Trial Tax Compliance: The Burden & The Barrier

As clinical trials expand across geographies and patient populations, tax compliance has become one of the most complex parts of trial operations. Sites and sponsors are expected to navigate evolving tax regulations, country-specific requirements, and shifting reporting thresholds, all while managing participant payments accurately and on time. When tax compliance is mishandled, it becomes a significant operational risk and a source of confusion for both research teams and participants.

Then there’s the overwhelming stress some participants feel around tax reporting. For the millions of people living in the US who rely on public assistance, trial payments labeled as taxable income have reporting requirements that can threaten eligibility for programs like SNAP (food stamps) and Medicaid. The threat of losing the benefits they need deters participants from enrolling in a trial, or leads them to drop out ahead of reaching the reporting threshold. As a result, low-income groups remain severely underrepresented in clinical research.

Our Long-Term Goal: No Tax on Participant Compensation 

Clinical trial participants will only be free from worrying about tax reporting when compensation is no longer treated as taxable income. It’s the future we’re working toward — and we won’t stop until we get there. 

In 2024, Mural Health introduced The Harley Jacobsen Act (H.R. 7418) to Congress, co-sponsored by Pennsylvania Congressional leaders Mike Kelley and Chrissy Houlahan. The bill seeks to exclude all payments to all participants in all clinical trials from being treated as taxable income.

Other legislative efforts are making progress, too. In 2026, the tax reporting threshold for 1099 forms was increased from $600 to $2,000, helping mitigate the initial fear participants experience when asked to provide tax information to a clinical trial vendor — that fear of losing public assistance.

Our Short-Term Solution: Minimize Tax Exposure and Take on Global Compliance When We Need To

Until tax-free clinical trial compensation is the standard, we built a centralized payment model that ensures fair pay and minimal out of pocket expenses for participants, while reducing tax complexity for sites and sponsors. 

Through this model, we don’t just facilitate participant payments — we become the payer. We assume full responsibility for payment structure, distribution, and tax obligation globally so sponsors and sites don’t have to. 

“Tax compliance is the responsibility no one wants to take on. Most participant management solutions prefer avoiding it and letting sites handle it. That’s not our approach,” said Sam Whitaker, CEO of Mural Health. “Participants should never be taxed. But until that changes, we’re purposefully built to own all compliance obligations.”

How Mural Health Takes on Tax Compliance Completely

1. We help sponsors develop payment policies that reduce tax exposure

The decisions made around participant payment structures can shape trial outcomes long before a study begins. Being deliberate about compensation begins with understanding the tax implications. We work directly with sponsors to define and co-develop the appropriate payment structure for each trial, embedding tax considerations into the design and managing global distribution to participants. Because we sit closest to the payment, Mural Health is fully liable for participant tax management across regions.

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2. We assess relevant taxable income (if any) and handle TIN collection

At the start of each trial, our team reviews the payment policies to assess whether tax reporting applies. To ensure we’re making participants financially whole, we minimize out-of-pocket expenses and tax exposure by prioritizing direct payments and reimbursement of clinical trial-related costs — which, unlike stipends, are not taxable income and do not require tax reporting by the payer. 

When reimbursements are prioritized, most trials avoid exceeding the $2,000 reporting threshold, and reporting isn’t needed. In cases where it’s still required, we act as the payer, collecting tax information and managing reporting obligations as needed.

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3. We’re global and we manage all country-specific tax compliance

We handle tax reporting globally. In most non-US countries where we don’t have a legal presence, tax reporting obligations are limited. In cases where reporting is required, we work with local tax advisors in the different countries we serve to assess jurisdiction-specific tax exposure and compliance needs. 

Through a recent expansion of global payments within Mural Link, we also offer local payment solutions like mobile wallets and local bank transfers, which eliminate cross-border transactions and any associated tax requirements.

Give Us the Burden, Break Down the Barrier

Until participant compensation is fully tax-free, trials need solutions that remove the barrier from participants and the burden from sites and sponsors.

By minimizing tax exposure and fully managing compliance when it’s required, Mural Health is that solution — helping trials enroll more representative populations while freeing site operators from one of the most complex and time-consuming aspects of participant payments.

If you’re ready to remove tax compliance from your trial operations, we’re ready to help.