U.S. Department of Health and Human Services, Office of Inspector General recently issued an opinion on healthcare providers' issuance of discount coupons for medical services, finding the practice permissible if it is structured with certain safeguards.
Federal law, including the Antikickback Statute, prohibits the offering, solicitation, payment or receipt of any form of payment in return for referring an individual for any service that could be reimbursed under Medicare or Medicaid. Since these healthcare coupons may offer discounts on items or services reimbursable by federal healthcare programs, the OIG identified safeguards to mitigate risks.
1. Coupons would offer discounts, not free services. The OIG said patients' cost-sharing obligations would not be entirely waived, and third party payors — including Medicare and Medicaid — would benefit from the reduced costs associated with the coupons.
2. The website offering coupons would not be that of a provider. The website would bea third-party marketer that charges providers a flat fee to host coupons. Marketing by healthcare providers, especially physicians, is subject to closer regulatory scrutiny, according to the OIG. Medical providers are in positions of trust and could exert more influence when recommending healthcare services.
3. Providers would not rely on coupon use. The OIG said providers and advertisers would pay a set fee, consistent with fair market value, to purchase space for posting coupons on the website. This fee would not factor in the value or volume of any business generated by the coupons, such as how many customers downloaded them.
4. Customers' personal information would not be shared with providers. Customers do not need an account to access the coupon site. If they provide an email address for additional alerts, that information would not be shared with providers.
5. Coupons would be like those that are mailed to customers. Customers would not have paid for the coupons, as pre-payment increases the risk of service overutilization. For instance, if the customer bought the coupon, he or she may feel pressured to receive medical treatment that is unnecessary and it may also cloud providers' clinical judgment to deliver such care.
6. Providers would comply with the discount safe harbor. For the sake of the safe harbor, providers would be the "sellers" and coupon customers would be the "buyers." Buyers and sellers have certain reporting obligations to ensure any discounts to federal healthcare programs fall under the safe harbor.
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Federal law, including the Antikickback Statute, prohibits the offering, solicitation, payment or receipt of any form of payment in return for referring an individual for any service that could be reimbursed under Medicare or Medicaid. Since these healthcare coupons may offer discounts on items or services reimbursable by federal healthcare programs, the OIG identified safeguards to mitigate risks.
1. Coupons would offer discounts, not free services. The OIG said patients' cost-sharing obligations would not be entirely waived, and third party payors — including Medicare and Medicaid — would benefit from the reduced costs associated with the coupons.
2. The website offering coupons would not be that of a provider. The website would bea third-party marketer that charges providers a flat fee to host coupons. Marketing by healthcare providers, especially physicians, is subject to closer regulatory scrutiny, according to the OIG. Medical providers are in positions of trust and could exert more influence when recommending healthcare services.
3. Providers would not rely on coupon use. The OIG said providers and advertisers would pay a set fee, consistent with fair market value, to purchase space for posting coupons on the website. This fee would not factor in the value or volume of any business generated by the coupons, such as how many customers downloaded them.
4. Customers' personal information would not be shared with providers. Customers do not need an account to access the coupon site. If they provide an email address for additional alerts, that information would not be shared with providers.
5. Coupons would be like those that are mailed to customers. Customers would not have paid for the coupons, as pre-payment increases the risk of service overutilization. For instance, if the customer bought the coupon, he or she may feel pressured to receive medical treatment that is unnecessary and it may also cloud providers' clinical judgment to deliver such care.
6. Providers would comply with the discount safe harbor. For the sake of the safe harbor, providers would be the "sellers" and coupon customers would be the "buyers." Buyers and sellers have certain reporting obligations to ensure any discounts to federal healthcare programs fall under the safe harbor.
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