Infection_Ag11 said:
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But the "rumor" is absolutely true
It's true in the same way that it's true to say "Team X hasn't finished in the AP top-5 in 50 years" when that team has finished in the 6-10 range 14 times and the top-25 40 times in those 50 years. The statement is in fact true, but what is being implied by that statement (namely, that team X is an unsuccessful program) is not true by any reasonable metric. It's an example of making a statement in a vacuum using selective data to illicit a desired conclusion by one's audience.
A diagnosis of "MRSA pneumonia" carries higher medicare reimbursement than "Pneumonia due to unknown organism", assuming the totality of my documentation supports that diagnosis and is indicative of the hospital providing the level of care generally required for that diagnosis. And a patient with MRSA pneumonia who gets intubated will bring more Medicare reimbursement than a patient with MRSA pneumonia who does not get intubated. Can we therefore conclude that there is possibly, or even very likely, a rash of physicians falsely coding patients as having MRSA pneumonia in order to inflate their reimbursement? Is the government encouraging MRSA pneumonia diagnosis to inflate the numbers of supposed MRSA infections? Or is it simply that this is a more complicated infection that on average requires a higher level of care, greater healthcare resources and longer hospitalizations?
Look, Medicare reimbursement is not based on a simple diagnosis alone. I can list a diagnosis all day long, if the totality of the chart does not reflect that diagnosis it matters not to the person auditing it. And a pattern of consistent, demonstrable misdiagnosis/overbilling constitutes Medicare fraud and is a federal crime. Many doctors have lost their licenses, and entire facilities have been shut down, for such practices. The penalties are SEVERE.
It is simply not rational to believe that there is a rash of physicians risking millions in lifetime earning potential, and facilities/institutions rising hundreds of millions in future revenue, in order to help prop up short term claims of inflated COVID numbers. To believe such a thing is occurring is not only irrational as it would require the most coordinated and widespread conspiracy in human history, it is to deny the nature of human self-preservation.
So, let's recap on a few points:
1) I originally responded to the question of whether or not hospitals are paid more for Covid related deaths, which we apparently all agree is true. Hence it not being a rumor.
2) I pointed out that the USA Today article said that there is no known widespread occurrence of deaths being wrongly coded, and that Jensen never said that it's happening a significant amount.
3) I did say that I believe it's almost certainly happening to some extent, which is supported by your statement quoted below, showing that doctors DO on occasion intentionally misclassify things to commit fraud:
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Many doctors have lost their licenses, and entire facilities have been shut down, for such practices. The penalties are SEVERE.
4) I have never suggested that there is a widespread coordinated effort to intentionally misclassify deaths as Covid related solely to pump up the numbers, which I agree would be a large conspiracy. Unrealistically large. What I have suggested is that there are likely some one off instances of it around the country. That doesn't constitute some large conspiracy, nor does it constitute a conspiracy at all moreso than the other one off instances of fraud which we can all agree happens.
Last, how much higher is the reimbursement for MRSA pneumonia than "Pneumonia due to unknown organism"? Is it in the range of $15-30k higher, the way that a Covid diagnosis is? If it is, then hey that's a fair point. If it's not, then you're comparing oranges to mandarins.
I'm not suggesting that you or any other doctor that posts here is unethical enough to do something like this. But not all doctors or hospital administrators are ethical. And a
terrifying global pandemic that has gripped the world in fear with hundreds of thousands of senseless deaths is a pretty good cover IF some unethical doctor were to attempt fraud. And IF the payment for a Covid death is significantly higher than any other coding a doctor could choose, that establishes a pretty significant motive.
Personally, I find it pretty naive to simply assume that there haven't at least been a few intentionally misclassified "probable" Covid deaths.
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