Is Medicare Paying Hospitals $13K for Patients Diagnosed with COVID-19, $39K for Those on Ventilators?

Questions were raised on cable news about whether hospitals have financial incentives to diagnose patients with COVID-19.

  • Published 17 April 2020

Claim

Medicare is paying hospitals $13,000 for patients admitted with COVID-19 diagnoses and $39,000 if those patients are placed on ventilators.

Rating

What's True

It is plausible that Medicare is paying hospital fees for some COVID-19 cases in the range of the figures given by Dr. Scott Jensen, a Minnesota state senator, during a Fox News interview.

What's False

However, Medicare says it does not make standard, one-size-fits-all payments to hospitals for patients admitted with COVID-19 diagnoses and placed on ventilators. The $13,000 and $39,000 figures appear to be based on generic industry estimates for admitting and treating patients with similar conditions.

Origin

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In mid-April 2020, social media users shared a meme implying that hospitals had a financial incentive to inflate the number of COVID-19 patients they were admitting in the midst of the ongoing COVID-19 coronavirus disease pandemic.

The meme contained red text that said, “So, hospitals get an extra $13,000 if they diagnose a death as COVID-19 and an additional $39,000 if they use a ventilator!” and prompted readers to ask Snopes.com to verify whether the statement is true:

The idea that hospitals are getting paid $13,000 for patients with COVID-19 diagnoses and $39,000 more if those patients are placed on ventilators appears to have originated with an interview given on the Fox News prime-time program “Ingraham Angle” by Dr. Scott Jensen, a physician who also serves as a Republican state senator in Minnesota.

During the April 9, 2020 interview, Jensen suggested to host Laura Ingraham that he believed the number of COVID-19 cases in the U.S. was being artificially inflated. “The idea that we’re going to allow people to massage and sort of game the numbers is a real issue because we’re going to undermine the (public) trust,” he said.

Ingraham then played footage from a press conference with comments from Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in which Fauci called claims that the number of coronavirus cases are being “padded” a conspiracy theory. In an exchange that followed, Jensen suggested that Medicare, the national health care plan for the elderly, was paying hospitals set amounts for each patient diagnosed and treated for COVID-19:

INGRAHAM: Dr. Fauci was asked about the COVID death count today. Here’s what he said, in part.

[Cut to briefing]

REPORTER: What do you say to those folks who are making the claim without really any evidence that these deaths are being padded, that the number of COVID-19 deaths are being padded?

FAUCI: You will always have conspiracy theories when you have very challenging public health crises. They are nothing but distractions.

[Cut back to Ingraham]

INGRAHAM: Conspiracy theories, doctor? So you’re engaging in conspiracy theories. What do you say to Dr. Fauci tonight?

JENSEN: Well I would remind him that any time health care intersects with dollars it gets awkward. Right now Medicare has determined that if you have a COVID-19 admission to the hospital, you’ll get paid $13,000. If that COVID-19 patient goes on a ventilator, you get $39,000, three times as much. Nobody can tell me after 35 years in the world of medicine that sometimes those kinds of things impact on what we do.

We attempted to reach Jensen by phone and email, but did not get a response in time for publication.

We also reached out to the U.S. Centers for Medicare & Medicaid Services (CMS) to ask whether the statement that Medicare was paying hospitals $13,000 and $39,000, respectively, for patients admitted with COVID-19 diagnoses and patients with the disease who are placed on ventilators.

A spokesperson for CMS told us that whether hospitals are paid by Medicare for care of a COVID-19 patient would depend on whether that patient was covered by Medicare insurance. CMS also told us there is no set or predetermined amount paid to hospitals for diagnosing and treating COVID-19 patients, and the amounts would depend on a variety of factors driven by the needs of each patient. Pay-outs would also depend on the variance of the costs of medical care in different regions.

The closest match for the numbers cited by Jensen we could locate was in an April 7, 2020, article published by the health care nonprofit Kaiser Family Foundation. As a starting point to estimate how much hospitals might get paid by the federal government for treating uninsured COVID-19 patients, the article used average payments for hospital admissions for similar conditions in 2017: 

For less severe hospitalizations, we use the average Medicare payment for respiratory infections and inflammations with major comorbidities or complications in 2017, which was $13,297. For more severe hospitalizations, we use the average Medicare payment for a respiratory system diagnosis with ventilator support for greater than 96 hours, which was $40,218.

But while these industry estimates are similar to the numbers Jensen cited, they do not represent actual Medicare payments to hospitals for COVID-19 diagnoses or treatment, or even a national average of such payments. 

We therefore rate this claim “Mixture.” While it seems plausible that Medicare disbursements to hospitals treating COVID-19 patients could be in the range given by Jensen in the Fox News interview (if those patients are covered by Medicare), we found no evidence to support Jensen’s assertion that “Medicare has determined” that hospitals will be paid $13,000 for patients with COVID-19 diagnoses or $39,000 for COVID-19 patients place on ventilators.