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.