Dr. Abraar Karan, an internal medicine physician at Brigham and Women’s Hospital, had just finished a 15-hour shift Saturday night when he opened Twitter and saw a video of President Trump on the campaign trail, parroting a roundly debunked conspiracy theory that hospitals have been inflating COVID-19 deaths for financial gain.
At a rally in Waukesha, Wisc., on Saturday, Trump said “doctors get more money and hospitals get more money” if they report that their patients died of COVID-19, as opposed to other preexisting conditions or comorbidities. “Think of this incentive,” the president said, insinuating as he has before that the death toll from the virus is not to be trusted. He then claimed the pandemic, which has killed more than 226,000 Americans, is “going away,” even as the country approaches a third wave of infections.
“When I got out and I saw that, I found it extremely insulting and frustrating,” Karan said of the president’s comments. “This is somebody who just got taken care of by doctors, who just benefited from our medical system — presumably on taxpayer money — and he’s coming out criticizing the health care profession in what seems like a politically motivated attempt to further downplay the seriousness of the virus.”
Trump’s accusations that doctors are overcounting COVID-19 deaths have sparked a surge of criticism from the American medical community. In a statement issued Sunday, the American College of Emergency Physicians called the president’s assertions “reckless and false.” The American College of Physicians, which represents internal medicine doctors, denounced the president’s allegations as “a reprehensible attack on physicians' ethics and professionalism." The Council of Medical Specialty Societies said Trump’s claims “promulgate misinformation that hinders our nation’s efforts to get the COVID-19 pandemic under control.”
Karan was similarly appalled at what he called Trump’s attempt to “vilify physicians" and interfere with doctor-patient trust.
“I’ve taken care of more COVID patients than I can count, and I have not one time ever thought about compensation financially, or what that would mean," Karan said. “A lot of us worked more hours than we were ever scheduled to work. We were taking care of more patients than we were ever scheduled to take care of. ... But this was never about the money. This was about taking care of people in a health emergency."
Dr. Ashish Jha, dean of Brown University’s School of Public Health, said Trump’s suggestion that doctors are falsifying COVID-19 deaths is not only demeaning — to health care workers, to those who have died from COVID-19, and to their families — but nonsensical.
“You have to believe a few things for this conspiracy theory to make sense,” Jha said. “One is you have to believe that all the doctors, all the nurses, and all the health care executives are morally corrupt. Second, that you can do widespread fraud across the entire system and no one is really going to pick it up and that there would be no repercussions to this. You would just have to believe things that are so clearly not true.”
“Obviously there is fraud,” he added. “But it’s pretty infrequent, and when it happens, it gets prosecuted.”
Under the Coronavirus Aid, Relief, and Economic Security Act, passed by Congress and signed by Trump in March, hospitals are eligible for a 20 percent increase in Medicare reimbursements for patients diagnosed with COVID-19. For a typical coronavirus patient, Jha said, that bonus translates to an extra $1,500 to $2,200 per patient. The consequences for overbilling Centers for Medicare and Medicaid Services with fraudulent diagnosis codes are stiff.
“If you’re a doctor who did this, you’ll lose your medical license. If hospital billing departments started doing this, obviously people would lose their jobs. ... There are a whole series of penalties, including jail time," Jha said. “Not a lot of people are willing to go to jail for a couple of grand.”
Dr. Josh Barocas, an infectious disease physician at Boston Medical Center, said he found Trump’s comments “outrageous and totally demoralizing,” especially as he and many of his colleagues on the front lines of the pandemic continue to battle with burnout, trauma, and nightmares brought on by the first surge of the outbreak. Barocas, who started his medical career under President George W. Bush, said he has never felt disrespected by a sitting president, until now.
“There’s just a total disregard for the sacrifices that health care workers have made,” Barocas said. “It would be funny if we weren’t all so tired, depressed, and anxious, and if our lives weren’t literally on the line.”