Hospitals and doctors get paid more for Medicare patients diagnosed with COVID-19 — or if it’s presumed they’ve contracted the virus save for laboratory-confirmed tests — and then the payout triples if those patients are placed on ventilators, a USA Today fact check confirms.
Minnesota state Sen. Scott Jensen — a Republican and a physician — made the claim to Fox News’ host Laura Ingraham on April 8, the paper said, adding that the claims was published April 9 by The Spectator, and then WorldNetDaily followed suit on April 10.
On April 15, Jensen noted on his Facebook page: “How can anyone not believe that increasing the number of COVID-19 deaths may create an avenue for states to receive a larger portion of federal dollars.”
Four days later, he said via video on his Facebook page that “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 up on a ventilator, it goes up to $39,000,” USA Today reported.
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Jensen clarified in the video that he doesn’t think physicians are “gaming the system” so much as other “players,” such as hospital administrators, who he said may pressure physicians to cite all diagnoses, including “probable” COVID-19, on discharge papers or death certificates to get the higher Medicare allocation allowed under the Coronavirus Aid, Relief and Economic Security Act. Past practice, Jensen said, did not include probabilities.
He noted that some states, including his home state of Minnesota, as well as California, list only laboratory-confirmed COVID-19 diagnoses. Others, specifically New York, list all presumed cases, which is allowed under guidelines from the Centers for Disease Control and Prevention as of mid-April and which will result in a larger payout.
Jensen said he thinks the overall number of COVID-19 cases have been undercounted based on limitations in the number of tests available.
How coronavirus relief factors in
USA Today said coronavirus relief legislation created a 20% premium, or add-on, for COVID-19 Medicare patients, citing the American Hospital Association Special Bulletin on the topic.
The outlet said there have been no reports of hospitals exaggerating COVID-19 numbers to receive higher Medicare payments, adding that Jensen did not return an email request from USA Today for comment about his claim.
Affirming Jensen’s claims
But the outlet said Marty Makary — a surgeon and professor of health policy and management at Johns Hopkins Bloomberg School of Public Health — noted in a Tuesday email that “what Scott Jensen said sounds right to me.”
Snopes also investigated the claim and concluded it’s plausible Medicare pays in the range Jensen mentions but without a “one-size-fits-all” disbursement, USA Today said.
PolitiFact reporter Tom Kertscher wrote, “The dollar amounts Jensen cited are roughly what we found in an analysis published April 7 by the Kaiser Family Foundation, a leading source of health information,” USA Today added.
The outlet also called attention to Ask FactCheck’s report saying “the figures cited by Jensen generally square with estimated Medicare payments for COVID-19 hospitalizations, based on average Medicare payments for patients with similar diagnoses.”
“Jensen said he did not think that hospitals were intentionally misclassifying cases for financial reasons,” Ask FactCheck reporter Angelo Fichera noted, according to USA Today. “But that’s how his comments have been widely interpreted and paraded on social media.”
Still Ask FactCheck’s conclusion was that “recent legislation pays hospitals higher Medicare rates for COVID-19 patients and treatment, but there is no evidence of fraudulent reporting,” the outlet said.
Julie Aultman — a member of the editorial board of the American Medical Association’s Journal of Ethics — went a bit further, telling PolitiFact it is “very unlikely that physicians or hospitals will falsify data or be motivated by money to do so,” USA Today reported.