OIG Finds $25 Patient Gift Card Low Risk of Fraud and Abuse | Rivkin Radler LLP

The Office of Inspector General (OIG) of the US Department of Health and Human Services recently issued an advisory on offering gift cards to patients to complete an online patient education program.

In this particular case, the online program was used to educate patients about the risks, benefits and expectations of surgeries, and it was separated into two modules: the first module to help patients understand their diagnosis and non-surgical treatment options, and the second module to help patients who choose to have surgery prepare for surgery and post-operative care to reduce the risk of complications.

Under provider contracts with some Medicare Advantage plans, plan enrollees would receive a $25 gift card to a retailer for completing the first module of the program. The gift card was not contingent on the patient undergoing surgery or any other treatment option. Additionally, the program was open to all enrollees even if they did not have an imminent need for surgery, as the program can be used more broadly to educate patients on basic health care literacy skills.

The OIG concluded that the program did not constitute grounds for sanctions under the federal anti-bribery law or the civil monetary penalties law based on the following factors:

  • The program is unlikely to increase the costs of federal health care programs. In fact, the program may have the opposite effect, as it may reduce the provision of medically inappropriate surgeries and alleviate post-operative complications by improving patient knowledge of surgery.
  • The program is unlikely to significantly influence an enrollee’s selection of a particular Medicare Advantage plan that participates in the program, as the program is not marketed to non-enrollees or potential enrollees prior to enrollment. . In addition, the limited frequency and value of the gift card (i.e. no more than once per year at a value of $25) is unlikely to influence participants’ decision-making in with respect to enrollment and re-enrollment in the Plan and/or selection of a Surgical Provider.
  • Finally, while the program educates patients about the different types of facilities available for surgeries (e.g., hospital versus outpatient surgery center), it does not refer or make recommendations for any particular provider, facility, or service. .

As a result, the OIG concluded that the program poses a low risk of fraud and abuse.

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