Particularly at this time of year, many doctors consider providing a gift or other form of remuneration to a patient. Over the years, we have seen that the contemplated gift can come in a variety of forms and amounts. Although the motivation for a gift if well founded, doctors must be careful in their gift giving. There are both state and federal limitations on the nature of gift giving by a physician. In a recent “policy statement, the OIG clarified what gifts to Medicare and Medicaid beneficiaries will be regarded as acceptable.
The policy statement was issues on December 7, 2016 and is designed to address the Civil Monetary Penalties Law (hereinafter, “CMP”) of the Social Security Act. This law imposes civil penalties against a person who offers or transfer remuneration to a Medicare of Medicaid beneficiary when the person offering the gift “knows or should have known” that the gift is likely to influence the beneficiaries decision to select a particular provider, practitioner or supplier of any item or service for which payment maybe made, in whole or in part, by Medicare or Medicaid. “Remuneration” is defined as including various things, including waivers of co payments and deductible amounts;as well as, transfers of items or services for free or for other than fair market value.
This statute has always been interpreted as permitting incentives that are of a “nominal value”. With this recent policy statement, nominal value has been interpreted to mean no more than $15 per item or $75 in aggregate value on an annual basis. Annual basis would be interpreted within a one year period. When applied to items, the giving party would need to interpret the fair market value of the item as being less than the newly stated amounts.
This website has addressed issues similar to this both at the “Ask CL Page” and at the “Resources” section of the website. With regard to the “resources” page, viewers who are seeking more information on the matter can examine the articles under the section for “business operations”.
COMMUNITY.