by Dr. Eric Snyder and Dr. Amy Cerato

Covid-19 Death Coding, Inflation, and Upcharges

Prior to the arrival of Covid-19 in the United States, most individuals had very little understanding of how death certificates were determined and coded as these types of questions are certainly not common at casual events or gatherings given the seriousness of the topic. If nothing else, the content within this chapter should elicit sparkling conversation at dinner with your family as you deconstruct some of the processes put in place during this worldwide event. Does the physician, medical examiner, or coroner determine the cause? Where must they report the documentation? What entity is required to collect data regarding the types of deaths that occur in the United States?

In the United States, death certificates are reported to the National Center for Health Statistics (NCHS) through the Division of Vital Statistics (DVS). The data is subsequently recorded at the state level first by a certifier (i.e., physician, medical examiner, or coroner are all classified as certifiers) and then sent and archived in the National Vital Statistics System (NVSS). Bear with us as we recognize acronym overload.

The first preliminary guidance for certifying Covid-19 deaths was released on March 4, 2020 by NVSS. The language within the guidance permitted certifiers (i.e., physicians, medical examiners or coroners) to report a death where the virus “caused or is assumed to have caused or contributed to death.” At this time, the guidance recommended the use of the World Health Organization standard terminology on the certificate of “Covid-19.” It was not until twenty days later, that a NEW ICD (U07.1 – store this in your memory) code was introduced for Covid-19 Deaths.

In August of 2018, our own CDC provided a 50-slide training titled “Improving Cause of Death Reporting,” which provides excellent documentation of the process for those interested in delving deep. On slide 3 of the presentation, the orator states

“What a physician writes in the certificate’s ‘cause of death’ section is as important to public health practitioners as what a physician writes in a patient’s medical chart is to patient care.” Cause of death information is used to detect trends, such as those listed on this screen, that determine public health programs and health care funding allocations.

Let’s take a moment to dissect this narration. It is an absolute fact that what a physician, medical examiner, or coroner writes as the cause of death is of critical importance. It is also a fact that those reports detect trends that are then used to create public health policy and funding allocations. The trends also elicit many human emotions, especially if our decisions could result in death as we conduct risk analyses every day. Given the importance of reporting such trends and the fact that we have spent the past 21 months curbing the spread, would it not be reasonable to require these physicians, medical examiners, and coroners to provide “actual evidence” to justify a death certificate “cause?” Would it not be in the best interest of public policy to inform Americans that each Covid-19 death results in the following financial compensation, as released by FEMA on March 24, 2021?  Let us be clear, we take zero issue with families being compensated for their loss as we genuinely care about our fellow citizens.

• Financial Assistance for funeral expenses, internment, or cremation incurred after Jan 20, 2020 for deaths “related” to Covid-19.
• The assistance is limited to a maximum financial amount of $9,000 per funeral and maximum of $35,500 per application.

Within the FEMA document, the following documentation is required:

• An official death certificate that attributes the death to COVID-19 and shows that the death occurred in the United States. The death certificate must indicate the death “may have been caused by” or “was likely the result of” COVID-19 or COVID-19-like symptoms. Similar phrases that indicate a high likelihood of COVID-19 are considered sufficient attribution.

Does the linguistic use of “Covid-19 like symptoms,” or “likely the result of,” bother anyone else as we turned on the television in the evening and watch a “death ticker” continue to rise?  Try being at an educational institution where the safety of those you care about and love is of vital importance. See the image below. Is it possible to deny how concerning a visual like this would be if shown to a random person who wasn’t aware of the worldwide circumstance? Would you travel? Would you leave your home? Would you send your children off to university, or public/private school?

We take no issue and are thankful for our trained medical examiners. But shouldn’t using their “best medical judgement,” be rooted in scientific evidence? Shouldn’t we require the best test to recognize the presence of the virus within the system of the individual?  We have a “gold standard” test called the “Polymerase Chain Reaction (PCR)” that provides us evidence of a Covid-19 infection, right? Oh wait, that information will be in one of our forthcoming chapters because the PCR is actually not a diagnostic tool but rather analytical. What about antigen testing? We’ll discuss that in subsequent chapters as well.

