Addiction Clinic to Motivate Patients With Financial Rewards

There is currently an active complaint case against the Montana clinic, Oxytocin, with the Montana’s Department of Public Health and Human Services and Department of Justice.

A Montana addiction clinic wants to help patients with substance use disorders stay in their program by giving them vouchers and gift cards worth nearly $2,000 each.

The incentive program in Kalispell, Montana, is paid for by a grant from the local government and is only for individuals who remain consistent at the Oxytocin outpatient clinic program.

The Kalispell clinic, called Oxytocin, is not the first to have an incentive-based drug addiction program.

Since 2021, a number of clinics have been opened in California, Washington, and Wisconsin as a result of recent studies showing the overwhelmingly effectiveness of incentive-based drug addiction programs.

Still, doctors and city officials in Montana are worried that the large amounts of money offered through their program might put them in a gray area with federal law.

One of the issues raised about Montana’s Oxytocin program is that the total amounts that may be given to its patients are not well-defined. Though the clinic is government funded, it is outside of the state’s pilot program that happens to have more regulations.

For example, state pilot sites' incentives can't go over $315 total per beneficiary a year.

The federal government doesn’t have a rule limiting the size of financial awards or guidelines detailing best practices, so states and providers make it up as they go along.

Dr. Richard Rawson, Substance Abuse Program specialis

The Kalispell clinic is allowed to use $300,000 of their grant in a 20-week treatment course. During that time, participants could get gift cards or vouchers worth up to $1,966.50.

Patients are able to earn an incentive each week by attending treatment and passing urine tests. The amount they are awarded increases with each success.

These motivational incentives are called contingency management, known to be the only evidence-based intervention for methamphetamine use disorder. Oxytocin was the only clinic in the county approved to use treatment-funded contingency management.

In November, at least one complaint filed with Montana's Department of Public Health and Human Services and Department of Justice claimed Oxytocin was committing Medicaid fraud by paying its clients, most of whom are Medicaid recipients.

In 1972, a federal law called the Anti-Kickback Statute made it illegal to give a federal beneficiary, like a Medicaid recipient, something of value to get them to choose a certain provider.

"Safe harbors" were made to keep some government programs from being seen as corrupt, but they don't usually protect programs like Oxytocin that give incentives to people who use them, according to the U.S. Department of Health and Human Services’ Office of Inspector General.

Tammera Nauts of the Montana Primary Care Association said that providers can legally offer their own rewards program without going through the state. Since Oxytocin is not one of the pilot sites connected to Montana's program, it may get a pass.

Emilee Cantrell, a spokesperson for the Department of Justice, said that the agency's Medicaid fraud unit was working with the health department. She couldn't say more because details about an active complaint are private criminal justice information.

The Oxytocin clinic’s director declined an interview with KHN but expressed in an email, “There is a reason the community stands behind us, and it is not because we do fraudulent things.”