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Medicare participants who complete an educational program can receive a gift card

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On August 19, the Office of the Inspector General of Health and Human Services (“OIG”) posted favorable advisory opinion AO 22-16 regarding the provision of gift cards to Medicare Advantage (“MA”) plan participants. . Complete specific steps in the online patient education program. This opinion is based on the opinion that Medicare Advantage Organizations (“MAO”) and its vendor partners identify learning and healthcare practices that may improve health outcomes without inappropriately directing patients to specific healthcare providers or MA plans. It highlights potential flexibility for providing patients with incentives to engage in activities.


Requesters and their decision-making tools: The OIG’s Opinion is in response to a request from a company (“Requester”) that operates an online shared decision-making and learning tool designed to educate patients about the risks and benefits of surgery. This tool consists of two modules. The first module is intended to help patients understand their diagnosis, discuss those diagnoses with their providers, and educate patients about non-surgical options. Surgery on potential provider types, preparation, and postoperative care. This tool does not endorse any particular healthcare provider.

Contract with MAO: Requesters enter into agreements with MAOs to provide tools to each MAO’s registrants for a monthly fee per member.

gift card: The requester will provide a $25 retail store gift card along with the survey to registrants who complete the first module of the program, regardless of the treatment option or other factors the registrant pursues. A registrant can use this tool multiple times, but she is only eligible to receive one gift card per year.

promotion: Requesters send direct mailings and emails about the program to registrants. Some will be sent to all enrollees, some will be sent only to those who are likely to face a surgical decision, but the provision of that tool or gift card will be sent to patients who have not enrolled in the program. does not advertise. Contract MAO. MAOs are also contractually prohibited from promoting gift card offers in future marketing communications to subscribers.


Low risk of AKS violation: The OIG has concluded that gift cards are implicated in federal anti-kickback statutes because they may cause registrants to introduce themselves to MA plans offered by the MAO with which the applicant is contracted. But fraud and abuse. In assessing risk, the OIG highlighted several factors.

  • Gift card offerings are unlikely to increase the cost or cause inappropriate use of the Federal Health Care Program (“FHCP”) and may have the opposite effect of improving patient medical literacy. there is.

  • Ads limited to current subscribers, and re-enrollment decisions likely to be based on other broad facts, and limited frequency and modest value of rewards.

  • The tool does not endorse any particular healthcare provider, so gift card offerings are unlikely to affect competition among healthcare providers.

Irrelevant BIP: The OIG also notes that this tool does not endorse any particular provider and that the ban on beneficiary solicitation applies only to, and may affect, compensation that may influence choice of provider. concluded that the offering of a gift card does not imply a prohibition on the solicitation of beneficiaries, as it does not apply to certain rewards. Choice of MA plan.

MAO and its partners are increasingly seeking mechanisms to improve patient health and wellness engagement in enrolled populations. AO 22-16 suggests welcome flexibility by the OIG regarding arrangements for rewarding patients for participation in such efforts. Nonetheless, companies considering implementing patient compensation programs should keep in mind certain facts highlighted in the OIG’s analysis and work closely with their attorneys to ensure that appropriate safeguards are built into the program. You need to make sure that you are

Copyright © 2022, Sheppard Mullin Richter & Hampton LLP.National Law Review, Vol. XII, No. 234