Author Archives: Hannah Zuckerman

Do COVID-19 Restrictions Apply to Religious Ceremonies?

Since the beginning of the pandemic, health experts have urged social distancing practices to mitigate the spread of the COVID-19. Nevertheless, some Americans continue to disregard health experts’ recommendations by both refusing to wear masks and social distance. One common trend across the U.S. that poses a health risk are religious ceremonies with many in attendance and few masks in sight. For example, James River Church in Springfield, Missouri continues to hold multiple Christmas celebrations with thousands of attendees. Additionally, a few thousand Orthodox Jews attended a secret wedding in early November. These events act as “superspreaders” due to the quantity of individuals present, many of whom travel from across the country.

In New York, Governor Cuomo attempted to curb the spread of COVID-19 by restricting social gatherings including limiting indoor religious ceremonies to 10-25 people. The Roman Catholic Diocese of Brooklyn and Agudath Israel of America filed suit against the state arguing that restricting religious gatherings infringes religious freedoms provided under the First Amendment. The New York Supreme Court upheld the COVID-19 restrictions. On appeal however, the U.S. Supreme Court overturned the ruling in a 5-4 decision granting the exemption. The Justices determined that the First Amendment granted religious individuals an exemption from adhering to social gathering restrictions because it infringes the right to freely practice religion.

The plaintiffs further argued that the state’s COVID-19 restrictions targeted religious groups differently than essential businesses that are operating. Similarly, in Employment Division v. Smith, the Supreme Court ruled generally applicable laws that unintentionally burden religious freedoms are not excusable. Furthermore, they declared only laws intended to limit free exercise of religion or violate other constitutional rights must be analyzed in connection to the state’s compelling interests and implemented in the least restrictive means. Therefore, a court may uphold restrictions on religious gatherings if the state can either prove restrictions are generally applicable or that there is a compelling interest such as the health risks posed by COVID-19.

This Supreme Court decision contrasts those prior to Justice Ginsburg’s death wherein restrictions on religious ceremonies in California and Nevada were upheld. This recent case is yet another example of the Supreme Court’s battle with balancing religious freedoms and societal stability. Consistent with the historic trend of conservative SCOTUS majorities, cases concerning one’s “freedom of religion” may inadvertently infringe upon others’ rights to pursue “life, liberty, and the pursuit of happiness.” With the Supreme Court’s ability to impact every American’s life, they play an important role in preserving the health and safety of the public. With nearly 17 million cases this week, this recent decision will undoubtedly delay the urgent attempts to mitigate the spread of COVID-19 in America.

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Are Physicians and Hospitals Profiting from Over-Reporting COVID-19 Deaths?

Currently, there are over 11.8 million active cases and 253,600 COVID-19 related deaths in the United States. Since the onset of the pandemic, the Trump Administration has repeatedly downplayed COVID-19, denounced mask-wearing mandates, and refused to order a nationwide shutdown. Moreover, the current administration has been criticized for false claims that physicians are financially benefiting from the increase in COVID-19 cases. For instance, at a Michigan rally, President Trump stated that “our doctors get more money if somebody dies from COVID.” He then criticized the United States’ method of reporting COVID-19 deaths by stating deaths are characterized differently in other countries if a patient has multiple causes of death. However, this is misleading because the World Health Organization dictates that COVID-19 deaths should “not be attributed to another disease (i.e. cancer) and should be counted independently of preexisting conditions that are suspected of triggering a severe course of COVID-19.”

The interpretation of the administration’s unsubstantiated statements is that physicians and hospitals are incentivized to over-report COVID-19 deaths in order to receive additional federal funding supplied by the Coronavirus Aid, Relief, and Economic Security Act (CARES). The term “upcoding” is used when providers fraudulently request reimbursements for services they did not provide to patients. Upcoding violates the False Claims Act (“FCA”) which prohibits providers from intentionally making false claims to federal healthcare programs. Penalties for violating the FCA include fines triple the amount of the claim plus $11,000, criminal prosecution, and imprisonment.

Unjustified claims against COVID-19 reporting reveal a general misunderstanding of how the U.S. healthcare billing system functions. Insurance companies and payor systems, including Medicare, require physicians to bill for various services provided to the patient throughout their treatment. Therefore, providers are compensated for treating COVID-19 related symptoms regardless if the patient dies from a pre-existing condition. Since reimbursements are not increased based on cause of death, providers have no financial incentive to over-report COVID-19 deaths.

The CARES Act increased physician and hospital reimbursements by 20% in an effort to assist hospitals with the increased costs related to COVID-19. Medicare has estimated the cost of treatment for an inpatient with COVID-19 to be around $13,000. If the patient requires a ventilator, the cost of treatment increases to roughly $39,000. The reimbursements that insurance companies pay out is split between the physicians and hospitals. Physicians are reimbursed for services rendered to patients, while hospitals are reimbursed for the use of equipment, nurse and staffing salary, laboratory services, and various treatment related services. Although hospitals stand to receive additional financial compensation, these institutions are not “financially benefiting”. The additional funds are allocated to cover the increased cost of resources needed for treating COVID-19 patients in addition to providing personal protective equipment (PPE) to employees. The additional money from the CARES Act also allows hospitals to hire additional nurses and staff. Furthermore, while the federal government has provided aid in supplying expensive medical equipment, the increase in cases have left many hospitals needing to purchase additional ventilators. The CARES Act reimbursement enables hospitals to purchase additional necessary equipment required to treat COVID-19 patients and PPE to protect hospital staff from contracting the virus.

Although data shows reimbursement rates for COVID-19 patients are higher, there is no evidence suggesting provider upcoding or other fraudulent over-reporting of COVID-19 deaths. Unsubstantiated claims against physicians and other providers gravely undermines the ethics and hard work of many American frontline workers and lends itself to the fear that surrounds the impact of COVID-19 in the US.


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