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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.