Do rich foreign women give birth in Miami then not pay the bill, as Rubio said?

Marco Rubio brought up a new wrinkle in the country’s immigration debate that hits especially hard, he argues, in Miami.

"I see people that fly in on their private jets into Miami, Fla., have a child because they are eight and a half months pregnant when they get here," Rubio said at a town hall in Iowa on Jan. 24. "They are wealthy. They fly back home on the private jet. Their kid is now a U.S. citizen, and they don’t pay the hospital bill."

It sounds like insult to injury for taxpayers -- the babies get citizenship, residents get the unpaid tax burden. But is this really even happening in South Florida, like he says?

Yes, and no. The evidence is too murky for us to draw a firm conclusion, so we decided not to rate his statement on our Truth-O-Meter.

Births by foreign women are on the rise in Florida, and some Miami doctors openly welcome birth tourists. But it’s not at all clear these women are then stiffing hospitals, at least two of which require proof of payment upfront.

Birth tourism

Some Republican presidential candidates have raised the alarm about "anchor babies," but this isn’t the situation Rubio talked about in Iowa.

Under the 14th Amendment to the Constitution, babies born on U.S. soil are American citizens regardless of their parents’ citizenship. The child becomes an "anchor" that their parents may hope helps them avoid deportation.

Rubio was talking about wealthy foreigners who don’t want to settle here and instead fly back home after giving birth. Under this scenario, American citizenship is an extra benefit their children will be able to take advantage of later in life. Or perhaps the parents simply prefer the American health care system.

The business of "birth tourism" drew attention in March 2015 when federal authorities raided maternity hotels in California. Authorities were looking for evidence of harboring undocumented visitors, misuse of visas, tax evasion and other potential crimes. No indictments have been issued.

A Rubio spokesman sent us a 2013 NBC News report about wealthy foreign women paying tens of thousands of dollars for lodging, airfare and medical expenses. The article focused on California and only briefly mentioned Miami as a city that has advertised birth tourism centers.

Still, we found other news articles about birth tourism in Miami.

In April 2014, the Moscow Times reported that expectant Russian moms spend up to $50,000 to give birth in the United States. The head of one company estimated there are about 40 to 60 women a month who travel to give birth in Miami.

A pediatrician in Miami, Wladimir Lorentz, told PolitiFact Florida it is common for obstetricians in Miami to deliver foreigners’ babies. He started a high-end concierge service for foreign expectant parents about three years ago, and he estimates that he delivers about four babies a month through that part of his practice. (He also has American patients.)

Lorentz’s Portuguese language website "Ser Mamae em Miami," which means "Being Mommy in Miami," features a photo of a pregnant mom on a beach and a cartoon drawing of a baby wrapped in an American flag. It includes referrals for legal advice, Brazilian restaurants, and personal shoppers. The cost for a natural childbirth at one hospital is $9,849, which includes  prenatal care starting at 32 weeks, the hospital cost and then care for the baby through the first two months.

He disagreed with Rubio’s characterization of rich foreigners flying in on jets and then skipping town without paying their bill.

"Nobody comes here on a private jet -- that’s absurd," he said. "They come here on regular flights. They pay every single penny ahead of time for the services. ... They even ask for receipts to show they paid every penny."

We found no comprehensive data on whether foreign women giving birth here pay their bills; however, Miami-Dade hospital systems Baptist Health South Florida and Jackson Health System require foreigners to show ahead of time that they can pay through insurance or out of pocket. The foreign women represented about 2 percent of their births, spokespersons said.

As for how often foreign women give birth in Florida in the first place, state data show 625 such births in 2014. This marked an increase from the previous four years, where births ranged from 550 to 589.

The largest group, according to the Agency for Health Care Administration, was 382 in Miami-Dade County followed by 108 in Broward County.

The actual number for mothers from foreign countries could be higher due to quirks in recordkeeping for foreign deliveries. That includes 135 deliveries in which the zip code was unknown.

The most common countries the pregnant women were from were Venezuela, Russia and Mexico, said Bill Sampsel, founder of HealthScope Software Solutions, a company that tracks hospital patient data in multiple states including Florida.