Health funding misuse feared

Ineligible foreigners cost Medicaid up to $12 million annually, Sabatini says

Hospitals deny abusing program

Md. system sought to check visa status

May 02, 2004|By Walter F. Roche Jr. | Walter F. Roche Jr.,SUN STAFF

Citing what they say may be a multimillion-dollar abuse, Maryland health officials are tightening controls over emergency medical care provided to residents of foreign countries under the Medicaid program.

Health Secretary Nelson J. Sabatini says he suspects that up to $12 million a year in Medicaid funds is being spent improperly to provide health care to aliens who have come to the U.S. expressly for medical treatments that are sometimes expensive and "esoteric."

In a series of recent interviews, Sabatini also said he suspects that the problem stems from hospitals that might be steering patients to Maryland for expensive treatments at public expense. He said he based his cost estimates on a computer analysis of Maryland Medicaid claims filed on behalf of patients who are not U.S. citizens.

"I want to do something about people who are here primarily as visitors and then go in and get health care. That's not appropriate. I want to start complying with the law," said Sabatini. "We've heard allegations that health care providers will even find or provide transportation."

Hospitals contacted by The Sun strongly denied doing anything to circumvent the law.

The health secretary said he has no objections to providing medical care to aliens who have a genuine health emergency and are legally eligible for coverage for the state- and federally funded program. Under state and federal law, aliens who meet income limits are generally eligible for emergency care under the Medicaid program, but they must indicate an intent to stay in Maryland.

"Undocumented aliens who need emergency care have a right to get that care. I have no desire or interest to change the law," he said.

Sabatini said that an alien who has come here on a tourist or visitor's visa already has stated an intent to immigration officials that his or her stay will be temporary.

A policy alert issued in March by the state Department of Health and Mental Hygiene warns health care providers that emergency care will not be covered by Medicaid if the patient is in the state as a visitor. Sabatini said it is too early to determine whether that notice will halt what he considers an improper use of the health care program.

He said the state also needs to develop a system to verify the visa status of Medicaid applicants with the federal government. At present, he said, Medicaid applicants could tell state officials they intend to become permanent residents while they have stated the opposite to immigration officials.

Although Sabatini repeatedly declined to name any hospitals, he did point to recent cases that he said were suspect. In one case, he said, a woman "from a country thousands of miles away" came to Maryland twice to deliver her babies. In another case, he said, a patient, who ultimately did not survive, came to the United States for expensive cancer treatment.

"We know a lot are coming here shortly before getting health care ... like a bone-marrow transplant or some other very expensive procedure. It's pretty clear they came here specifically for medical care," he said.

Sabatini said he suspects that some hospitals "try to capture the patients and bring them here for esoteric procedures ... that can help with research and teaching programs ... and generate a lot of revenue." He said that an additional problem for state Medicaid officials is determining whether an alien Medicaid applicant meets income requirements.

He said the state has no way to quickly verify whether an applicant is telling the truth when claiming to have few or no assets or income.

Sabatini noted that under federal law and the recently issued policy directive, illegal aliens, including those who are here on expired visitor's visas, are eligible for Medicaid coverage.

Records obtained by The Sun under a public-records law request show the state spent about $34 million in the last fiscal year to provide medical care to non-U.S. residents. The data, however, do not give a breakdown of the visa status of the patients.

Holy Cross Hospital in Silver Spring topped the list, with $6.2 million, followed by Prince George's Hospital Center with $4.6 million. Officials of the two hospitals said they don't steer foreign patients to their facilities.

"That's not happening here," said Robert Howell, a spokesman for the Prince George's health facility. A Holy Cross spokesman said the hospital simply treats those who show up there.

In the Baltimore area, Johns Hopkins, with $1.7 million in billings, and the University of Maryland Medical System, with $2.4 million, were on the list of the top 10 facilities treating aliens.

"Johns Hopkins Medicine does not recruit or encourage foreign nationals to come to any of its health facilities for the purpose of exploiting loopholes in Maryland Medicaid regulations, nor does it condone the practice," said Gary Stephenson, a Hopkins spokesman.

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