Center, “The first thought when we first heard about it was, ‘Who’s going to tell us if they’re illegal?’”

But, both Bynum and Peek-Lee noted the federal rules prohibit hospitals from asking patients directly if they are undocumented.

Instead, a hospital first asks if the patient is eligible for Medicaid; if not, the patient is asked whether he is “a Mexican citizen with a border-crossing card” or has been paroled into the Unites States; then, if not, the patient is asked if he or she has a “foreign place of birth” and is asked for documented verification, or the patient is asked if he or she has a Social Security number. If not, the patient is more likely eligible for reimbursement, according to information provided by General Hospital.

HCA does not submit the names of patients to CMS. Asked if Nashville General does, Peek-Lee said only that the facility submits a patient’s bill to the government’s private collection agency, TrailBlazer.

CMS does require that some photocopies of verification documentation the patient provides be submitted.

There have been posts here that indicate some municipalities are upping the assesment of homeowners to cover these costs. It happened in Clayton County, GA. This is unconstitutional.

I have an idea. If they are illegal with no insurance than they should have their butts sent back to where they came from. I am sure they tell the hospital because they want free care. If a hospital has to by law report gunshot wounds, child abuse cases, suspicious deaths and certain other things, then why is confidentiality an issue with illegals. They should be able to report them and when they are ready to leave then they can have an escort.....ICE.

Okay, so we're forced to treat illegal immigrants under the Emergency Medical Treatment and Active Labor Act (EMTALA)(1986). Is there anything in this federally mandated program that states patient information of those suspected of being illegal immigrants cannot be turned over to the federal government?

Why aren't the hospitals providing the information to ICE? Wouldn't it be a huge benefit to the hospitals in the long run? Deporting the illegals will certainly stop them from being repeat customers, which would save the hospitals and insured patients a ton of money. Yes, hospitals raise the cost of services to the insured to subsidize the uninsured. They have to recoup some of their losses or they would be forced to close. Let's not forget, there have been over 86 hospitals in the SW that have done exactly that due to losses acquired from providing services and care to illegal immigrants.

What's the problem, I don't see a morale issue in play here. Turning the information over to ICE after care has been provided is not denying anyone care. Of course the pro-illegal immigrant advocates will say that such a move would stop illegals from seeking care. To that I say, the federally mandated EMTALA law was originally designed to provide for emergency treatment only, not be a quick-stop for every little ill that befalls an illegal immigrant.

Let me get this right. not only do taxpayers already pay for this through outrageous bills from the hospital, but now they want us to pay AGAIN through our taxes. Is that right or am I misunderstanding this?

Let me get this right. not only do taxpayers already pay for this through outrageous bills from the hospital, but now they want us to pay AGAIN through our taxes. Is that right or am I misunderstanding this?

Yes, this is right. Your bills after your insurance is applied reflects overcharges that will help the hospital pay for unpaid charges of those not insured. A friend of mine was in the hospital for 28 hours just for a reaction to ammoxicillan. The total hospital bill was over $7,000. Then, according to 2 posts that I've read here, the assesment of a homeowner's property given by the county has a certain % added to the actual assesment to help cover those costs again. In one post, a woman complained about seeing a $300 rise in her assesment, I don't know if the statement indicated such. The other post was clearly titled Clayton County raises property assesments to cover rising hospital costs. I don't want to mislead anyone here, but to me this seems to be the case.

This is insane. I am sick and tired of paying their way. My adoptive parents were immigrants and they never got 1/4 of what these people are getting. They had to work for everything, learned English, and were grateful to be here. But then again they were legal.