OIG rules in favor of grocery store gift cards for non-covered preventive care to Medicare patients

Can a provider offer appropriate gifts to Medicare-age patients without running afoul of HIPAA gift regulations discussed in last week’s post? In an OIG (Office of the Inspector General) opinion dated December 27, 2012, the OIG ruled to allow a specific Health Center the right to offer grocery store gift cards to Medicare age patients. However, it was done on a specific case inquiry made by this one particular Health Center. All exceptions to the rule must petition the OIG or there may be legal ramifications. Below is the legal rationale. If you wish to offer such gifts to Medicare-age patients, contact the OIG with specific inquiries.

The CMP (Civil Monetary Penalty) contains an exception for incentives given to individuals to promote the delivery of preventive care. See section 1128A(i)(6)(D) of the Act. The applicable regulations exclude from the definition of “remuneration” incentives “given to individuals to promote the delivery of preventive care services where the delivery of such services is not tied (directly or indirectly) to the provision of other services reimbursed in whole or in part by Medicare or an applicable State health care program.” See 42 C.F.R. § 1003.101. The regulations define “preventive care” to mean any service that “(1) [i]s a prenatal service or post-natal well-baby visit or is a specific clinical service described in the current U.S. Preventive Services Task Force’s Guide to Clinical Preventive Services [(the “Guide”)], and (2) [i]s reimbursable in whole or in part by Medicare or an applicable State health care program.” Id.

See also https://www.healthlawpolicymatters.com/2013/01/09/oig-approves-gift-cards-to-encourage-clinical-visits-to-health-center/