Hospitals claim millions of dollars in charitable care tax benefits every year. Marcelo Hochman, MD, a Charleston-based independent physician and former president of the Independent Doctors of South Carolina, thinks that physicians should have the same opportunity — and he has a proposal.
He is preparing a South Carolina income tax bill that would create a specific, documented incentive for individual physicians who provide genuine pro bono care. The bill is modeled on federal legislation he told Becker’s that he helped develop with Sen. Tim Scott, R-S.C. That bill never advanced out of committee.
The state version has been drafted with guardrails: physicians must have an established relationship with a qualifying charitable organization, the services that qualify are defined, there are caps on the benefit, and the incentive is structured so that, as Dr. Hochman put it, “you can’t get rich off of this.”
These guardrails would correct flaws Dr. Hochman sees in the hospital-based charity care system today.
“[Hospitals] will say they did $50 worth of pro bono care. Well, that’s not really charitable care,” Dr. Hochman said. “There are data on this that show that the amount of charitable care that is claimed is not truly reflective of true pro bono care. It’s this compilation of a lot of different things.”
A sponsor has not yet been identified. Because the bill would reduce state tax revenue, it requires fiscal analysis involving the state treasurer’s office and other agencies to be completed before Dr. Hochman’s targeted January 2027 introduction of the bill, when the South Carolina legislature returns to session.
“Right now, physicians who are employed — which is 75% to 80% in South Carolina — even if a physician wants to do a charitable case, you can’t get them in the hospital,” he said. “I can’t just bring a patient to the hospital and say, ‘I’m not going to charge anything.’ The hospital will go through all sorts of machinations to get paid.”
Dr. Hochman, who operates out of an office-based OR, said he has been able to absorb cases on his own without the incentive. But he argues that a tax benefit — modest and documented — could move physicians who currently avoid pro bono work because of the direct financial cost. At a moment when Medicaid cuts are compressing coverage in South Carolina and nationally, he sees even incremental uptake as meaningful.
“I don’t know a physician who wouldn’t do a case for free or take care of a patient,” he said. “Everybody does some form of that. But if it was actually incentivized, that would take some pressure off of some of the Medicaid stuff. It’s still small pieces, but it just takes a bunch of small pieces to make a difference.”
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