Various forms of the “Paid more for COVID” QAnon nutter tirade have been around since the pandemic started. Recently I had a phone call with a childhood friend who went on a QAnon nutter tirade along these lines.
There’s a family out here who had a member commit suicide and they got COVID put on the Death Certificate because they got paid more. I guarantee it!
part of the tiraid
Had I wanted to end our 30+ year friendship right then and there all I would have had to say is
Give me the name of the person and a link to their obituary.
the response to shut it down
I didn’t, but will next time. We will get into the details of how that shuts them down in a moment. First you need a bit of background on me.
Who Am I?
Regular readers know I’m an IT geek, traveling computer consultant whose not into traveling anymore, and award winning author. That’s not enough for this conversation. People without any facts behind them always try to shred the messenger so you need to know a bit more to understand how familiar I am with Medicare and insurance fraud. You also need to know that my mother passed away in 2023 so I have just went down the Death Certificate path.
First Programming Job
My first programming job was with Crescent Counties Foundation for Medical Care. I was the quality of care programmer. Six feet from me was the cost analysis programmer. We are still friends exchanging Christmas letters today. It was a not-for-profit peer review organization for Medicaid and Medicare. It got paid by the government programs to get all of the HICFAs (Health Insurance Claim Form) entered into a database we could then run analysis on.
A large number of RNs also visited every doctor’s office and hospital reviewing medical records and procedures, mostly randomly. Everything they found got a rank from 1 to 4.
- Rank 1 – documentation error. Wrong X-ray in file for patient and stuff like that. Everybody had these because we were using paper forms everywhere.
- Rank 2 – it may be medical care but it isn’t patient care. At twenty something I never understood this. It wasn’t until recently when my mother had a broken arm and I was taking her to the Oak facility near here that I learned just what this was.
- Rank 3 – medical mistake with or without adverse outcome. Typically this was a medication error. When hospitals put multiple patients in the same room it was not uncommon for a medication swap. Sometimes it was a dosage error.
- Rank 4 – gross and flagrant. Surgeon left a clamp inside when the closed you up, wrong patient got amputation, etc.
Bad Things Happened
Despite someone having a job in the surgery room of counting every tool on the tray, not ten years ago the girlfriend of a former coworker and friend got a clamp left inside her. She went to the ER of a different hospital because it was closer and when they took a picture of her gut the whole staff provided their info and offered to testify in court.
The accidental amputations/wrong surgeries are why every medical worker asks you for your first and last name followed by your date of birth. Two patients with the same name and different dates of birth got each other’s surgeries more than once. The question also helps reduce rank 3 issues.
Yes, I’ve talked about Medicare before on this blog.
My Department
My department had to identify outliers, create CAPs (Corrective Action Plans), monitor the plans and evaluate their effectiveness. All rank 4 issues went to full board review. If you failed your CAP we recommended your license be revoked. Some agency and political people dissed us for taking so few licenses. Our view was if the CAP fixed the educational or procedural problem with the professional, it was better to have them out there providing medical care.
Everybody had rank 1 issues. Because we had limited resources I ran the cross tabulations and other analysis to identify outliers. We focused our CAPs on the facilities with the greatest number of these to get the most improvement. We documented the facilities which had almost none so their processes could become part of future CAPs. Did the same for rank 3 issues as well.
All my coworkers told me rank 2 was almost impossible to create a CAP for. This being the 1980s and me being in my twenties I kept asking for a better explanation. “You know it when you see it” was the response. Here’s the real answer. This is usually a doctor. They have developed the “I am God, you will do what I say” complex. When a patient asks a question like “why didn’t my arm heel after months of immobilization?” they ignore it. When said patient seeks answers from the only medical professional who will talk with them, the doctor gets indignant/offended.
Why Was CAP for Rank 2 so Difficult?
You can’t teach someone to not be an asshole. The military can fix that shit by putting a heavy pack on their back and making them hike 25 miles per day in the desert. In an office environment you just can’t fix it. You can bar them from the Medicaid and Medicare programs though. Doctors who are assholes tend to have a high percentage of Medicare and Medicaid patients. Why? Because only patients with little to no choice go to them once word gets around.
Relevant Consulting
Multiple times during my consulting career I worked at Caremark. Once when it was part of Baxter and later when it was Caremark Homecare, just busted for Medicare fraud. Looking at some of the reports I had to run it was just stunning what they thought they could get away with. I used to think they would all go to prison in the 1990s, if you want to know why read through everything on this site. You would think after the $161 million in 1995 they would have learned something. Not so much. This isn’t all of them, but:
- $5 million in 2012
- $4.25 million in 2013
- $6 million in 2014
- $1 billion in 2018
- $4.25 million in 2021
- $500,000 in 2022
It should be noted that Caremark was acquired by CVS in 2015 but obviously the leopard didn’t change its spots. Oh, if you are signing up for ObamaCare and wonder why none of the Blue Cross plans cover CVS, here’s why.
Who Am I Summary
Crescent Counties For Medical Care hasn’t existed for many years. I don’t know who is doing that work now. It has to be contracted out at some level, maybe not. Maybe they directly employ thousands of nurses to audit all of the facilities now? The cost analysis stuff we did back then lead to things like this. My friend and I helped each other with our software development and analysis. We had four developers packed into one office right beside the computer room. Everybody did everything. Our titles existed for budgetary reasons. I’m well versed in what Medicaid, Medicare, and insurance fraud is.
