Are Doctors Scamming Healthcare Systems?

Physicians in every state are required to earn a certain number of Continuing Medical Education credits (CME) annually to renew their medical licenses and stay on top of their practice. This has created a multi-billion dollar market for medical educators offering training to meet these regulation requirements, as well as cutting-edge learning opportunities that make a significant difference in patient outcomes.

Healthcare systems, including the Veterans Health Administration, provide CME allowances as an employee perk, in order to take advantage of these opportunities. Many may be scamming the healthcare system out of money earmarked for continuing education in return for gift cards to Amazon, Apple, and other major brands.

How the CME Gift Card Graft Works

The average CME reimbursement ranges between $1,500 and $5,000 annually. Previously, these funds were largely used for in-person conferences, but with COVID limiting travel, dubious education providers have rushed to allow doctors to “Spend Your CME allowance”. The companies in question offer CME for a year, then reimburses purchasers with a gift card amounting to 50% or more of their initial payment. The physician then turns in the original receipt and can pocket the gift card.

Sites like BoardVitals.com show smiling faces of doctors holding Amazon and Visa gift cards as they purchase two-year CME subscriptions for $5,450, while pocketing $3,000 gift cards in return, effectively laundering their CME allowance.

VisualDx uses gift cards to entice doctors and promotes that the gift card amount will not appear on the receipt. One can easily understand why a doctor may prefer to keep the gift card amount off the receipt, as it could potentially raise questions from a healthcare system if they were to be used for reimbursement.

These sites make it easy for doctors to potentially scam their employers by employing the following 3-step process:

Choose a medical specialty: Choose a medical speciality like anesthesiology, dermatology, radiology, etc
Select Budget: Physicians enter their CME reimbursement amount.
Pick a Gift Card: Physicians can choose between an Amazon and Visa gift card worth the value of their allowance less the annual CME subscription.

It's so prevalent and lucrative that companies offering CME are willing to bid more than $100 for a single click on Google. Physicians, online ad networks, shady “medical educators”, and even Amazon all stand to profit from the CME allowances.

Who doesn’t? In my opinion, the healthcare systems that ultimately pay the price and the patients receiving a lower standard of care because their physicians spent their CME allowance on Amazon instead of medical education.

According to Google Keyword Planner, many physicians are actively searching for Continuing Medical Education (CME) with offers for gift cards. The high volume of searches has created intense competition, with online Continuing Medical Education companies spending over $100 per click on Google to attract customers and profit from CME allowances.

This post on Reddit by a Physician Assistant suggests that some healthcare systems are cracking down on gift card incentives by reimbursing only the actual cost of the CME course, excluding the gift card amount.

This Reddit post reveals a concerning trend among some medical professionals who are seeking ways to take advantage of gift card promotions offered by CME providers by sneaking it past their healthcare systems expense system.

However, the response by another user encouraging the use of Photoshop to alter receipts is particularly alarming, as it suggests that some medical professionals are actively engaging in fraudulent activities to take advantage of CME allowances. This behavior not only goes against the American Medical Association's Code of Ethics but also undermines the trust and integrity of the medical profession.

What Should Happen Next

I believe that there are many physicians who are intentionally deceiving healthcare systems to receive extracurricular benefits from continuing medical education and something needs to be done about it.

Here are the six solutions:

Gift Card Issuers: Amazon, Visa, and other brands who issue gift cards should discontinue enabling CME Providers to offer gift cards to doctors in exchange for their CME Allowances.
Google: It violates Google Ad's’ policies to enable dishonest behavior. Health Educators should no longer be permitted to target ads for doctors seeking gift cards with their continuing medical education allowances.
Inspector General: The Office of the Inspector General needs to investigate government healthcare systems that employ physicians (Indian Health Service, Veterans Health Administration, Federal Prison System, etc.) and reimburse them for continuing medical education.
IRS: The IRS should formally investigate BoardVitals.com and all other “medical education” providers that openly offer these promotions to see which physicians received gift cards but failed to claim them on their tax returns. Any audits done on physicians in a normal year should examine “Medical Education” deductions to identify CME vendors, and assess unreported gift card income.
Healthcare Systems: Should continue to offer reimbursement to doctors for continuing education, but should audit doctors for receipts from any CME provider who has been identified as one that offers gift cards in addition to CME.
Accreditation Bodies: The American Association of Continuing Medical Education (AACMET), American Medical Association (AMA), and the Accreditation Council for Continuing Medical Education (ACCME) should immediately remove the accreditation of providers who offer gift cards.

I've put together a spreadsheet of continuing medical education providers who offer gift cards in exchange for CME allowances. It can be used by healthcare systems, government agencies, and accreditation bodies to investigate fraudulent reimbursement that may be occurring.

Each record includes the cost of a 1-year or 2-year CME subscription. Any expense report submitted above those rates needs to be scrutinized. You can also contribute to this sheet by submitting this form.

Creating a Better Healthcare Education System

Today's rapid pace of medical innovation and scientific developments increases the need to share advances with physicians. Knowledge of new treatments, therapies, and standards of care can directly affect patient outcomes.

My father had an advanced form of cancer. He benefited from receiving an immunotherapy treatment researched at Memorial Sloan Kettering, approved and released just a few months ago.

Reimbursing and incentivizing doctors to continue their medical education is critical because every patient deserves access to the best level of care. We must continue to give practitioners up-to-date and viable ways to improve on the patient care they deliver.

The gold ethical standard of medicine is the Hippocratic Oath, written in 400BC. A classic 1849 translation of the oath from Greek text includes that physicians "will abstain from every voluntary act of mischief and corruption." From my perspective, physicians who partake in gift card offers with CME violate the very fundamentals of their profession.

It's time to investigate this further and take action to hold accountable any physician who launders their CME allowance for personal benefit.