Effective today, the Department of Health and Human Services Office of Inspector General (“OIG”) issued a Policy Statement regarding gifts of nominal value to Medicare and Medicaid Beneficiaries (“Beneficiary(ies)”). In its statement, OIG increased the dollar amount of the “nominal value” exception to the Civil Monetary Penalties law (“CMP”) from $10 per item or service and $50 in the annual aggregate per Beneficiary to $15 per item or service and $75 in the annual aggregate per Beneficiary.
OIG established through previous published guidance that incentives of nominal value may be provided to Beneficiaries without being subject to the CMP.1 OIG noted that it would periodically review these limits and adjust them according to inflation, if appropriate. After 16 years, this marks the first time OIG has made such an adjustment. Consistent with its previous interpretation, OIG noted that the items may not be cash or cash equivalents. Additionally, gifts that are valued at or below these thresholds need not fit into an exception to the CMP.
As a reminder, the CMP prohibits a person from offering or giving something of value to a Beneficiary that such person knows or should know is likely to influence the Beneficiary to order or receive items or services from a particular provider that may be payable by a federal health care program and carries civil monetary penalties of up to $10,000 for each wrongful act. Therefore, to meet the nominal value exception, the value of an incentive (item or service) must be $15 or less, and the benefit to each Beneficiary must not exceed the annual aggregated limit of $75.
Practical Takeaways
- Health care providers should review and adjust their current policies and procedures with respect to providing patients items or services of nominal value.
- Health care providers offering incentives or incentive programs should carefully consider any items or services provided to Beneficiaries in order to ensure that any incentives do not violate the Anti-Kickback Statute or the CMP.
If you have questions or would like additional information about this topic, please contact:
- GinaMarie F. Geheb at (248) 457-7823 or ggeheb@wp.hallrender.com;
- John P. Weber at (248) 457-7816 or jweber@wp.hallrender.com;
- Lisa A. Lucido at (248) 457-7812 or llucido@wp.hallrender.com; or
- Your regular Hall Render attorney.
1The previous values were established in OIG’s Final Rule on the CMP issued in April of 2000 (see 65 FR 24400, 24411 (April 26, 2000)).
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