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Are deaths unrelated to COVID-19 being marked as COVID-19?

Posted at 11:00 PM, Jul 31, 2020

You may have seen a version of this on social media:

The claim: Arizonans who are suspected to have COVID-19 and have died in recent months have all been marked as COVID-19, even if they did not die from COVID-19.

This claim originates from the Federal CARES Act passed by Congress and signed into law by President Trump in March. A provision in the appropriation allows for the Centers for Medicare & Medicaid Services, also known as CMS, to compensate hospitals at a higher level for the treatment of COVID-19. According to, speculation that hospitals were taking advantage of this increased payout for services began after Dr. Scott Jensen, a Minnesota physician and state legislator appeared on a national talk show to assert that hospitals get paid more for COVID-19 patients, significantly more when a ventilator is required. Almost immediately following this, social media memes claiming that hospitals get additional money for diagnosing COVID-19 deaths began to pop up.

Chatter on hospitals wrongly coding COVID-19 deaths picked up again when a man who died in a motorcycle crash was counted as a COVID-19 death. It reached the highest levels of government when US House Representative Blaine Luetkemeyer (R-MO) stated in a hearing that hospitals and attendant physicians have a “perverse incentive” to mark a death as COVID-19 to qualify for the higher CMS compensation.

There is evidence that there may be some deaths certified as COVID-19 that were probably coded improperly as provided by the Florida motorcycle death (which was reviewed and removed by health officials), as well as a valley woman who argues that her husband’s death certificate that lists COVID-19 as the cause of death.

Do these two examples, however, prove the claim that the marking of COVID-19 deaths is pervasive and over-inflated?

The answer is very likely no.

Dr. Cara Christ, the head of the Arizona Department of Health Services told ABC 15 that the attending physician that witnesses a death is responsible for determining the cause of death. Not only do most doctors not have a financial incentive to determine causes of death, but there are multiple steps in the medical billing and coding process that are designed to prevent “upcoding” from happening.

Dr. Murtaza Akhter is a professor at the University of Arizona College of Medicine, and an Emergency Room physician, who has had to sign several death notes in his line of work. We asked him if upcoding deaths for COVID-19 could occur in Arizona.

“Neither me, nor any of my colleagues do any upcoding, much less for COVID. I’ve never seen it done, that doesn’t mean it’s not possible, but even the data nationally suggests that it’s not happening. Remember, there are liabilities for anybody who does that. The OIG watches this carefully, and in fact, give reimbursement to people who are whistleblowers.” Dr. Akhter told us that the liabilities for upcoding are both civil and criminal.

The purpose of the death upcoding argument is to give people a reason to argue that COVID-19 deaths in Arizona are inflated and that the number of people who have died this year amounts to a bad flu season.

This is simply not the case.

The most recently available death statistics for the Arizona Department of Health Services show that 34,457 people died in Arizona from January to June of this year. This same time last year recorded 30,522 deaths. This is a 12 percent year over year increase, almost four thousand additional deaths. The next closest year-over-year death increase in Arizona occurred between 2015 and 2016. That period had an increase of 7 percent, a little over half of what we are seeing now. In fact, the ten-year average for the January to June time frame, not counting 2020, was only 3.4 percent year-over-year.

We did ask Dr. Christ about the motorcycle fatality in Florida and if something like that could happen here. She told us “If someone died in a car accident and was COVID-19 positive, they would not be counted on our dashboard as a COVID-19 death.”