What Can Providers Give To Patients - Part 4
On May 24, 2021, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued another FAQ on the Application of Administrative Enforcement
Authorities to Arrangements Directly Connected to the Coronavirus Disease: Would the offer or provision of cash, cash-equivalent, or in-kind incentives or rewards to Federal health care program beneficiaries who receive COVID-19 vaccinations during the public health emergency violate the OIG’s administrative enforcement authorities?
The OIG first addressed this question by acknowledging that a broad range of entities, including providers, are offering a wide variety of incentives and rewards; such as food and beverages, tickets to concerts and sporting events, and cash; to recipients who are vaccinated. The OIG recognizes that widespread vaccine administration is crucial to the pandemic response and that incentives and rewards may promote broader access and increase the number of recipients.
The OIG also pointed out, however, that these rewards and incentives may violate the federal Anti-Kickback Statute (AKS) and the Civil Monetary Penalties Law (CMPL) governing beneficiary inducements.
The OIG then concluded that providers, in the limited context of the COVID-19 public health emergency, may give rewards or incentives to beneficiaries who receive either one or both doses of the vaccine because such incentives and rewards “would be sufficiently low risk under the Federal anti-kickback statute and Beneficiary Inducements CMP.”
Providers must, however, meet the following requirements:
˗ The incentive or reward must be furnished in connection with receipt of a required dose of COVID-19 vaccine, including either one or two doses depending on vaccine type.
˗ The vaccine administered is authorized or approved by the Food and Drug Administration (FDA) as a vaccine for COVID-19 and is administered in compliance with all other applicable federal and state rules and regulations, including conditions for receipt of vaccine supplies from the federal government by providers.
˗ Incentives or rewards are not tied to or contingent upon any other arrangement or agreement offering incentives or rewards between providers and beneficiaries.
˗ Incentives or rewards are not conditioned on recipients’ past or anticipated future use of other items or services that are reimbursable in whole or in part by federal health care programs.
˗ Incentives or rewards are offered without taking into account insurance coverage for patients or lack of insurance coverage, unless incentives or rewards are offered by a managed care organization (MCO) and eligibility is limited to its enrollees.
˗ Incentives or rewards are provided during the COVID-19 public health emergency.
The OIG then pointed out that the AKS and CMPL relate to items and services for which payment may be made in whole or in part under a Federal health program. According to the OIG, it is unlikely that these statutes are implicated by incentive and rewards furnished to commercially insured or uninsured individuals.
Finally, the OIG concluded by saying that it would not express any opinion on the merits or utility of particular incentives or rewards to address the goal of encouraging vaccination.
So, as long as the criteria above are met, providers may give incentives or rewards to beneficiaries in order to encourage them to be vaccinated.
Elizabeth E. Hogue, Esq.
©2021 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.