Undocumented Aliens: Questions Persist about Their Impact on Hospitals' Uncompensated Care Costs
Highlights
About 7 million undocumented aliens lived in the United States in 2000, according to Immigration and Naturalization Service estimates. Hospitals in states where many of them live report that treating them can be a financial burden. GAO was asked to examine the relationship between treating undocumented aliens and hospitals' costs not paid by patients or insurance. GAO was also asked to examine federal funding available to help hospitals offset costs of treating undocumented aliens and the responsibility of the Department of Homeland Security (Homeland Security) for covering medical expenses of sick or injured aliens encountered by Border Patrol and U.S. port-of-entry officials. To conduct this work, GAO surveyed 503 hospitals and interviewed Medicaid and hospital officials in 10 states. GAO also interviewed and obtained data from Homeland Security officials.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | To help ensure that funds appropriated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 are not improperly spent, the Secretary of Health and Human Services should, in establishing a payment process, develop appropriate internal controls to ensure that payments are made to hospitals and other providers only for unreimbursed emergency services for undocumented or certain other aliens as designated in the statute. In doing so, the Secretary should develop reporting criteria for providers to use in claiming these funds and periodically test the validity of the data supporting the claims. |
CMS developed procedures for processing claims under this provision (Section 1011 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) that include measures to help ensure that payments are made to providers for unreimbursed emergency services for only undocumented and other eligible aliens. Specifically, CMS developed a provider payment determination form that includes reporting criteria for providers to use to affirm and to attest to the best of their knowledge the patient's eligibility. The form allows the provider to (1) to note if the patient identified himself or herself as an undocumented alien, or (2)indicate that the patient is a Mexican citizen with a border crossing card or who was paroled into the United States (two categories of eligible aliens under the statute) based on supporting documentation, or (3) affirm eligibility by demonstrating the patient was born in a foreign country AND has one of the following: foreign birth certificate, foreign passport, foreign voting card, expired visa, foreign driver's license, Matricula Consular or other foreign identification card, or invalid or no SSN. Providers are required to retain the provider payment determination forms and supporting documentation. Beginning in July 2007, CMS's contractor began conducting compliance reviews of providers that claimed payments under this provision. As part of these reviews, providers are required to submit a copy of the provider payment determination form and accompanying documentation. If the contractor determines discrepancies in eligibility determination, it may take steps to withhold discrepant amounts from the provider's next quarterly payment.
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