Charitable hospitals that treat uninsured Americans will be subjected to new levels of scrutiny of their nonprofit status and could face sizable new fines under Obamacare.

A new provision in Section 501 of the Internal Revenue Code, which takes effect under Obamacare, sets new standards of review and installs new financial penalties for tax-exempt charitable hospitals, which devote a minimum amount of their expenses to treat uninsured poor people. Approximately 60 percent of American hospitals are currently nonprofit.

Charity for the uninsured is one of the factors that could discourage enrollment in Obamacare, which requires all Americans to purchase health insurance or else face new taxes themselves from the IRS.

“It requires tax-exempt hospitals to do a community needs survey and file additional paperwork with the IRS every three years. This is to prove that the charitable hospital is still needed in their geographical area — ‘needed’ as defined by Obamacare and overseen by IRS bureaucrats,” said John Kartch, spokesman for Americans for Tax Reform.

“Failure to comply, or to prove this continuing need, could result in the loss of the hospital’s tax-exempt status. The hospital would then become a for-profit venture, paying income tax — hence the positive revenue score” for the federal government, Kartch said. “Obamacare advocates turned over every rock to find as much tax money as possible.”

Additionally, the rise in the number of insured Americans under Obamacare will make it more difficult for tax-exempt hospitals to continue meeting required thresholds for treating the uninsured, driving more hospitals into the for-profit category and yielding more taxable money for the federal government.

“The requirements generally apply to any section 501(c)(3) organization that operates at least one hospital facility,” according to a “Technical Explanation” report of new Obamacare provisions prepared by the congressional Joint Committee on Taxation (JCT) on March 21, 2010, the day Obamacare passed.

Obamacare’s new requirements could slam hospitals with massive $50,000 fines if they fail to meet bureaucrats’ standards.

“The hospital must disclose in its annual information report to the IRS (i.e., Form 990 and related schedules) how it is addressing the needs identified in the assessment and, if all identified needs are not addressed, the reasons why (e.g., lack of financial or human resources). Each hospital facility is required to make the assessment widely available. Failure to complete a community health needs assessment in any applicable three-year period results in a penalty on the organization of up to $50,000,” according to the JCT report.

The government is particularly interested in how and why hospitals will be providing discounted or free care to poor patients, requiring each of them to “adopt, implement, and widely publicize a written financial assistance policy” and explain the methods they use to screen applicants for assistance and how they calculate patients’ bills.

A delegate working under the Department of Health and Human Services must review the innumerable reports charitable hospitals file every three years, along with copies of their audited financial statements.

After sifting through this massive amount of information, the delegate and HHS secretary must attempt to identify trends in the hospitals’ spending and send in a comprehensive report of their findings to Congress by 2015, according to the JCT report.

Healthcare experts warn that the Obamacare’s new requirements make it almost impossible for charitable hospitals to navigate treacherous new waters.

“Nonprofit hospitals should be advised that the new PPACA requirements will play a significant role in how they operate and report, specifically when it comes to billing and collections for services provided to the uninsured. The new law leaves many gray areas and hospitals themselves will have to establish eligibility criteria for financial assistance. Following the new procedures as best they can will ensure the best chance of maintaining their tax exempt status,” wrote D. Douglas Metcalf, partner at the law firm Lewis and Roca, in a 2013 op-ed entitled “Will nonprofit hospitals disappear under Obamacare?”

The White House did not return a request for comment.

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