Hospitals Get Paid More For COVID-19 Coronavirus Patients: Fact Check

Fox News and some other news outlets have been criticized and accused of misleading the public recently. They reported that US hospitals get paid more for Medicare patients listed as COVID-19 patients and three times as much for virus patients on a ventilator. Is it true?

Here’s the video from Fox News:

The claim was backed up by Sen. Scott Jensen of Minnesota, himself a physician. He made the statement on a television show, then reiterated it on his Facebook page. Here is what he said on Facebook:

“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.”

Jensen did not say he thought doctors were cheating to increase hospital payouts under the CARES act. He indicated that administrators could be tempted to list non-COVID deaths as COVID-19 deaths because the Act provides a 20% premium, or payment added to the normal Medicare payout, for COVID-19 related deaths.

The first $30 billion paid out to hospitals was paid according to Medicare guidelines. The second wave, however, is slated to go to providers in areas hardest hit by the virus. This is where the problem arises.

Jensen isn’t the only one who is concerned that hospitals might artificially inflate their COVID-19 deaths to get more money. Other public health officials have expressed concern about over-reporting COVID-19 deaths to get a larger payout.

While there has been no cited evidence of over-reporting, there’s no question that the possibility exists. Jensen was concerned about the temptation for administrators to game the system. He said “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.”

According to PolitiFact reporter Tom Kertscher, the numbers make sense. “The dollar amounts Jensen cited are roughly what we found in an analysis published April 7 by the Kaiser Family Foundation (1,) a leading source of health information.”

The number are also backed up by the CARES Act itself.

USA Today’s Fact Check gave the claim made by Sen. Jensen, Fox News and others a rating of “true.” Here is their statement:

“We rate the claim that hospitals get paid more if patients are listed as COVID-19 and on ventilators as TRUE.

Hospitals and doctors do get paid more for Medicare patients diagnosed with COVID-19 or if it’s considered presumed they have 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.

This higher allocation of funds has been made possible under the Coronavirus Aid, Relief and Economic Security Act through a Medicare 20% add-on to its regular payment for COVID-19 patients, as verified by USA TODAY through the American Hospital Association Special Bulletin on the topic.” (2)

To be completely clear, I’m not accusing hospitals of lying about cause of death to get more funds. I believe mis-reporting cause of death has likely occurred, but more as a function of the chaos brought on by dealing with a pandemic in the hardest hit areas. But at some point, cooler heads have to step in and begin to square the circle and find out the real numbers.

We’ve spent trillions of dollars because we were told SARS-CoV-2 was a deadly pandemic that would kill millions. Those trillions are going, in part, to hospitals to cover the costs of caring for COVID-19 patients. Oversight is necessary, even in an emergency.

Let’s hope someone, somewhere has the good sense to provide some. Keep the faith and keep after it!

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  1. https://www.kff.org/uninsured/issue-brief/estimated-cost-of-treating-the-uninsured-hospitalized-with-covid-19/
  2. https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/

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