Hospitals Get Paid More if Patients Are Listed as COVID-19 and On Ventilators

By: Michelle Rogers USA TODAY Network

Sen. Scott Jensen, R-Minn., a physician in Minnesota, was interviewed by “The Ingraham Angle” host Laura Ingraham on April 8 on Fox News and claimed hospitals get paid more if Medicare patients are listed as having COVID-19 and get three times as much money if they need a ventilator.

The claim was published April 9 by The Spectator, a conservative publication. WorldNetDaily shared it April 10 and, according to Snopes, a related meme was shared on social media in mid-April.

Jensen took it to his own Facebook page April 15, saying, in part:

“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. Already some states are complaining that they are not getting enough of the CARES Act dollars because they are having significantly more proportional COVID-19 deaths.”

On April 19, he doubled down on his assertion via video on his Facebook page.

Jensen said, “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.”

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.

The coronavirus relief legislation created a 20% premium, or add-on, for COVID-19 Medicare patients.

There have been no public reports that hospitals are exaggerating COVID-19 numbers to receive higher Medicare payments.

Jensen didn’t explicitly make that claim. He simply suggested there is an “avenue” to do so now that “plausible” COVID-19, not just laboratory-confirmed, cases can be greenlighted for Medicare payment and eligible for the 20% add-on allowed under the relief act.

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