Posted on Sat, Sep. 10, 2011
By John Dorschner
A longtime federal fugitive who was an undocumented immigrant cost taxpayers more than $350,000 in healthcare at Miami-Dade hospitals before he died last year, a county investigative report has revealed.
The Miami-Dade Office of the Inspector General said the patient was a Colombian who fled the United States in 1983 after a cocaine smuggling conviction but returned under a false name. In 26 visits to the Jackson Health System from 2003 through 2010, his care cost $201,716 — $155,334 in charity care paid by Miami-Dade taxpayers and $46,382 paid by Medicaid, the state-federal program for the poor.
The man also ran up $163,734 in bills from other healthcare providers that were paid by Medicaid.
The OIG report identified the man only by his initials, citing federal patient privacy laws, but the U.S. Marshals Service said Friday that the man was Luis Hernando Franco-Pinilla, who used the alias Eliseo Delatorre Castro.
With Jackson struggling to overcome more than $400 million in losses the past three years and Florida legislators trying to reduce ever-increasing Medicaid costs, the case raises crucial questions about providing healthcare to people who are in the United States illegally and verifying patient identities. “Do we just let them suffer?” asked Alan Sager, a health policy expert at Boston University. “There are many issues here. If this individual had been apprehended, his care would have been paid for in prison.”
There are broader healthcare concerns, too, he said, such as stopping spread of contagious diseases and providing primary care so patients don’t end up in expensive hospital stays.
State Sen. Alan Hays, R-Umatilla, called this case “a horrible thing… You’re just scratching the surface of a very deep and enormous problem… a very vivid example of why persons like this should never have been in the United States in the first place. I am tired of our citizens having to support the healthcare of these kind of people.”
His double life didn’t unravel until shortly after he died at age 63 surrounded by family members in Jackson Memorial Hospital at 2 a.m. Dec. 10. Relatives asked Jackson staff members to change the name on his death certificate to facilitate shipping the body to Colombia for burial, according to the OIG report. Jackson refused, reporting the odd request and starting the investigation.
The inspector general’s office learned that Franco-Pinilla had been arrested in December 1982 by federal agents, who charged him with conspiracy to smuggle cocaine and possession with intent to sell. He was convicted. Before sentencing, he fled the United States, the report said.
In October 1996, he was arrested by the U.S. Border Patrol for trying to enter the country illegally. He pleaded guilty and was deported, the report said, noting it wasn’t clear whether the agency knew he was a fugitive on the drug charges.
In May 2000, he reentered the U.S. with a passport and visa in the name of his alias. For seven years, he was treated in local facilities. In June 2010, the staff at Palmetto General Hospital told him he had cancer, the report said. On Nov. 29, he entered Palmetto, then was transferred to Jackson Memorial, where he died.
In hospital records, Jackson categorized the fugitive as an EO2, meaning he was an “undocumented illegal alien” with an income level that qualified him for charity care. He received this coding because he presented a “fraudulently obtained Florida Driver’s License and Florida Identification Card” in the name of his alias, the report said.
He signed papers saying he was unemployed and had no medical insurance. He offered no Social Security number. His wife later told OIG investigators that Jackson staff members were aware that he was in the country illegally.
Jackson did a credit check on Franco-Pinilla under his alias , which came back: “HIGH RISK FRAUD ALERT … NO SUBJECT FOUND.” A Jackson staffer told investigators that in such cases — with no Social Security number and no credit history — “the person automatically meets charity care guidelines,” according to the report.
The report noted two contradictory statements made by Franco-Pinilla to Jackson staff members trying to determine if he qualified for charity care. In one, he said his family consisted of five people; in another, he said there were two. A staffer told investigators that, at the time, such discrepancies were not caught because forms were not compared, but that policy has since changed, and if discrepancies are found, “the person would be suspended from the program,” the report said.
OIG investigators found Jackson had five different policies about qualifying for charity care, some requiring proof of citizenship or legal residence, and others saying immigration status was irrelevant.
In a reply to Mazzella, Stephen Weimer, Jackson’s corporate director of internal audit, said Jackson “provides various financial assistance options to uninsured and underinsured’’ Miami-Dade residents. Weimer said Jackson “adhered to the guidelines” in providing charity care for Franco-Pinilla and was updating its policies to make clear it provides care regardless of immigration status.
A Jackson pamphlet about applying for charity care tells patients: “We believe that every person living in Miami-Dade County has a right to health care that they can afford. To find out what each patient can pay, we ask for information that shows your income and that you live in the county… Your information is kept confidential. Immigration documentation will not determine how much you pay or whether you receive services. So if you do not give us immigration information, access to healthcare services will not be delayed or denied.”
This is not a cheap policy. Federal funds offer no support for undocumented immigrants, and Florida’s Medicaid program pays only for emergency room care. For each of the past three years, Jackson has spent about $50 million to treat those who are here illegally, according to an OIG analysis.
Jackson issued a brief statement Friday when asked whether executives thought the hospital should continue to pay for undocumented immigrants: “This is a conversation that the South Florida community and the nation as a whole have been having and will continue to have.”
Cheryl Little, executive director of the Florida Immigrant Advocacy Center, said Friday: “I certainly understand why this would cause concern among U.S. citizens, many of whom can’t afford decent medical care. However, immigrants don’t impose a disproportionate financial burden on our healthcare system. According to a July 2009 study in the American Journal of Public Health, immigrants use less medical care, and less expensive care, even when they have health insurance.”
Hays, the state senator, says he understands Jackson’s need to treat such patients, because federal law requires anyone entering an emergency room to be cared for. He believes the real culprits are federal officials because they don’t do enough to keep out those who enter illegally.
As for Franco-Pinilla, the OIG report stated that the Bernardo Garcia Funeral Home added his real name to his death certificate. Nine days after death, his body was transported to Colombia for burial. Miami Herald staff writers Jay Weaver and Marc Caputo contributed to this report.
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