The Office of Inspector General (OIG), U.S. Department of Health and Human Services, in August 2002 released a special advisory bulletin, titled " Offering Gifts and Other Inducements to Beneficiaries " ( PDF ). The bulletin clarifies that offers of "remuneration" (gifts) to Medicare or Medicaid beneficiaries, including a waiver of copayment and/or deductible and providing services free of charge, are prohibited - and subject to a civil penalty of up to $10,000 - if the offer is likely to influence the beneficiary's choice of covered services or items.
The OIG follows these guidelines regarding gifts or inducements to Medicare or Medicaid patients:
- Physicians providing Medicare and Medicaid services can give beneficiaries inexpensive gifts or services (other than cash or cash equivalents), defined as having a retail value of no more than $10 individually, for a maximum of $50 per patient annually.
- Physicians may give Medicare and Medicaid patients more expensive items and services that fall within one of five statutory exceptions: waivers of cost-sharing amount based on financial need, properly disclosed copayment differentials in health plans, incentives to promote the delivery of certain preventive services, any practice permitted under the federal antikickback statute, or waivers of hospital outpatient copayments in excess of the minimum copayment amounts.
- The OIG is considering allowing complimentary local transportation and free goods in connection with certain clinical studies.
- The OIG will continue to entertain requests for advisory opinions relating to gifts or inducements to beneficiaries. Expect favorable opinions to be limited to a narrow scope of interpretation.
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Last Updated On
May 13, 2016