Are hospitals falsely tagging patients with COVID-19 to make money?
Senior Medicare Patrol • July 8, 2020
Senior Medicare Patrol Investigates
You’ve probably seen the headlines making the social media rounds. Claims that “hospitals get paid more to treat COVID-19 patients” and “is medicare paying hospitals $13,000 for patients diagnosed with COVID-19 and $39,000 for those on ventilators?”
In a recent post to the KPRC 2 Facebook page, a woman claimed discharge papers showed her mom had COVID-19 when she “absolutely did not have it,” and her husband told her hospitals get $30,000 per patient.
She’s not alone in asking Channel 2 Investigates about this, so we decided to put two claims through our Trust Index.
Is Medicare paying hospitals more for COVID-19 patients?
Here’s how Medicare, which is funded through your tax dollars, works.
When patients are discharged, hospitals assign them a code on their diagnosis and treatment, and Medicare pays hospitals a set amount based on that code. But when Congress drew up the CARES Act, it created a 20% “add on” for treatment of COVID-19 patients.
“The key component of it was an additional reimbursement for patients who had COVID to offset the revenue the would’ve made for their typical procedures,” explained hospital billing expert Shawn Fry. “Depending on the severity of the patient, you could make double, or even four or five times as much on that COVID patient.”
Politifact looked at an analysis by the Kaiser Family Foundation which found the average Medicare payment for a less severe COVID-19 hospitalization was just over $13,000, and for a hospitalization requiring a ventilator it was just over $40,000. This includes the 20% “add on” through the CARES Act. That increases the hospital’s standard payment for similar treatment of non-COVID patients.
We rate the claim that hospitals make more money from COVID-19 patients as true.
Are hospitals falsely tagging patients with COVID-19 to make money?
“It is a possibility, any time you’re dealing with billing and coding,, there is a possibility for error,” said Jennifer Salazar with the Better Business Bureau’s Texas Senior Medicare Patrol. She advises that patients be proactive in tracking their diagnoses and treatments.
“When you got to the hospital or you see your doctor, write it down, write down what you’ve had done,” Salazar said.
And always review your discharge papers.
“If you see anything that looks suspicious or incorrect, if your not sure about, call us at the Texas Senior Medicare Patrol,” she said.
But there’s no hard evidence that hospitals are fraudulently identifying patients as “COVID positive”.
“To my knowledge, and I’ve talked to several different hospitals, no doctor has ever been incentivized to add the COVID-19 diagnosis to any patient’s file,” Fry said.
There are protocols in place to prevent that, including frequent audits, and harsh penalties for those who are caught doing it.
We rate the claim that hospitals are falsely tagging patients with COVID-19 to make money as false.
The East Texas Council of Governments (ETCOG) is pleased to announce the appointment of Adrian Cornejo as the new Director of the Area Agency on Aging of East Texas (AAA). In this role, Cornejo will lead efforts to develop and coordinate services that support the health, independence, and quality of life of older adults across ETCOG’s fourteen-county region. Cornejo brings a strong background in healthcare leadership and military service. He most recently worked as an Account Manager for Humana’s Institutional Special Needs Plan program, where he partnered with skilled nursing facilities to improve care coordination, leading to a 20% reduction in hospital readmissions. Earlier in his career, Cornejo served in the United States Navy for nearly two decades, rising to the rank of Senior Chief Petty Officer and managing budgets exceeding $550 million while leading more than 350 Sailors and Marines. “Adrian’s leadership experience in both healthcare and the military has equipped him with the skills and dedication needed to serve East Texas seniors,” said ETCOG Executive Director David Cleveland. “His background in building partnerships and his deep commitment to public service make him a tremendous asset to our team.” Cornejo shared his enthusiasm for his new role, saying, “It is an honor to join ETCOG and to serve the seniors of East Texas. My goal is to build on the strong foundation already in place at the Area Agency on Aging and continue to expand access to services that help older adults and their families live with dignity and independence.” The AAA is administered through ETCOG and is part of a nationwide network created through the Older Americans Act of 1965. It provides a wide range of services, including information and referral, benefits counseling, case management, health education, senior nutrition programs, housing repair, caregiver support, and Ombudsman advocacy for individuals in long-term care facilities. These programs are designed to help older residents remain active and independent in their homes and communities for as long as possible.
Medicare Open Enrollment is right around the corner, and with so many plans and choices, it’s easy to feel overwhelmed. But you don’t have to figure it out alone. Our certified benefits counselors are here to help—whether you prefer to sit down one-on-one or schedule an educational session for your group or organization. They provide clear, unbiased information about Medicare so you can make informed decisions that fit your needs. These services are free and available to individuals, families, churches, senior centers, civic clubs, and other local groups. If you or someone you know has questions about Medicare coverage, upcoming changes, or available plans, now is the time to reach out. To schedule an appointment or request a group presentation, contact us at 1-800-442-8845 or www.easttexasaaa.org/request-speaker .