You needed to know that so that when I tell you “Paid more for COVID” is complete bullshit you understand that unlike Donald Trump and his followers, I’m not talking out my ass. “Paid more for COVID” really is bullshit. Next we will discuss why and how this got started.
Billing – The Non-fraudulent Type
Multi-part forms like this one
You will notice there are only 6 lines for “Procedures, Services, or Supplies.” If you had a ton of stuff to bill for you had to use multiples of these filling in everything else again. In later years when hospitals had electronic medical records systems this wasn’t a big problem. For doctors and facilities that could not afford an electronic medical records system there were (and probably still are) Medical Billing companies. They would receive the records, create, sign, and send off the HICFAs for a fee.
The sales pitch for these companies was that they would “legally” increase the income of their customers. How?
The Code Tree
When I was working with this stuff it was ICD-9, today it is ICD-10, at some point it will be ICD-12 as new medical devices, treatments, and procedures come along. The government publishes full lists of the ones Medicare allows. Many/most (possibly all) of these codes have reimbursement amounts associated with them. There are rules for what can be coded together and even training seminars to go over the rules.
You have all seen television shows where a patient has to have intubation.
Usually they are in a rush to lube the tube and get it down then someone connects a bag and starts squeezing at a certain pace. Every step of that procedure has an ICD-9 (now 10) code. Here’s the one for inserting the tube. Given the hassles of billing back in the day the medical facilities usually only billed for the higher level procedure codes and just ate it for the lower ones because the reimbursement amount didn’t make the effort worth it.
The billing service firms receive the high level codes from the medical facility and used the published standardized procedures to include all of the lower codes. This is something the facilities simply weren’t doing because they didn’t want to invest in the software or pay staff to do it manually. Another great example is if you had a procedure like a surgery that required you to be on injectable antibiotics they generally only charged for the drug because it wasn’t worth the effort to code the injection as well.
Played Havoc With Identification
During my quality of care programming days my team was trying to identify facilities with large rank counts for insertion of the tube. Came back with a big goose egg searching the database for the code. The nurses had to give me a list of every high level procedure where the tube would be inserted and we had to drill down that way. Not coding everything lowered income for facilities but it also masked problems. If you had a lot of problems you were willing to throw a little money away.
Up-Coding vs. Full Coding
You are allowed to bill for every code Medicare publishes as long as you do it per the rules. That’s called full coding. It wasn’t possible without computers. Well, it certainly wasn’t worth the effort, it might have been possible with a ton of clerks. Ever since facilities and doctor’s offices were forced to submit claims electronically or wait until Medicare got around to looking at a paper HICFA, full coding has been pretty much the norm. The only way you got paid within a few days was to file electronically. If you think the government is losing your money with this, no, there were far better ways to commit Medicare fraud with paper forms.
Watch that entire video, it’s not long. Somewhere Mike Wallace has one too where he interviewed a man with Medicare statements lying in front of him on the table for replacement prosthetic legs and arms. I think 4 in total. He called Medicare repeatedly to report the fraud. Just to prove his point he stands up during the interview to show everyone the legs and arms he was born with.
Up-coding is billing for things patient didn’t have, services that weren’t provided, products never shipped instead of or in addition too what they really had/got. It is well below what the people in the above video were doing but no more ethical.
The Disinformation Specialists
Donald Trump has been talking out that ass sitting on his shoulders about this since 2020. Due to the accuracy level of the tests we have for COVID Medicare created a gray area where someone with symptoms and a false test could still be flagged for COVID. This was because you had to have COVID for a while before the tests could detect it. Would MBAs in charge of billing/collections try to flag every patient for COVID during the peak? You read some of the links for Caremark settlements, right? Sure.
Where Trump and his surrogates are putting a steaming pile of bull shit is extending that to death certificates. Trump doesn’t want to admit the body count he is responsible for so he claims death certificates are all being listed as COVID. Complete ka-ka and you all know it. You’ve seen it on television, in movies, and read it in newspaper articles about real life murder and wrongful death cases.
The cause of death on the death certificate and coroner’s report has to hold up in court!
Medicare does not pay for death certificates, you do. Coroner, while elected in most municipalities is a salaried position. There is a budget for the office to cover office supplies, transportation, special paper for certs, etc. but it is a salaried job. it doesn’t get paid by Medicare. Most Coroner offices don’t even forward the Death Certificate on to the Secretary of State’s office. You have to do that. Send it certified mail! Illinois residents need to send it to:
Secretary of State 2701 S. Dirksen Parkway Springfield, IL 62723
Identity Theft Alert
Do not publish an obituary until after you have confirmation the Secretary of State has processed the Death Certificate of your loved one. Too many people publish prior to services. Scammers monitor the obituary section of all newspapers online. You just fired the starting gun for check and credit card fraud at a time when nobody will be reviewing the bills for “odd” purchases.
It’s the Secretary of State’s office that flags the person as deceased in the country’s financial systems tagging all their accounts for fraud alerts. If someone tries to open a bank account or take out a loan once the Secretary of State has flagged the account the attempt goes straight to the FBI.
Between the time of death and the certificate being processed by the Secretary of States office you are exposed.
You Pay The Same Amount No Matter What
That’s right. Doesn’t matter what is on the Death Certificate, it costs you the same. Here are the costs for Kankakee County.
Your county’s fees may differ but they will be the same for all Death Certificates.
When it comes to what they died from, that isn’t being padded because it won’t hold up in court. Anyone who doesn’t die in the care of a medical facility has to receive an autopsy. No coroner is going to risk prison time putting down COVID as the cause of death when the body description shows a 9mm bullet hole in the skull from a suicide.
