On April 15, 2021, the Department of Health and Human Services Office of Inspector General (OIG) issued a statement reminding providers that the COVID-19 vaccine must be provided at no cost to the public. OIG issued this message as a result of complaints from patients about charges from providers for receiving the COVID-19 vaccine. All supply of the COVID-19 vaccine in the United States has been purchased by the United States Government and is only to be used by providers through the Centers for Disease Control and Prevention’s (CDC) COVID-19 Vaccination Program. Because the vaccine is being supplied by the federal government, any provider participating in the CDC COVID-19 Vaccination Program must comply with the terms of the program and offer the vaccine to recipients for free.
Providers participating in the CDC COVID-19 Vaccination program must sign a CDC COVID-19 Vaccination Program Provider Agreement. Providers are responsible for compliance with the requirements in the agreement. Compliance with the program requires that providers administer the vaccine at no cost to the patient. All organizations and providers enrolled in the program:
- Must administer the COVID-19 vaccine with no out-of-pocket charges to the patient
- Cannot deny anyone the COVID-19 vaccine because of the recipient’s coverage or network status
- Cannot charge an office visit or other fee to a COVID-19 vaccine recipient if the vaccine was the only medical service provided
- Cannot require other medical services to receive the COVID-19 vaccine
- Must not seek any reimbursement from the patient, including through balance billing
Providers may seek reimbursement for the administration of the vaccine, rather than the purchase of the vaccine, from programs or plans that allow it. Providers that charge improper fees must refund them, and make sure the patient is not charged fees for the COVID-19 vaccine or its administration in the future. Providers may bill third party payers, including Medicare, Medicaid, the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program, or a private insurer, for costs associated with administration of the vaccine. If a patient receives the COVID-19 vaccine but no other medical services, providers may not charge for an office visit or other fees. However, if a patient receives other medical services at the same time as receiving the COVID-19 vaccine, the patient may owe a copayment or deductible for those services.
OIG also emphasized its investigations of COVID-19 related fraud and abuse, including arrangements utilizing telemarketing, text messages, social media platforms, and door-to-door that do not comply with legal and regulatory requirements. OIG has investigated activity related to COVID-19 vaccines, such as, requests for payment in order to receive a vaccine, requests for payment in order to increase eligibility for a vaccine, offers to sell or ship doses of the vaccine for a fee, offers to purchase COVID-19 vaccination record cards with the individual’s personally identifiable information, and payment to participate in a COVID-19 vaccine survey.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in billing federal healthcare programs for COVID-19 vaccine administration reimbursement. If you or your healthcare entity has any questions pertaining to healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.