Recently, numerous healthcare workers from around the country have been leaking stories about how they are being pressured to designate patients as “presumptive COVID-19” when they die even if the virus had nothing to do with the person’s demise. A lot of people have tried to dismiss these whistleblowers as nothing more than disgruntled employees, but a couple of Kern County doctors who own five urgent care clinics are stating that is exactly the case.
Dr. Dan Erickson, co-owner of Accelerated Urgent Care in Kern County said:
“ER doctors now my friends and I talk to say you know it’s interesting when I’m writing up my death report I’m being pressured to add COVID. Why is that? Why are being pressured to add COVID? To maybe increase the numbers and make it look a little worse than it really is? I think so.”
The press conference which aired on channel 23 ABC News circa April 22, 2020 was enlightening especially given the comments made in an earlier interview by Senator Scott Jensen (R-Minn.) on April 8, 2020 with Laura Ingraham on April 8 on Fox News where he claimed hospitals get paid more if Medicare patients are listed as having COVID-19 and get three times as much money if they need a ventilator.
“How can anyone not believe that increasing the number of COVID-19 deaths may create an avenue for states to receive a larger portion of federal dollars. Already some states are complaining that they are not getting enough of the CARES Act dollars because they are having significantly more proportional COVID-19 deaths.”
On April 19, Senator Jensen reinforced his previous statement by way of video on his Facebook page saying: “Hospital administrators might well want to see COVID-19 attached to a discharge summary or a death certificate. Why? Because if it’s a straightforward, garden-variety pneumonia that a person is admitted to the hospital for – if they’re Medicare – typically, the diagnosis-related group lump sum payment would be $5,000. But if it’s COVID-19 pneumonia, then it’s $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000.”
This higher payout was made possible due to the Coronavirus Aid, Relief and Economic Security Act through a Medicare 20% add-on to its regular payment for COVID-19 patients, as verified through the American Hospital Association Special Bulletin on the matter.
Senator Jensen also noted that some states, including Minnesota and California, list only laboratory-confirmed COVID-19 diagnoses while others, such as New York, list all presumed cases, which is allowed under guidelines from the Centers for Disease Control and Prevention as of mid-April and which will trigger a larger payout.
Although no public reports have been made regarding hospitals artificially inflating COVID-19 numbers for billing purposes, we are beginning to hear increasing testimony to the contrary. From what Dr. Erickson and his colleagues have experienced in Kern County, there is definitely a concerted effort to drive up COVID-19 numbers. An obvious financial benefit exists for those designations, but perhaps there is another reason we have yet to discover. We’ll keep following the money trail to see where it leads.
FACT: Hospitals and doctors get paid more for Medicare patients diagnosed with COVID-19 or “presumptive COVID-19” absent a laboratory-confirmed test, and three times more if the patients are placed on a ventilator to cover the cost of care and loss of business resulting from a shift in focus to treat COVID-19 cases.
- The Spectator: “Hospitals get more to list patients as COVID-19 and three times as much if the patient goes on ventilator”
- The World Net Daily: “Hospitals get paid more to list patients as COVID-19”
- Snopes: “Is Medicare paying hospitals $13K for patients diagnosed with COVID-19, $39K for those on ventilators
- PolitiFact: “Hospitals get paid more to list patients as COVID-19”
- Kaiser Health News: “Estimated cost for treating the uninsured hospitalized with COVID-19”
- Factcheck.org: “Hospital Payments and the COVID-19 Death Count”
- Coronavirus Aid, Relief and Economic Security Act
- U.S. Department of Health and Human Services: “Guidance for Certifying Death Due to COVID-19”
- Verywellhealth.com: “How a DRG determines how much a hospital gets paid”
- American Hospital Association Special Bulletin
- American Hospital Association special bulletin.