Last week a man smugly repeated this “fact” to me: Covid deaths are fake because hospitals make more money if they put Covid on the death certificate.
I know we are heading into a holiday weekend, but we reached a milestone last week, and a pernicious rumor needs killing.
The Milestone- A Million People in America Dead from Covid
According to figures released by CMS, America hit one million Covid deaths on May 16th. That number equates to the number of American casualties in the Civil War and World War II combined; it would be as if 9/11 happened every day for almost a year (336 days). (Source) We have had more deaths per capita than Canada or any other country in Western Europe and are at least a lap ahead of the second-worst country’s rating (Brazil at 664,967) or third (India at 524,241). (International comparisons are dated May 16th and are available here.)
The numbers in Brazil, India, and other countries are likely artificially low due to undercounting, but so are ours. For example, the Boston University School of Public Health estimates US Covid fatalities are 36% higher than reported.
In recognition of that volume of loss and grief, it’s time to unpack the rumor about fake Covid deaths for Cash.
The Rumor- Hospitals Make More Money if they Falsely Label Deaths with Covid
The rumor about falsely reporting Covid deaths for Cash began with Minnesota State Sen. Scott Jensen, a family physician in the state legislature. On April 9, 2020, Dr. Jenson appeared on Fox News’ ‘Ingraham Angle’ and claimed Covid deaths were overcounted, citing increased Medicare reimbursement for Covid cases.
Dr. Jensen reasserted his claim on a Facebook video ten days later (USA Today Fact Check):
“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 upon a ventilator, it goes up to $39,000.” [Source]
(The Medicare reimbursement amounts cited by Dr. Jansen differ regionally and among providers but set a reasonable standard for this discussion.)
Dr. Jansen’s connection between Covid Deaths and Cash “generated a frenzy of headlines on social media.” [source] A rumor was born.
The CARES Act Initially Allowed Unsubstantiated Covid Claims
On March 25, 2020, President Trump signed the CARES Act (the Coronavirus Aid, Relief, and Economic Security Act), including a 20% increase in reimbursement for Medicare patients who came into a hospital with Covid. The Act also provides hospitals reimbursement for uninsured Covid patients.
In the early stage of the pandemic, hospitals could claim the Covid bonus for laboratory-confirmed cases or, if a test wasn’t available, “if the circumstances (that a patient has Covid) are compelling within a reasonable degree of certainty.” CDC Guidance.
Was this a loophole? Yes. Is it possible some providers falsely diagnosed Covid to get the extra funds? Yes.
That was the reality of the world when Dr. Jensen spoke to Laura Ingraham in April 2020. In fact, in a subsequent phone interview with FactCheck.org, Dr. Jansen clarified that he wasn’t alleging global fraud but “how deaths classified as COVID-19 without corroborating positive test results could lead to an over-counting.” source
For the sake of argument, let’s assume there was some false reporting under the laxer standard early in the pandemic. That only brings 1,091 Covid deaths into question (see chart).
Keep in mind that the “Cash for Deaths” claim only applies to Medicare patients and the uninsured. As we all know, hundreds of the earliest killed by Covid were working-age adults, so most of the 1,091 deaths reported by September 1st were legitimate; they didn’t have anything to do with Medicare and increased reimbursement.
CMS Closed the “No Test Available” Loophole on September 1, 2020
As Covid entered its 6th month, CMS tightened the requirements for additional funding; “the impetus for the new change is to combat fraud, the agency said.” [Quote] Since September 1, 2020, increased Medicare Covid reimbursement depends on a positive test result in the patient’s chart (either taken in the hospital or within 14 days prior to admission). [Source]
In other words, any of the 998,909 Covid deaths reported between 9/1/20 and 5/16/22 eligible for extra Medicare dollars would require a positive lab test in the patient’s record. Could those be falsified too? Yes, but…
Medicare reimbursement has been an open trough of money since 1965; it invites criminal behavior. However, from my 26 years teaching health care executives as the Adjunct Professor for Health Law at Trinity University, I can assure you that hospital administrators invest considerable resources to prevent fraud. No one is cavalierly creating false Covid lab results.
There are multiple guard rails to protect federal funds from outliers in the industry, including audits, electronic verification of claims, comparing providers against each other to detect higher than average reimbursements, and significant financial incentives for whistleblowers. In 2021 alone, the Department of Justice [DOJ] recovered $5 Billion from criminals involved in healthcare fraud.
Of course there have been fraudulent Covid Claims, and it is safe to assume those criminal acts will be discovered and punished. But did that happen a million times? Not even close.
Medicare Covid Reimbursement is For Patient Care, Not Deaths
Another flaw in the “Fake Death” rumor is the connection between Covid and Cash has nothing to do with patient deaths. Hospitals earn extra reimbursement for caring for eligible patients.
Covid may be listed as the cause of death or a contributing factor on a death certificate, but that form isn’t the ticket for increased funding.
And don’t even get me started on the insinuation that doctors are putting people on ventilators unnecessarily to increase the bonus. Anyone who has witnessed an intubation, an incredibly invasive, demanding procedure, knows that is just silly.
Let’s Get Back to Those Million Deaths
So here we are. A million Deaths in America (and continuing at a rate of around 300 new deaths a day). A million killed by Covid? At least.
It’s time to pause with respect for those lost and their loved ones.
It’s time to be grateful for how far we’ve come in two years.
As we go into Memorial Day, remembering those who fought and died for our freedom, let’s not forget the million we lost while gaining a foothold in the intervention and treatment of this terrible virus.
Want to Know More
I have a quick update on my last Fontenotes covering the criminal case against RaDonda Vaught for a fatal medication error. On May 13th Ms. Vaught was sentenced to 3 years of probation for negligent homicide and adult abuse; she will not have to go to jail.
I am relieved for Ms. Vaught while also standing by my previous comment. This case never belonged in a Criminal tribunal.