Hospitals receiving larger reimbursements in federal dollars for treating COVID-19 patients

Under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, hospitals receive larger reimbursements for COVID-19 patients than other patients because it costs more to treat coronavirus infections.

The Kaiser Family Foundation is a leading non-partisan group that studies health policy. Spokesperson Karyn Schwartz says a part of the CARES Act pays additional funding on top of traditional Medicare rates during this public health emergency.

"We do know that Medicare has increased its reimbursements to hospitals by 20% for patients who’ve been diagnosed with COVID-19," Schwartz said.  "Hospital reimbursement depends on why the person’s there, what kind of treatments they got, and hospitals are paid more for certain things."

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Under the CARES Act, the U.S. Department of Health and Human Services (HHS) is distributing $175 billion to hospitals and healthcare providers. Schwartz says Medicare has depended on hospitals to be reporting that information accurately. With that money, there will also be an oversight. 

"There is a concern. It’s an awful lot of money being pushed out in a very short time. As far as the hospitals themselves, even being able to track the funding carefully, it’s gonna be difficult," explains Bill Root, a former HHS special agent.

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Root says some states will have to add resources to make sure coronavirus costs are accurate.

"Those claims with the COVID expense, they’re gonna have to pull the file, they’re gonna have to pull the charts, they’re gonna have to make sure it was properly coded so that they can trace and make sure those funds were used properly," he says.

We reached out to the HHS Office of Inspector General and received this reply:

"First and foremost, we support medical professionals providing the care patients need during this unprecedented public health crisis.  However, when we determine that any health care provider or other individual/company is improperly billing federal healthcare programs, our watchdog agency moves quickly and aggressively to clamp down on such behavior, in cooperation with the Center for Medicare and Medicaid Services’ program integrity staff. 

"Our data analysis team continually reviews Medicare claims to uncover unusual billing patterns and spikes, which are thoroughly followed up by investigators and other professionals.  

"In addition, our fraud hotline takes tips on possible fraud schemes, which regularly require our careful review.  And when evidence warrants it, we look behind claims made to federal health care programs to see if the medical record warrants the actions taken by a provider."