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Doctors and coroners fill out death certificates according to established rules and face legal penalties for falsification.
Hospitals must prove to Washington that patients tested positive for the virus, and their doctors gain nothing from a COVID-19 diagnosis.
There is no evidence that official death counts over report the reach of the disease.
A few weeks ago, President Donald Trump had praise for doctors on the frontlines of treating coronavirus patients.
"Since the plague arrived from China, we have seen our doctors, nurses, first responders, scientists, and researchers at their very best," he said Sept. 24.
Trump has changed his tune. In his recent rallies, with COVID-19 cases skyrocketing and deaths climbing, he has taken to accusing physicians of inflating deaths to line their pockets.
"Our doctors get more money if somebody dies from COVID," he told supporters at a rally in Waterford, Mich., Oct. 30. "You know that, right? I mean, our doctors are very smart people. So what they do is they say, ‘I'm sorry, but, you know, everybody dies of COVID.’"
This is a persistent theory that lacks any proof.
Johns Hopkins University researchers reported that the virus has killed more than 230,000 people. There is no evidence that figure is exaggerated. If anything, public health analysts say it likely undercounts the reach of the disease.
And while the government offers 20% more for the care of Medicare patients with COVID-19, the majority of doctors work for hospital systems. That means whatever higher payments might come, they don't go to them.
In order for Trump’s claim to have an appreciable impact on reported deaths, thousands of doctors would need to lie on death certificates without any financial benefit.
We recently rated False a similar claim from Trump that focused on hospitals.
Trump’s words imply that death certificates are subject to the whim of physicians. That’s wrong, and here’s why.
Ashish K. Jha, dean of Brown University’s School of Public Health, noted there are legal sanctions for falsifying death records.
"Doctors aren't taking random deaths and calling them COVID deaths," Jha wrote Oct. 27 in the website MedScape. "That would be fraud."
Jha also dismissed the impact of additional payments. He gave the example of a patient who spends more than four days on a ventilator.
"Without COVID, Medicare pays about $35,000 for that patient's care," Jha wrote. "With COVID, about $40,000."
In a tweet, Jha noted that to get this bump, the hospital must prove that the patient tested positive for COVID-19.
For the first time ever, in 2018, the number of doctors working for hospitals exceeded those who worked in independent practices. This means that the additional payments Trump referenced don’t apply to most doctors. A COVID-19 diagnosis doesn’t change what they charge.
"Hospitals are paid that way, not doctors," said Maggie McGillick, spokeswoman for the American College of Emergency Physicians. "Doctors are typically paid based on the service they deliver."
The majority of deaths take place in hospitals and nursing homes. Trump’s statement would mean that doctors who stand to make no financial gain would put themselves at legal risk by falsifying a death record.
Decisions on how to classify a given death are made by local doctors or coroners, but they are based on World Health Organization guidelines followed by the U.S. and nearly every other country.
The approach to identifying an underlying cause is laid out by the World Health Organization, which says a "death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma)."
The CDC reported that as of early October, the U.S. had about 300,000 more deaths in 2020 than would be expected in a typical year, two-thirds of which can be attributed directly to COVID-19. The data snapshot was based on Oct. 3 figures.
That would put the death toll at 200,000, which was very close to the number reported by another regular source, the COVID Tracking Project.
But the CDC went further.
"As of Oct. 15, 216,025 deaths from coronavirus disease 2019 (COVID-19) have been reported in the United States," the report said. "However, this number might underestimate the total impact of the pandemic on mortality."
Individually and collectively, doctors have rejected Trump’s claim.
Philadelphia physician Dr. Priya Mammen tweeted that many frontline workers are buying their own personal protective equipment because hospitals don’t have enough. Mammen said many of her colleagues are "exhausted by saving lives of preventable COVID."
The American College of Emergency Physicians said Trump’s implication that doctors seek to gain financially is "offensive."
"Emergency physicians and other health care workers have risked their lives day in and day out for almost a year battling the greatest public health crisis in a generation — all while watching countless patients die alone, going to work without sufficient protection equipment, and struggling with crushing anxiety about getting sick or spreading the virus to their loved ones," the group said Oct. 25.
We reached out to the Trump campaign for evidence that doctors are inflating the death figures. We did not hear back.
Trump said that doctors inflate the number of COVID-19 deaths to "get more money. ... So what they do is they say, ‘I'm sorry, but, you know, everybody dies of COVID.’"
There is no evidence to back this up.
Doctors and coroners follow established guidelines on the cause of death, and false reporting is a crime. A plurality of doctors work for hospitals and have no financial incentive to falsify death records.
Medicare does pay more for COVID-19 patients, but hospitals must prove a positive diagnosis for the disease.
A CDC analysis, in line with other research, finds the reported deaths from COVID-19 likely underestimate deaths from the virus.
We rate this claim False.
Donald Trump, Rally in Waterford, Mich., Oct. 30, 2020
Johns Hopkins University, Coronavirus Resource Center, Oct. 31, 2020
American Medical Association, Physician Practice Benchmark Survey, 2019
The BMJ, Covid-19: At least two thirds of 225 000 excess deaths in US were due to virus, Oct. 12, 2020
Center for Infectious Disease Research and Policy - University of Minnesota, US leads 19 nations in COVID-19, all-cause death rates, Oct. 12, 2020
Centers for Disease Control and Prevention, Percentage of Deaths by Place of Death, May 15, 2020
Factbase, Donald Trump Discusses His America First Healthcare Plan in Charlotte, Sept. 24, 2020
MedScape, COVID-19 Data Dives: Claims About False COVID Deaths Are Reprehensible, Oct. 27, 2020
Centers for Medicare and Medicaid Services, Preliminary Medicare COVID-19 Data Snapshot, Sept. 11, 2020
Covid Tracking Project, National data, accessed Oct. 31, 2020
Scientific American, Debunking the False Claim That COVID Death Counts Are Inflated, Oct. 20, 2020
Centers for Disease Control and Prevention, Excess Deaths Associated with COVID-19, Oct. 23, 2020
American College of Emergency Physicians, ACEP Rebuts President Trump’s False Statements about Overcounting COVID-19 Deaths, Oct. 25, 2020
Ashish K. Jha, tweet, Oct. 25, 2020
Prya Mammen, tweet, Oct. 25, 2020
Factcheck.org, Trump Baselessly Suggests COVID-19 Deaths Inflated for Profit, Oct. 29, 2020
Boston Globe, Doctors condemn conspiracy theory pushed by Trump that COVID-19 deaths are over-counted by hospitals, Oct. 30, 2020
PolitiFact, Fact-check: Hospitals and COVID-19 payments, April 21, 2020
PolitiFact, Trump wrong to claim U.S. is padding COVID-19 stats, Oct. 27, 2020
Email exchange, Maggie McGillick, spokeswoman, American College of Emergency Physicians, Nov. 1, 2020
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