On March 2, the Office of Inspector General (OIG) posted Advisory Opinion No. 22-04 to a digital health company that provides personalized treatment of substance use disorders based on contingency management incentives (the CM Program). According to the OIG, while the CM Program would typically generate fraud and abuse concerns, it would not impose enforcement action after analyzing the totality of facts and circumstances.
The CM Program is operated by a privately held digital health company. It is not enrolled as a provider or supplier in any federal healthcare program, and most of its customers do not currently bill any federal healthcare program. Patients participate in the CM Program via self-referrals or referrals by health plans, addiction treatment providers, employee assistance programs, or research institutions. Patients receive cash-equivalent incentives via restricted-use debit cards if they achieve personalized behavior health targets. OIG reached a favorable conclusion regarding the CM Program, based on its analysis of four key factors: (1) The CM Program is evidence-based and protocol-driven, and is not an inducement to seek federal reimbursement of services. (2) The cash-equivalent incentives have a relatively low value (under $5 per achievement and capped at $200 per month and $599 per year). (3) Various entities and individuals refer patients to the CM Program, and many are not motivated by patient inducement. (4) The CM Program includes sufficient safeguards against fraud and abuse for the restricted-use debit cards, including anti-relapse protections (i.e., purchases at bars, liquor stores, and casinos are blocked).