Paying docs more to boost screenings isn't a kickback: HHS

Paying doctors bonuses to increase the number of preventive screenings they provide to Medicaid patients doesn't violate federal anti-kickback laws, according to a federal watchdog.

An unnamed insurer approached HHS' Office of Inspector General with a plan to increase the number of early and periodic screening, diagnostic and treatment services physicians provide. Those services include vision and hearing tests, and examinations of physical and mental health, growth, development, and nutritional status. The goal is to detect ailments early before they worsen and become more complex and expensive to treat. HHS issued a public response to the request on Thursday.

In order to comply with its contract with a state Medicaid agency, the unnamed insurer must provide screenings for 75% of its Medicaid enrollees between the ages of 1 and 21 and an 85% rate of its enrollees under the age of 1.

Failure to meet these goals may lead to financial penalties from the state, the insurer said.

Therefore, the insurer suggested offering incentive payments to physicians in its network starting next year. The more clinicians increase their rate of applicable screenings compared to what they performed in 2018, the higher their incentive payments would be.

If a provider increased their screenings by at least 10% from 2018, then they would receive a $1 bonus for each enrollee who received an eligible screening in 2019. If the increase were at least 20%, they would receive $2 per patient. A 30% or greater increase in screenings would result in a $3 incentive payment per enrollee.

The insurer clarified that the proposed arrangement would not provide an incentive to recruit new Medicaid beneficiaries and would not encourage providers to take part in its other lines of business, which includes a Medicare Advantage plan. It also insisted that it would cover the payments out of its own pocket and not pass them on to the state Medicaid agency.

"Based on the facts certified in your request for an advisory opinion and supplemental submissions, we conclude that the proposed arrangement would not generate prohibited remuneration under the anti-kickback statute," HHS' OIG said in its advisory opinion.

The HHS OIG advisory opinion is legally binding, meaning that the HHS will not pursue legal action on a matter it has ruled upon.