Health care systems in the United States are experimenting with a form of surveillance and intervention known as “hot spotting,” which targets high-cost patients—the so-called “super-utilizers” of emergency departments—with intensive health and social services. Through a calculative deployment of resources to the costliest patients, health care hot spotting promises to simultaneously improve population health and decrease financial expenditures on health care for impoverished people. Through an ethnographic investigation of hot spotting’s modes of distribution and its workings in the lives of patients and providers, we find that it targets the same individuals and neighborhoods as the police, who maintain longer-standing practices of hot spotting in zones of racialized urban poverty. This has led to a convergence of caring and punitive strategies of governance. The boundaries between them are shifting as a financialized logic of governance has come to dominate both health and criminal justice. Keywords: health care, chronic illness, governance, policing, poverty, United States