The US Department of Health and Human Services, Office of Inspector General (OIG) has announced that it is revising its interpretation of “nominal value” for purposes of determining permissible gifts to Medicare beneficiaries. As of Dec. 7, 2016, OIG will interpret “nominal value” to be a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis (as compared to the $10 per item or $50 in the aggregate per patient).
Under the Social Security Act (SSA), section 1128A(a)(5), any person who offers or transfers to a Medicare or Medicaid beneficiary 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 wrong act.
For purposes of this section, the statute defines “remuneration” to include, without limitation, waivers of co payments and deductible amounts and transfers of items or services for free or for other than fair market value. However, Congress expressed its intent that inexpensive gifts of nominal value are permitted. Initially in 2000, OIG determined “inexpensive” or “nominal value” to mean a retail value of no more than $10 per item or $50 in the aggregate per patient on an annual basis, and noted that it would periodically review these limits and adjust them according to inflation. OIG is now adjusting those figures.
To obtain more information go to https://oig.hhs.gov/fraud/docs/alertsandbulletins/OIG-Policy-Statement-Gifts-of-Nominal-Value.pdf.