Are doctors being paid to falsify death certificates, pumping up the COVID-19 death toll by a factor of more than 16 times the real number? No, that's not true. The person making the claim misstates the difference between underlying and immediate causes of death, and fabricates without evidence the claim that doctors are being paid a bounty for falsifying death certificates. Several physician organizations have denounced the claim as false.
The claim is part of a four-tweet thread (archived here) on the SusieQ4USA Twitter account on October 22, 2020, under the title: "Update from CDC"
It opened:
Of the 220,000 deaths reported as due to COVID, the actual cause was:
88,208 - pneumonia & influenza
17, 799 - chronic respiratory disease
26, 365 - respiratory distress synd.
44, 261 - hypertensive disease
23, 275 - heart disease
28, 000 - cardiac arrest
6,892 - other cardiac, renal, cerebrovascular diseases, diabetes, sepsis, cancer, obesity & dementia.
This is what the post looked like on Twitter at the time of writing:
(Source: Twitter screenshot taken on Mon Oct 26 18:24:26 2020 UTC)
"This series of tweets grossly misinterprets the data on comorbidities," the chief of the Mortality Statistics Brach at the National Center for Health Statistics wrote in an October 26, 2020, email to Lead Stories. Robert Anderson, Ph.D., said many of the conditions listed, such as pneumonia, respiratory distress and cardiac arrest are caused by COVID-19.
So, the death certificate might report the cause of death as respiratory distress syndrome due to pneumonia due to COVID-19, i.e., a logical causal sequence from the immediate cause (respiratory distress) working back to the underlying cause (COVID-19). Other pre-existing conditions that may be present (e.g., hypertension, heart disease, diabetes, COPD) are most often reported as contributing factors, not as the underlying cause. In 92% of deaths where COVID-19 is reported on death certificates, COVID-19 is reported as the underlying cause of death.
The American College of Emergency Physicians on October 25, 2020, said it was appalled President Donald Trump had repeated the claim, calling it "reckless and false." The claim is "a reprehensible attack on physicians' ethics and professionalism," said the American College of Physicians in an October 25, 2020, statement from the group, which represents internal medicine specialists. The Council of Medical Specialty Societies, a coalition of 45 organizations representing 800,000 doctors, condemned the claim as "baseless" and said many of its members have taken a cut in pay while continuing to care for COVID-19 patients.
The American Medical Association declined to provide a statement, saying it had already spoken to Politifact about the claim.
The series of SuzyQ4USA Tweets goes on to claim:
130k of total deaths were patients who already had life ending diseases. More than 10k of the 13,200 who died from COVID were already on Hospice care. Doctors speculate these patients were critically ill & likely died from a preexisting condition.
The CARES Act, passed by Congress, gives hospitals a 20% bonus on their diagnosis related group paid for by Medicare. Doctors are being paid to list deaths as COVID w/o ANY indication the patient's death was COVID related. Around 3,000 have actually died from COVID alone. This report has been officially published by the CDC.
The $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act was passed by Congress and signed into law March 27, 2020, and included a variety of economic relief programs aimed at reducing the public health and economic impacts of the COVID-19 pandemic. Included in that was a provision for reimbursement to hospitals for treating COVID-19 patients.
The American Hospital Association's president and CEO addressed the claims in a blog post titled "COVID-19's death count is real. So is the financial strain on life-saving hospitals." Rick Pollack wrote that hospitals do not receive extra funds when patients die from COVID-19 and are not making money on treating COVID-19.
An AHA report estimates total losses for our nation's hospitals and health systems of least $323 billion in 2020. There is no windfall here. Further, hospitals and health systems adhere to strict coding guidelines, and use of the COVID-19 code for Medicare claims is reserved for confirmed cases. Coding inappropriately can result in criminal penalties and exclusion from the Medicare program altogether.
Doctors are not reimbursed for completing death certificates, Anderson wrote to Lead Stories. Plus, in many states, COVID-19 death certificates aren't even signed by doctors, they are handled by the local medical examiner or coroner, who certifies the cause of death or reviews the doctors' certifications.
Anderson said the huge increase this year in total deaths in the U.S. versus what would be statistically consistent with recent history can only be explained by the pandemic. "If anything," he wrote, "we are undercounting COVID-19 deaths."
The Centers for Disease Control and Prevention posted to YouTube a video to help doctors fill out forms correctly, making clear the difference between the immediate cause of death, underlying cause of death and co-morbidities.
When a person dies in a state of acute respiratory distress, for instance, while fighting pneumonia caused by COVID-19, that's the order in which each condition is listed on the death certificate. In that example, COVID-19 is the underlying cause of death that brought on the pneumonia and respiratory distress.
Comorbidities (listed last on death certificates) such as hypertension, heart disease, obesity or diabetes kill slowly and reduce patients' ability to bounce back and are listed on the bottom of the form, for record-keeping purposes. But they are neither the immediate nor underlying cause of death, which is the error the Twitter series makes.
Here is the CDC's video instructions to doctors filling out death certificates.
Since death comes in stages, so too are causes logically reported in stages, the CDC video says:
Report the immediate cause on line A. This condition should be followed by any relevant intermediate causes in a logical sequence in terms of time and etiology below. A specific underlying cause should go on the lowest line used in Part I. Leave any unused lines blank. Any other conditions that may have contributed, but were not part of the sequence in Part I, should be reported in Part II.
If COVID-19 is determined to be the underlying cause, it should be reported on the lowest line used in Part I with any conditions to which it gave rise, such as pneumonia or respiratory distress, in a logical sequence on the lines above. Comorbidities that contributed to death, such as COPD or hypertension, should go in Part II.
