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OIG Issues Policy Statement Regarding Gifts of Nominal Value to Medicare and Medicaid Beneficiaries

The OIG issued a Policy Statement regarding Gifts of Nominal Value to Medicare and Medicaid Beneficiaries.
Under section 1128A(a)(5) of the Social Security Act (the Act), enacted as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a person who offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of Medicare or Medicaid payable items or services may be liable for civil monetary penalties (CMPs) of up to $10,000 for each wrongful act. For purposes of section 1128A(a)(5) of the Act, the statute defines “remuneration” to include, without limitation, waivers of copayments and deductible amounts (or any part thereof) and transfers of items or services for free or for other than fair market value. The statute and implementing regulations contain a limited number of exceptions.

Prior to issuing this Special Advisory Bulletin, the OIG interpreted the prohibition to permit Medicare or Medicaid providers to offer beneficiaries inexpensive gifts (other than cash or cash equivalents) or services without violating the statute in a 2002 Special Advisory Bulletin.  For enforcement purposes, inexpensive gifts or services were said to be those that have a retail value of no more than $10 individually, and no more than $50 in the aggregate annually per patient.

The OIG believes the figures from 2000 should be adjusted. Thus, as of the date above, the OIG are now interpreting “nominal value” as having a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis. Consistent with previous interpretation, the items may not be cash or cash equivalents. If a gift has a value at or below these thresholds, then the gift need not fit into an exception to section 1128A(a)(5).

The OIG will continue to monitor these thresholds and will announce any future increases, if appropriate.

The accompanying guidance can be found using this link, https://oig.hhs.gov/fraud/docs/alertsandbulletins/OIG-Policy-Statement-Gifts-of-Nominal-Value.pdf

 

For more information about this topic, please contact Adrienne Dresevic, Esq. at (248) 996- 8510 or by email at adresevic@thehlp.com

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