Healthcare News & Insights

Coupons for medical services?

A lot of people are familiar with daily deal sites. But now there’s a new wrinkle: Certain sites offer healthcare coupons. Providers who participate, however, need to be very careful.

While healthcare coupons may offer discounts on items and services reimbursable by the federal healthcare program, there are a lot of stipulations that have to be taken into consideration.

To help keep providers and facilities safe so they don’t break any laws, like those of the Federal anti-kickback statute, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued an advisory opinion (No. 12-02) with the following guidelines:

  • Coupons may only offer discount services, not free services. And providers must give the same discount to any third-party payor or insurance carrier that the provider offers to the patient. For example, a provider may not offer a 20% discount directed only at the patient’s cost-sharing amount. The website must include information explaining that the coupons apply to the entire service, and the coupons themselves must include similar language.
  • The website offering the coupon can’t be that of a provider. It would have to be a third-party marketer that charges providers a flat fee to host the coupons. Any marketing done by a healthcare provider of any type would be subject to extra scrutiny. Reason: The OIG says “healthcare providers and suppliers are in a position of trust and may exert undue influence when recommending healthcare-related items or services.”
  • Coupon use can’t be relied on by providers. The OIG states that providers and advertisers would pay a set fee, consistent with fair market value to purchase the space for posting their coupons on the website. And the fee wouldn’t take into account the volume or value of any business garnered by the coupon. For example, providers would be able to see statistics regarding how many times their profile was viewed and how many times customers downloaded their coupon, but the fee charged wouldn’t vary based on these statistics.
  • Personal information about the coupon purchaser can’t be shared with the provider. In other words, an account can’t be a requirement to download the coupon, and any personal information provided, such as an email address, can’t be shared with the provider.
  • The coupon has to be structured like the ones people get through snail mail. To decrease the risk of violating the anti-kickback statute, the customer can’t pay anything up-front for the coupon. Prepayment of a coupon increases the likelihood of service over-utilization. The example the OIG gave was, if a person bought a prepaid coupon for service x, when that person walks into the offering provider’s office requesting service x — having already paid for service x — the offering provider might feel pressure to render it even if it isn’t medically necessary.
  • Providers must comply with the discount safe harbor. Under the arrangement, providers would be the “sellers” and the customers would be the “buyers” for purposes of the discount safe harbor.  To qualify for protection under the discount safe harbor, buyers and sellers have certain reporting obligations to ensure that any discounts are shared with federal healthcare programs.

What do you think about providers offering service coupons — good idea or just too risky? Share your thoughts below.

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