The media have widely reported that several government, non-profit and private organizations, including entities in the health sector, are offering various incentives to encourage more people to take the COVID-19 vaccine. While this approach may increase the number of people vaccinated, it may also involve healthcare fraud and abuse laws when recipients of the federal health program, such as Medicare participants, are pressured to roll up. their sleeves and get vaccinated (or two).
Recognizing that some in the healthcare industry would like to offer immunization incentives and the compliance risks these incentives may pose when federal health program beneficiaries are involved, the Office of the Inspector General (OIG) of the Department United States Health and Human Services Department recently released a Faq determine whether offering or providing cash, cash equivalent, or incentives or in-kind rewards to federal health program beneficiaries who receive COVID-19 vaccines during the public health emergency violates the administrative authorities of the OIG. In the FAQ, the OIG explains that the risk of OIG enforcement activity varies depending on who offers the incentives and provides guarantees on how health sector actors can minimize their risk of non-compliance. -compliance.
Health care sector entities offering incentives to beneficiaries of the federal health care program
Because federal health programs, including Medicare, reimburse administration of the COVID-19 vaccine, offering or providing incentives to recipients of federal health programs involves Federal Anti-Recoil Law (AKS) and the provision relating to the civil financial penalty (CMP) of incentives to beneficiaries. The FAQ states that healthcare providers, providers or managed care organizations offering an incentive or reward in connection with a beneficiary receiving the COVID-19 vaccine would present a sufficiently low risk under the AKS and CMP authorities if the following safeguards are in place:
- the inducement or reward is provided in connection with receipt of a required dose of a COVID-19 vaccine (which may include one or two doses, depending on the type of vaccine);
- the vaccine is licensed or approved by the Food and Drug Administration as a COVID-19 vaccine and is administered in accordance with all other applicable federal and state rules and regulations and the terms for the supplier or supplier receiving the vaccine supply from federal government ;
- the inducement or reward is not tied or subordinated to any other arrangement or arrangement between the entity offering the inducement or reward and the recipient of the federal health care program;
- the inducement or reward is not conditional on the recipient’s past or future use of other items or services reimbursable, in whole or in part, by federal health programs;
- the inducement or reward is offered regardless of the patient’s insurance coverage (or lack of insurance coverage) unless the inducement or reward is offered by a managed care organization and that eligibility be limited to its registrants; and
- the incentive or reward is provided during the COVID-19 public health emergency.
Non-health entities offering incentives to federal health program recipients
In addition, the OIG states that companies that are not affiliated with any stakeholder in the health industry, for example, restaurants and government entities such as local and state health departments that offer incentives to beneficiaries of the health care system. Federal health program to receive the COVID-19 vaccine poses minimal risk under the AKS and, where applicable, the CMP. Provided that the inducement provider was not engaged in another fraud scheme, the OIG would not initiate coercive administrative action when such non-health entities offer inducements for vaccination.
Incentives for commercially insured / uninsured persons
Finally, the OIG notes that, since AKSs and CMPs relate to items and services for which payment can be made under a federal health care program, it is unlikely that the anti-recoil law and PMCs are involved when immunization incentives are offered to people with commercial insurance or who are uninsured.
Take away food
To minimize the risk of OIG enforcement activity, healthcare providers, providers, and managed care organizations who wish to offer rewards to encourage individuals, including Federal Health Program recipients, to follow suit. to be vaccinated must integrate the guarantees described above into their incentive program. They should also keep in mind that these new guidelines are limited to the duration of the COVID-19 public health emergency and plan to review any vaccination incentive program when the end of the public health emergency is over. announced.