Mehmet Oz made claim about audits, but experts say he misidentified routine administrative errors
The administrator for the Center for Medicare and Medicaid Services (CMS), Mehmet Oz, recently claimed that an audit revealed “more than $1bn of federal taxpayer dollars were being spent on funding Medicaid for illegal immigrants”, but experts say the audits were unrelated to immigration, and that rhetoric like this could make immigrant families – regardless of legal status – afraid to seek necessary medical care.
Leo Cuello, a research professor at Georgetown University’s Center for Children and Families, noted that he has not “seen what this audit is”, but “based on the reporting, it appears that it is related to administrative errors in state claiming for matching funds, which is a relatively common occurrence, and which CMS monitors closely as they should”.
For example, it is common for states to ask for federal reimbursement for programs that are supposed to receive state funding exclusively, such as Meals on Wheels. Cuello said these types of audits are “the most vanilla and normal thing that happens all the time. States are constantly sending CMS claims, and CMS is constantly reviewing whether or not they’re paying something properly.” Reporting from Oregon Live and KFF confirms that the audits were routine.
So all of this is a big lie. Immigrants aren’t given free healthcare; hospitals are required to give emergency healthcare regardless of whoever walks in the door, then left with the bill if/when their patients end up not being able to pay.
Literally the entire situation is the direct result of Ronald-fucking-Reagan signing the 1986 EMTALA Act that effectively creates an unfunded mandate of care for virtually all hospitals. They mandated healthcare but refused to pay for it.
Every year U.S. hospitals treat all kinds of people in their emergency rooms. Federal law prohibits hospitals from turning anyone away from emergency care, no matter the reason.
A percentage of the people treated are what are colloquially called “indigent care” (basically, so poor that you couldn’t make them pay if you wanted to). The bar for whether hospitals consider them “indigent” is whether or not they would ordinarily qualify for Medicaid in their state—regardless of citizenship status.
Every year, hospitals can submit claims for a certain percentage of their states’ Medicaid funds in order to help the hospital make up for the deficit they incur from treating people who have not paid their bill—as long as the hospital can provide documented evidence of a the bills that were not able to be paid.
There’s other restrictions and things involved, but the important part is that the hospital has already eaten the cost—they’re only trying to scrape back some money to break even.
Based on both personal experience as well as public data, undocumented immigrants account for less that 1% of the claims submitted by hospitals for Medicaid reimbursement. Moreover, many (many) hospitals make up for the huge deficits they run each year by relying on several of these reimbursement schemes.
Gutting Medicaid reimbursement to states will effectively render poor hospitals insolvent and—if they’re"lucky"—candidates for being bought up by private equity (or even worse, monopolistic conglomerates like Kaiser).