Hospitals could pay steep penalties for treating illegal immigrants

One of the greatest feats of journalism in the past year occurred in Florida--not at the current Republican convention, but when a would-be reporter proffered Gov. Rick Scott a cup during a press conference last fall and asked him to fill it up.

"You benefit from hundreds of thousands of taxpayer dollars every year," Aasif Mandvi noted in his request. As a result, he wanted to ensure Scott was clean--a retort to the governor's program to test welfare recipients for drugs.

Mandvi isn't actually a journalist; he just plays one on television's "The Daily Show." As to why he inhabits his role with more courage and asks tougher questions than the real thing is beyond my pay grade.

"I've done it plenty of times," Scott replied coolly to the request. However, it turned out that press conference would be not one of them.

Why, oh why, am I bringing this up? Because hospitals in Florida and elsewhere have huge reasons to be very afraid of Rick Scott.

Scott's administration leads the nation in punishing anyone in need or those who provide assistance. The drug program was a fiasco; only a tiny percentage of welfare users tested positive. Florida squandered hundreds of thousands of dollars on testing before a judge halted it earlier this year.

And as I have noted before, no individual in this country's entire history has vacuumed more dollars from the healthcare system while benefiting more from doing so. He left the former Columbia/HCA in the mid-90s with hundreds of millions of dollars in his pocket, while leaving the company on the hook to settle billions worth of Medicare fraud charges.

That score apparently wasn't enough for Scott. His state's Agency for Health Care Administration--a favorite personal fiefdom of his--is now auditing many of Florida's safety-net hospitals to make sure they haven't lavished too much care on undocumented patients. If they spent a penny in Medicaid funding going beyond merely medically stabilizing an illegal, the Sunshine State wants it back. And just to show it's big-hearted about the issue, it's only conducting these audits retroactively to 2005.

Such financial scrutiny is a lot more complicated than handing out cups and messengering them to a local lab, so I'm sure many more of Florida's hard-earned taxpayer dollars will fall down a rabbit hole before this quest is complete. I'm also certain the state and the hospitals will fight bitterly over the hundreds of millions of dollars of attempted clawbacks sure to ensue.

I'd laugh for the utter lunacy of it all, but immigration has tremendous traction in states where the GOP holds sway, such as Florida. A 2,000-mile fence and the livelihoods of most of the statehouse inhabitants in the South and Southwest rest on the shoulders of this issue.

And given a plank of the Republican platform recently drafted in Tampa includes a pledge to pressure illegals to self-deport, denying healthcare services to them makes perfect sense.

Taken with the red-state anger over the implementation of the Patient Protection and Affordable Care Act--and the fact that it specifically excludes illegal immigrants from participation in Medicaid expansion or the exchanges--don't be surprised if this is used as leverage by other states to try and co-opt their hospitals into becoming an arm of the U.S. Border Patrol.

Resisting means potentially losing millions in critical funding--and still having to treat those darned illegals.

If Scott wins this battle, expect hospitals in large swathes of this country to proffer cups of their own. They'll just be seeking liquidity, not liquid. - Ron (@FierceHealth)