Timothy M. O’Shea, Acting United States Attorney for the Western District of Wisconsin; Richard G. Frohling, Acting United States Attorney for the Eastern District of Wisconsin; Lamont Pugh III, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General – Chicago Region (HHS-OIG); and Karen Timberlake, Secretary-designee of the Wisconsin Department of Health Services, advise the public that they should not be asked to pay any costs to receive the COVID-19 vaccine and warn COVID-19 vaccination providers not to seek payment from individual COVID-19 vaccine recipients.
COVID-19 vaccination providers participating in the U.S. Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program are required to sign a provider agreement to receive and dispense vaccines. Among the requirements in the agreement, providers must not sell or seek reimbursement for the COVID-19 vaccine or any related supplies and must administer the vaccine regardless of the recipient’s ability to pay. While providers may seek appropriate reimbursement from a public benefit program or private insurance program or plan that covers COVID-19 vaccine administration fees, providers may not seek any reimbursement from the vaccine recipient.
Providers may also seek reimbursement from the Health Resources and Services Administration’s (HRSA) COVID-19 Uninsured Program for the costs of administering COVID-19 vaccines to uninsured recipients, or from the HSRA Coverage Assistance Fund (CAF) for the costs of administering COVID-19 vaccines to recipients whose health insurance does not cover vaccine administration fees.
Noncompliance with the terms of the CDC Provider Agreement, such as by billing vaccine recipients for the COVID-19 vaccine or its administration, including co-pays, or denying an individual a vaccination because they are unable to pay any out-of-pocket costs, may result in the provider’s suspension or termination from the CDC COVID-19 Vaccination Program and potential criminal and civil penalties.
“Providers cannot charge anyone to get the COVID-19 vaccine or deny anyone from getting the vaccine if they are uninsured or underinsured – adding unlawful charges creates barriers, especially for persons of limited means, and undermines public health and safety,” said Acting U.S. Attorney O’Shea. “Non-compliance with the CDC Provider Agreement’s requirements may result in federal criminal or civil penalties, including but not limited to those set forth in the False Claims Act.”
“Along with our federal, state, and local partners, the Department of Justice is committed to using all available tools to ensure that no one is charged for access to the COVID-19 vaccine,” said Acting U.S. Attorney Frohling.
“Providers need to be on notice that the COVID-19 pandemic should not be exploited as a money-making opportunity by inappropriately charging beneficiaries for the administration of available vaccines,” said Lamont Pugh III, Special Agent in Charge, HHS-OIG – Chicago Region. “The OIG and its law enforcement partners will continue to support the unprecedented COVID-19 public health effort by holding accountable people who attempt to inappropriately profit from the pandemic.”
“COVID-19 vaccines are safe, effective, and free for everyone 12 years old and up across our state,” said Secretary-designee Timberlake. “We stand with our federal partners in our commitment to making sure everyone in Wisconsin can get vaccinated without worrying about what they may have to pay.”
If you know or suspect that any healthcare provider, healthcare facility, vaccination site, or pharmacy is improperly charging any costs for the COVID-19 vaccine, please report such conduct to the federal government or call 1-800-MEDICARE (1-800-633-4227), or TTY/TTD users can call 1-877-486-2048. Complaints may also be submitted to the State of Wisconsin at [email protected] or call 844-684-1064.