My problem with conspiracy theories is the require a large number of people to have a secret and keep quiet about it (which I don’t believe is possible with human nature).
Hospital CEOs and CFOs may have an evil desire to line their pockets with COVID money. That’s your premise, right?
But those people don’t code healthcare transactions. For this to be true on any meaningful scale, you would need thousands of physicians to be in on the scheme.
They along, with a tech are generally taking notes on patient care, which is then passed over to a coding specialist (these people make like $40k a year). Hospitals have full teams of coding specialists in charge of coding daily transactions.
So in all honesty, you would need 100s of people (per hospital) in on it to have a meaningful impact if your plan was to miscode.
And that’s honestly best case scenario, because in all honesty the majority of hospitals outsource their RCM process to third parties. Shit, tons of coding is outsourced to India.
*NOT A DOCTOR QUALIFIER*
i don't believe these hospitals are doing this as some sort of money-making scheme, but i would not doubt that they are doing it to get "more than zero" dollars for treating uninsured patients.
the govt is giving out a metric fvckton of "free money" across all sorts of platforms. at every level, you're going to have people gaming the system. you don't have to look very hard to find people taking advantage of PPP, either, which can also theoretically eventually be audited. the reality is that there is so much money flying around, the govt will never be able to follow up on all cases.
these hospitals are already hurting because elective surgeries were closed down. throw in mass unemployment due to the shut down and the fact that old retired people are hardest hit by CV19 (lack of insurance to cover costs), and its not hard to imagine how these hospitals are going to need additional funds to help keep the doors open.
who is to say (2 years after the fact when the govt has the time and means to finally investigate) that joe sixpack didn't have CV19? the threshold for CV19 diagnosis doesn't appear that stringent:
https://www.aappublications.org/news/2020/05/07/coding050720
How to code for COVID-19 diagnosis, testing, telehealth
from the AAP Division of Health Care Finance
May 07, 2020
- Coding Corner
Editor's note:For the latest news on COVID-19, visit https://www.aappublications.org/news/2020/01/28/coronavirus.
Coding for encounters related to COVID-19 is changing rapidly. Following is information that will help with coding for diagnosis and testing and getting paid for telehealth services.
Diagnosis codes
Positive COVID
Assign code U07.1, COVID-19, for a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, a positive COVID-19 test result or a presumptive positive COVID-19 test result. Confirmation does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.