CM for stimulant use disorder: No limit imposed by OIG

Abstract

The oft‐stated assumption that the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) bans any gifts of $75 or more as a contingency in the treatment of stimulant use disorder is incorrect. From the Federal Register announcement: “Gifts that implicate the Beneficiary Inducements CMP that exceed these dollar limits are not prohibited but are analyzed on a case‐by‐case basis for compliance under the statute,” according to the OIG December 2020 Federal Register final rule (https://www.federalregister.gov/documents/2020/12/02/2020‐26072/medicare‐and‐state‐health‐care‐programs‐fraud‐and‐abuse‐revisions‐to‐safe‐harbors‐under‐the). “We highlight, however, that this nominal value guidance applies to the value of in‐kind items and services, not to the value of incentive payments in the form of cash or cash equivalents. In other words, cash and cash‐equivalent payments under $75 would not be covered by this guidance. Moreover, this guidance applies only with respect to the Beneficiary Inducements CMP and not to the Federal anti‐kickback statute. Furthermore, we are aware that some industry stakeholders may be under a misimpression that OIG prohibits contingency management program incentives above $75. There is no OIG‐imposed $75 limitation on contingency management program incentives. Rather, the Federal anti‐kickback statute may constrain the ability of individuals or entities to offer contingency management program incentives of any value to Federal health care program beneficiaries, depending on the facts of the arrangement. Moreover, in‐kind incentives above the $75 annual, aggregate limit, and all cash or cash‐equivalent incentives regardless of the amount, must be analyzed on the basis of their specific facts for compliance with the Beneficiary Inducements CMP.”