Frontline Facts: Are doctors paid per vaccine jab?

Childhood shots

A viral meme entitled, “This is why your doctor gets aggressive,” claims that doctors receive $400 kickbacks from insurance companies for each baby they fully vaccinate, but stand to lose the entire bonus if the percentage of parents refusing to fully vaccinate their babies exceeds 37%. In this scenario, parents who want to delay or avoid childhood vaccinations are not seen as merely causing doctors to lose a potential $400, but as imperiling their chance to make tens of thousands of dollars should they miss their quota.

39 doses by 2nd birthday

The incentive for “fully vaccinating” children by 24 months of age is difficult to earn as the current CDC schedule calls for 29 vaccinations by then, as seen in this chart from the health care organization HealthPartners: 

Of those 29 jabs, five are DTap and MMR multiple vaccine shots, bringing the actual total number of vaccines scheduled in the first two years to 39. Healthcare workers offer multiple “make up shots” at one time, though, to get babies “caught up.” This way, even children who miss many of their vaccination appointments are caught up by their second birthday.

Fake?

The AP attacked the claim that doctors receive $400 bonuses reaching some $40,000 per year, for getting those 39 vaccines into a baby on time. Yet, while determining the claim to be “false,” they clarify that their objection is just that it's not one price scheme for the entire nation. 

CLAIM: Blue Cross Blue Shield pays doctors a $40,000 bonus for administering childhood immunizations to at least 100 patients under 2 years old and an $80,000 bonus for vaccinating 200 children.

AP’S ASSESSMENT: False. Blue Cross Blue Shield Association is a national federation of more than three dozen locally operated companies, and doesn’t offer such an incentive across the board . . .  [Emphases added].

The AP went on to say that the $400 bonus and 63% benchmark are in fact the exact figures for the incentives offered in Michigan.

The document that blog post referred to was a 2016 edition of a Performance Recognition Program specifically for the Blue Cross Blue Shield Blue Care Network of Michigan. In a table titled “Quality Incentive Measures,” the program lays out that doctors who meet 63% of their plan goal for childhood immunizations receive a $400 payout. [Emphasis added].

The only real correction offered by the AP was that the doctors were not as successful as assumed in getting all those shots in the babies' arms. The payouts in 2016, in Michigan, topped out at $9,600. At $400 each, that translates to just 24 fully vaccinated babies.

COVID jabs

Dr. Robert Malone, an inventor of mRNA vaccine technology, revealed a similar, but even more rewarding, incentive program that was quietly provided to physicians to push mRNA injections. The program provides physicians with some $380,000 annually based on an average of 1,800 unique patient visits per year per medical practice. 

This scheme uses an even higher vaccination rate than the childhood vaccine program. To receive the full bonus, 75% of patients at a practice must receive a minimum of one dose. Doctors may, however, receive a partial annual payment of some $75,000 that is not subject to a minimum overall vaccination rate. In this way, even doctors who realize that they are not likely to meet the 75% requirement are incentivized to continue pushing the mRNA injections throughout the year.

Dr. Malone listed the average amounts he expects to be earned according to each of the payment schemes:

  • $75,000 for payments per dose with no minimum vaccination rate
  • $168,750 for payments per dose when meeting the target vaccination rate
  • $138,375 for payments for new patients when meeting the target vaccination rate

Fake?

Before Dr. Malone published his article, USA Today challenged the claim that physicians receive bonuses for administering COVID jabs. Even as they cast doubt on the claim, though, they admitted that it's true, and simply noted that vaccinations are not the only thing for which doctors are given bonuses: 

In an attempt to cast doubt on the safety and efficacy of COVID-19 vaccines, some online users are claiming pediatricians are paid a bonus by Blue Cross Blue Shield based on the percentage of patients they vaccinate. . . .

Our rating: Missing context

Based on our research, we rate MISSING CONTEXT the claim that Blue Cross Blue Shield pays doctors bonuses based on the number of patients vaccinated. Providers receive bonuses for overall performance and service, which can include vaccinations. [Emphases added].

Proof

To remove any doubt, Dr. Malone provided a link to a webpage of Anthem Blue Cross and Blue Shield Medicaid (Anthem), in Kentucky, documenting a payment of $50 per vaccination throughout 2021 and 2022 in that state, as seen in this screenshot: 

Dr. Malone says that this $50 payment is not contingent on a minimum vaccination rate for the overall practice and that the payment is per dose, meaning that each patient could earn $200 or more for their physician. 

Additional payments are calculated on a graduated scale beginning with a benchmark vaccination rate of 30% which brings the per dose payment up from $50 to $70. At the highest vaccination rate, 75%, the $50 payment becomes $175.  

First-timers worth more

Yet another incentive is offered for each “newly vaccinated” person, topping off at an additional $250 per patient, meaning that with a 75% vaccination rate, each person getting their first, second and third shots would earn the doctor $175 for each of the three doses plus an additional $250 for a total of $775.

Verdict: True

The claim that doctors receive bonus payments from insurance companies on a per baby or per person basis and that some of the payments are subject to a minimum vaccination rate for the children in their practice is true. Those posting these facts are not privy to actual payment amounts and some have overestimated the total annual payments to the physicians, but the per person amounts offered and the benchmark vaccination rates are accurate in at least some states.

Whose money?

It is normally in the interest of health insurance companies to have doctors prescribe less drugs and vaccinations, not more, as they must pay some or all of the costs of those drugs. Why then do they incentivize doctors to administer more vaccinations? 

The only way insurance companies could profit from more vaccinations would be if the government reimbursed them more than the combined costs to the insurance companies of purchasing the vaccinations and paying the bonuses. Dr. Malone confirms that this is exactly the case with COVID vaccines, as the money, which originates with the federal government, covers the costs of the vaccinations, the physicians' bonuses and the profit of the insurance companies. It is, therefore, tax dollars that are being passed from the government to the insurance companies to the doctors:

The government paid insurance companies, who then would reimburse providers. The amount of money for this program is staggering, although the government has not made the individual distribution amounts of insurance companies, pharmacies, etc. public. Most likely, it will take a FOIA request to obtain specific information . . .

At a per dose cost of $115 for the Pfizer mRNA injection, three doses would cost an insurance company $345. Adding to that the potential $775 in bonuses that a doctor could earn for administering three doses to a person, as listed above, the total cost to the insurance company for that patient's COVID shots would be $1,120. The insurance company, therefore, only begins profiting from the COVID shots, for a person getting their first three shots, when the government offers more than $1,120. As Dr. Malone wrote, we may have to wait for a response to an FOIA request to find out how much more than $1,120 the government gave.

Which side is corrupt?

One might expect that such monetary incentives would put doctors in the spot light for pushing drugs when they have a conflict of interest involving those very drugs. But those who resist mRNA vaccinations are often the ones accused of being in it for the money.

The Center for Countering Digital Hate, for example, claimed, "With the anti-vaxxers, they're in it for the dollars." That might come as a surprise to those who lost their jobs for speaking out against the jabs. One X user reposted the attack with the question, “Who needs a laugh?”

See our previous COVID and NIH coverage: 

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