The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued an Advisory Opinion on offering gift cards to patients for completing an online patient education program.
In this particular case, the online program was used to educate patients on the risks, benefits and expectations relating to 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 those patients who elect to undergo surgery prepare for the surgery and post-operative care to reduce the risk of complications.
As part of the provider contracts with certain Medicare Advantage plans, enrollees in the plans 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. Also, the program was open to all enrollees even if they did not have an imminent need for surgery, because the program can be used more broadly to educate patients on core healthcare literacy skills.
OIG concluded that the program does not constitute grounds for sanctions under the federal Anti-Kickback Statute or Civil Monetary Penalties Law based on the following factors:
- The program is unlikely to increase costs to federal healthcare programs. In fact, the program can have the opposite effect, because it can reduce the provision of medically inappropriate surgeries and mitigate post-surgery complications by improving a patient’s literacy regarding surgery.
- There is a low likelihood that the program would meaningfully influence an enrollee’s selection of a particular Medicare Advantage plan that participates in the program, because the program is not marketed to any non-enrollees or prospective enrollees before enrollment. In addition, the limited frequency and value of the gift card (i.e., no more than one time per year at a $25 value) is unlikely to influence enrollees’ decision-making with respect to plan enrollment and re-enrollment and/or selection of a surgery provider.
- Finally, while the program educates patients on the various types of facilities that are available for surgeries (e.g., hospital versus ambulatory surgery center), it does not refer or make recommendations for any particular provider, facility or service.
Accordingly, OIG concluded that the program presents a low risk of fraud and abuse.
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