Gift Cards in Exchange for Health Services OK, Says OIG

Gift cards are widely used to drive recipients to particular retailers, so without risking federal sanctions, can a health care provider offer the same for grocery purchases in exchange for receiving a health screening or other clinical service that it furnishes? Yes, said the Health and Human Services Office of Inspector General (OIG) in Advisory Opinion No. 12-21, released Jan. 3 and based on the particulars of the proposed arrangement. Though implicating the anti-kickback statute, it would present a low risk of fraud and abuse, the OIG concluded, “and thus we would not impose administrative sanctions on the provider.” The Proposed Arrangement The party requesting the opinion is a federally qualified health center that proposes to offer a $20 grocery store gift card to certain patients in capitated Medicaid managed care plans as an incentive to receive screening tests or other clinical services. Eligible enrollees would get a letter from the center informing them of the chance to receive the gift card. Letters would be sent regardless of the health status of enrollees, and the center would not engage in additional promotion or marketing of the arrangement. The gift cards could not be cashed in, and receipt of the cards would not hinge on patients selecting a particular clinical service at the center. Patients would be limited to one gift card per year, and each card would include information on nutrition, health care, and the health center. The OIG’s Analysis The OIG found a minimal risk of fraud and abuse and thus declined to impose sanctions for a number of reasons:

• The arrangement would not result in higher costs to the federal health programs nor would the center have an incentive to provide unnecessary care. All eligible recipients would be enrolled in Medicaid managed care plans reimbursed on a capitated basis. Medicaid would not change the capitated payments to the plans based on the nature or number of services the center provides to those eligible. The center, in turn, would be compensated by the Medicaid managed care plans on a similarly capitated basis.

• The arrangement would not be advertised or marketed to the general public. “Additionally, it would limit the annual amount of incentives offered to an enrollee to one gift card of relatively modest value. In a different context remuneration of such value could have a substantial potential to steer patients. Given the facts here, however, we regard the offer as unlikely to harm the center’s competitors or result in a destructive race to the bottom among competing providers,” the OIG said.

• The arrangement would provide a benefit to members of the largely poor community that the nonprofit health center serves, “engaging beneficiaries and educating them about the center and its potential role to both improve health outcomes and make best use of resources in connection with capitated managed care plans.”