But seriously, if we are offering families in the United States assistance when their loved one passes of Covid-19, who else are we providing assistance to?  How about our hospitals and inpatient care facilities?  The Center for Medicare and Medicaid Services (CMS) released a document on August 17^th, 2020 and made an update on September 11, 2020 outlining provisions of the Coronavirus Aid, Relief, and Economic Security Act. Section 3710 of the CARES Act provides a 20% upcharge for Covid-19 patients through our Medicare and Medicaid services, which was corroborated by the American Hospital Association.

To be fair to the American Hospital Association, after their August Bulletin, a November article was released clarifying that:

“Hospitals do not receive extra funds when patients die from COVID-19. They are not over-reporting COVID-19 cases. And, they are not making money on treating COVID-19.”

How do hospitals not receive extra funds when a discharge status of in-hospital death can result in a U07.1 coding? From our own CDC website the following is available as of November 9^th, 2021.

A confirmed COVID-19 hospital encounter is defined as any listed International Classification of Diseases, 10th Revision, Clinical Modification (ICD–10–CM) diagnosis code of B97.29 and/or U07.1. Prior to April 1, 2020, CDC guidance started to code a confirmed COVID-19 hospital encounter as B97.29. On April 1, 2020, the guidance changed to code confirmed COVID-19 hospital encounters as U07.1.

Any discharge status that states “died” or “died in a ‘medical facility’” using the U07.1 code would automatically qualify the hospital for an upcharge according to Section 3710 of the CARES Act.

How can the AMA accurately state they are “not” over-reporting Covid-19 cases when we know with 100% certainty that the PCR tests which were approved to be included in the death certificate files, are not diagnostic tests?  What about certifiers that list presumed or probable without concrete scientific evidence?

And perhaps most preposterous is the statement that “they are not making money on treating Covid-19.” As a small glimpse of hospital profits in 2020, let’s consider the Triblive article dated February 26^th, 2021 regarding University of Pittsburgh Medical Center (UPMC) profits.

“The coronavirus pandemic did not thwart UPMC (Pittsburgh) from raking in a record-high $23.1 billion in 2020 operating revenue — nearly $2.5 billion more than the nonprofit health system generated in 2019 and $10 billion more than it did five years ago. Operating income — profit after deducting operating expenses — ballooned by 250%, up to $836 million for 2020, according to UPMC’s unaudited year-end financial documents.”

Currently we have 59 million Americans covered by Medicare and we know that this age group is most vulnerable to not only the virus, but also the experimental use authorization (EUA) “vaccine.” We have another 75 million Americans receiving Medicaid services. In a nation of roughly 332 million people, these two governmental organizations cover and account for almost 40% of the population. Knowing these numbers, and the financial incentives associated with the presence of Covid-19 on a death certificate, would it not be plausible that our death rates could be inflated for monetary gain? How many millions or billions of fiat currency has been printed, devaluing the American dollar to subsidize these entities?

We know from CMS that for financial reimbursement a lab test is preferred through either molecular or antigen testing. How many certifiers provided a PCR test (which is in the molecular category) with the death certificate? In October of 2020, world famous soccer player Christiano Ronaldo tested positive for Covid-19 three consecutive times using a PCR test.  This caused all sorts of red flags to surface regarding the validity and reliability of these tests, especially given his “asymptomatic” quarantine. (Note: after 22 months of searching the academic literature we have yet to find a peer reviewed published study that clinically proves the idea of “asymptomatic” infection. Could that be because asymptomatic is an idea, not a reality?)

How many death certificates were labeled incorrectly? Why does the World Health Organization require a U07.2 coding when a lab test for evidence cannot be provided? All of these questions require answers and given our healthcare system in the United States and access to resources, having the highest standard of evidence for a cause of death during this worldwide event remains necessary especially given the societal impact of our public policy.

The state of California actually decided to see if Covid-19 numbers were inflated regarding death certificates and conducted a soft audit of their certificates this summer. On 6/6/2021, an article was published by Katherine Huggins providing conclusive proof that Santa Clara and Alameda counties removed death certificates that were “clearly not caused by Covid.” The number was not 2% or 5%, it was actually 25% of those that were reported. If two counties in the United States had inflated Covid-19 deaths of 25%, what would an audit of all counties reveal?

