by Raquel Shumway
Apr 22nd, 2022
Creating incentives for individuals participating in a substance use disorders (SUD) program has always been challenging due to concerns over violating Federal laws such as the Anti-Kickback Statute (AKS) and the the Beneficiary Inducements Civil Monetary Penalties. That limit makes it hard for SUD programs seeking to incentivize treatment to encourage compliance.
DynamiCare Health Inc. has developed a contingency management program (CM) for those dealing with substance use disorders. CM “addresses the brain’s reward response in ways that conventional counseling and medications often cannot.” Over a course of 50 years, it has shown that these types of programs are effective.
DynamiCare Health requested an opinion from the OIG who reviewed their request and determined that there is low risk for fraud and abuse and has offered their opinion on the request of DynamiCare Health, Inc.
NOTE: OIG states that
|“This opinion may not be relied on by anypersonotherthanRequestor…”
To further clarify, the OIG footnote adds: 'We use “person” herein to include persons, as referenced in the Federal anti-kickback statute and Beneficiary Inducements CMP, as well as individuals and entities, as referenced in the exclusion authority at section 1128(b)(7) of the Act.'
If other programs wish to seek an advisory opinion, contact the OIG and make a request.
The advisory opinion No. 22-4 states that “based on the relevant facts certified in your request for an advisory opinion…..the OIG will not impose administrative sanctions on the Requestor in connection with the Arrangement under sections 1128A(a)(7) or 1128(b)(7) of the Act, as those sections relate to the commission of acts described in the Federal anti-kickback statute;” They also state that they “will not impose administrative sanctions on Requestor in connection with the Arrangement under the Beneficiary Inducements CMP or section 1128(b)(7) of the Act, as that section relates to the commission of acts described in the Beneficiary Inducements CMP.
Besides the fact that this opinion applies only to the requestor, the OIG opinion does add a few other limitations:
This opinion is also subject to any additional limitations set forth at 42 C.F.R. Part 1008.
DeConti, RK, (2022, March 2). Letter to Requestor. Office of Inspector General – HHS
Note: As stated above, this opinion does not obligate any agency other than the Department of Health and Human Services.
Knowing that the OIG has stated that it won’t impose sanctions opens the door to using the contingency management program as a good option for patients who would benefit from a substance use disorder or Contingency Management program.
About Raquel Shumway
Raquel has been an administrative assistant for 21 years. For the last 12 years she has worked editing medical coding books and articles, which has provided experience in understandint medical coding and requirements.