Lying about COVID-19 cases for extra insurance pay would be fraud

GRAND RAPIDS, Mich. (WOOD) — Some people have been reaching out to News 8, concerned that hospitals are lying about whether have patients have COVID-19 simply for a bigger insurance payout.

News 8 hasn’t been able to confirm any truth to such accusations.

While it’s true that a federal coronavirus response bill increased Medicare pay for COVID-19 treatment, any fraudulent claims or diagnoses can lead to civil penalties or criminal charges.

When a Medicare patient goes to the hospital, Medicare pays according to set rates. Starting April 15, the CARES Act increased payment for cases involving a person diagnosed with COVID-19 by 20%. A spokesperson for the Center for Medicare and Medicare Services explained the change is meant “to protect the health and safety of our nation’s patients and providers in the wake of the COVID-19 outbreak.”

Every local hospital that News 8 reached out to denied a request for an interview about the payments. 

But Metro Health-University of Michigan responded with an email, confirming it is being paid more when treating a COVID-19 Medicare patient and adding that most commercial plans were following suit with a “20% uplift in payments.”

New 8 was not given any specific dollar amounts for coronavirus treatments costs.

And Metro Health said hospitals can’t just add COVID-19 to a bill without cause.

“Coding guidelines are very clear that this is only to be used for confirmed cases and/or presumptive cases, not for suspected, probably or inconclusive cases,” its statement said.

That means the patient must have had a test run by a local or state lab come back positive for the hospital to collect on a COVID-19 payment.

“Medicare providers are required to accurately bill for services,” the federal CMS said.

News 8 asked the federal CMS if there have been any cases of fraud but had not heard back as of Monday evening.