Q&A of the Day – Are hospitals fudging coronavirus cases for more money?
Each day I’ll feature a listener question that’s been submitted by one of these methods.
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Today’s entry: Good morning Brian. When there is a bounty for COVID cases and hospitals get more money for COVID, WHAT is the truth when they are being paid to confirm the cases?
Bottom Line: One of the consistent ideas expressed regarding the rise in coronavirus cases has been the financial incentive hospitals receive by classifying a patient as a COVID-19 positive. First, let’s look at the validity of that claim. It is true that it’s possible for hospitals to receive higher levels of compensation for certain COVID-19 patients. Here’s what’s real. Under Medicare, fixed payments for COVID-19 patients do enable higher rates of reimbursement. Under the CARES Act, Medicare reimburses at a 20% higher rate for COVID patients due to the declared national emergency. There also is a provision under the ACT for uninsured COVID hospitalizations to be reimbursed. All in, $100 billion in additional funds were made available through Medicare to combat COVID-19. Like many conspiracy theories that may not check out, there is truth rooted in the narrative and the potential for what’s alleged to have occurred, but it’s important for a reality check.
First and foremost, when considering the theory that medical establishments are false diagnosing and treating patients, as COVID patients, let’s look at what’s not impacted regardless. The overwhelming majority of diagnosed patients. 85% of COVID-19 tests have been processed by labs that are unaffiliated with hospitals. So to begin with, only 15% of what’s reported in new diagnosed cases and related deaths, has the potential to be manipulated for financial gain. So, let’s dig in to the 15% and I’ll focus on Florida’s reported results as I break this down.
The average age of someone diagnosed with COVID-19 in Florida has been 39. Through Tuesday, 30,996 of the 210,594 Floridians diagnosed with COVID-19 were Medicare eligible. That’s under 15% of Florida’s total cases or around 4,600 people. That means only approximately 2% of Florida’s reported cases would be in a position where hospitals could benefit from manipulation. And what about the 2%? How likely is that to be manipulated?
Think about the people who’d have to be involved in the manipulation and the implications if they were found to have inflated cases. You’d have to have nurses, doctors and medical assistants operate as part of the scheme. You’re talking about our ICU operators at credible medical institutions. How likely is it that our largest hospitals in conjunction with their medical staff would risk Medicare fraud over a 20% kick on the relatively small number of cases which could be manipulated? I’m sure once all of the dust has settled on the pandemic, we’ll learn that it happened somewhere. As I’ve illustrated though, 85% of cases nationally, at a minimum, can’t be manipulated this way along with 98% of the cases in Florida. Simply put, it’s not going to be a number significant enough that’d meaningfully impact the broader perspective or public policy response.
I completely understand the desire for this to be something less than what we’ve been forced to deal with but from every analytical angle, this virus really is the worst our country has faced in 102 years. That’s not advocacy of any particular policy, it’s simply a statement of fact.