As we look across the pond to Europe, we find similar evidence of inflated death rates. Did you know that a Covid-19 death can be defined as a “death by any cause within 28/30/60 days of a positive PCR test” in certain European nations? An article written on March 23, 2020 in Off Guardian revealed the way in which these numbers were manipulated in Italy estimating that 88% of the death certificates may have been misconstrued. Similar to the United States, generous reporting allowances with terms like “likely” or died “with” Covid-19, not “of” Covid-19 continues the linguistic nuances associated with reporting procedures.

In Germany, any deceased person who is infected with coronavirus is calculated as a Covid-19 death, whether or not it actually caused death. We do not know how many Covid-19 deaths in Germany were the result of an invalid positive PCR and will likely never know due to the inability to test seroprevalence. But one thing is certain, there has been a concerted effort worldwide to not keep careful records differentiating presumed from actual Covid-19. There has also not been a requirement to definitively show infectious coronavirus as opposed to present coronavirus. These peculiar policy decisions call into question the legitimacy of the data, and rightfully so.

In the UK, and in Ireland, similar death reporting policies have been put in place. Given the guidance by the WHO, one could assume these policies have also been adopted in South America, Africa and Asia. Dr. Jay Bhattacharya, Professor of Medicine at Stanford University, on October 9^th, 2020 warned us about accurately recording fatality rates and recommended testing for seroprevalence. When he actually tested for seroprevalence in Santa Clara County, CA in April 2020, researchers found that 50,000 people had already been infected with the disease, while only 1,000 were identified as having Covid-19. Adding these 50,000 infected into the Infection Fatality Rate denominator (number of deaths/number of confirmed cases), we reduce the percentage chance of having a fatal case of the virus. If we were to provide all American’s with these tests, would we find that far more have already been exposed and recovered from the virus? Would this not increase numbers to reach herd immunity and exponentially support natural immunity? Using these tests for antibodies is extremely important because it means the fatality rate was closer to .2% in Santa Clara, CA. Since the article, there have been a plethora of seroprevalence studies (82+) from around the world that found a median fatality rate of .2%.

So let’s review what we now know to be fact.

1. A death certificate indicating a U07.1 coding does “not” require actual scientific evidence to justify the coding.
2. A death certificate indicating a U07.1 coding does not tell us if Covid-19 caused the death, was a variable that influenced death, or if Covid-19 was infectious and/or present.
3. A soft audit of death rates in two counties revealed a 25% reduction in U07.1 being reflected on death certificates due to inaccurate recording.
4. Seroprevalence testing of the population is recommended to provide an accurate Infection Fatality Rate [IFR] as it exponentially increased the denominator and subsequently reduces the IFR.
5. Having a required accurate test on file with a death certificate would substantially improve the death data.
6. There is a tremendous amount of money at stake.

In 2021, NVSS published two additional guidance documents bringing their total publications to nine since the start of the event (first guidance was on 3/4/2020).  Interestingly, in the April 15, 2021 Covid-19 Certification Guidance and Frequently Asked Questions document, the first mention of a Covid-19 “vaccine” causing or contributing to death is mentioned. This makes logical sense as we started vaccinating large groups of individuals in January of 2021, and reports in the OpenVAERS database started to reveal vaccination deaths at alarming rates. Which results in another important question. Are Covid-19 deaths due to adverse events of a vaccine given a special coding?

It is now clear the governments of the world are literally telling doctors that it is valid to list “Covid-19” as a cause of death when there may be no scientific evidence the deceased was infected. Due to these procedures, we have no reliable way of knowing how many people in the United States, let alone Oklahoma have died from Covid-19. We have very little hard data at all, just subjective conjecture designed to heighten human emotions and stir American anxiety.  It is clear that our own government and the individuals who represent us, are going out of their way to keep the data muddy so that the true story about this virus cannot be articulated to the world. Our job is to start asking why?

Questions to Consider.

1. Why did the United States not adopt a U07.2 coding to further disaggregate the data for conclusive evidence of Covid-19 being the cause of death?
2. What is the best way to confirm infectious Covid-19 is present in the human body?
3. If infection fatality rates are inflated due to loosely coupled procedures, but at the same time could be deflated due to mass seroprevalence testing, why create such a ridiculous reporting system that has limited scientific efficacy?
4. What other topics drive the narrative of this worldwide event? Masks? PCR Testing? Natural Immunity?

“Lies are rooted in our beLIEfs and it is the job of the individual to question and discover truth.” – Dr. Eric Snyder