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Are the rumors hospitals are reporting more COVID-19 cases for more money true?

Expert: "It’s just not believable."
Posted at 6:06 PM, May 15, 2020
and last updated 2020-05-15 18:26:30-04

BUFFALO, N.Y. (WKBW) — Rumors are flooding social media that hospitals are reporting more coronavirus hospitalizations than they're actually seeing to get more money from the Federal Provider Relief Fund.

“It’s just not believable that a hospital would actively pursue this,” said Larry Zielinski, the Executive in Residence for Health Care Administration at the University at Buffalo School of Management.

When a patient dies, his or her entire medical record is reviewed to determine their cause of death. The cost of that diagnosis is then billed to insurance.

“It's really based on the amount of resources a hospital puts into a case,” said Zielinski.

The Federal Provider Relief Fund enhances the hospitals reimbursement for a COVID-19 death by 20%. This is an attempt to offset money hospitals are losing due to fewer elective surgeries and preparing for the pandemic.

“The balance just isn't there. The hospitals lost a tremendous amount of money. This is a minor adjustment,” Zielinski said.

If the rumors were true, health care institutions would be committing Medicare fraud, which has serious consequences, such as steep fines.

“There may be criminal charges raised. And in addition to that, in addition to that your business has gone away because you can't participate in these contracts anymore,” said Zielinski, “You'd be risking the entirety of your operation for very minor potential illicit gain.”

Zielinski explained if a hospital is found guilty of Medicare fraud, Medicare will no longer work with that hospital. Other insurance companies sometimes require proof that hospitals work with Medicare in order for that insurance company to cooperate as well.

Zeilinski said, while there may be some outliers, it is highly unlikely any health care institution would risk committing Medicare fraud in the way these rumors insinuate.

Kaleida Health provided this statement:
“Kaleida Health did receive reimbursement from the Federal Provider Relief Fund, also known as hot spot funding. This was based on COVID-19 inpatient counts, not deaths. These much-needed dollars will help us begin to rebuild the financial health of our organization which has been battered these past few months. We have lost nearly $90 million year to date due to the coronavirus and we are projecting substantial losses moving forward.”

Catholic Health said in a statement:
“Determining whether a patient has COVID-19 is not a judgement call. It is based solely on the results of a laboratory test. Catholic Health have been testing all suspected COVID-19 patients in our facilities and those arriving at our Emergency Departments with symptoms since early March. Patients who are hospitalized with COVID-19, and subsequently die, may have other contributing health conditions, which are all noted in the patient’s medical record. Positive COVID-19 test results are documented, as are all other tests that are performed. Cause of death does not determine hospital reimbursement. Definitive COVID-19 is ONLY in the medical record if a patient tests positive.”

ECMC released the this statement:
“ECMC did not receive any funding from the recent “hot spot” disbursement connected to the federal Provider Relief Fund. Due to an arbitrary decision establishing January 1-April 10, 2020 as the timeframe for funding eligibility, hospitals received these federal funds only if they had 100+ COVID-19 positive patient admissions in that timeframe. ECMC had 70. Since April 10th, ECMC’s COVID-19 patient admissions have risen to 167. This federal funding was based on sustained COVID-19 inpatient admissions and not on discharges or deaths. Only individuals who passed away from COVID-19 were identified as such. ”

7 Eyewitness News also reached out to Eastern Niagara Health Systems, but did not hear back.