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It’s December, which means the holidays are here—and this typically is the time of year that our thoughts turn to gift-giving. We’ve talked about this before, but I thought this would be a good opportunity to remind you of a few considerations to keep in mind as you give gifts to employees, patients, referring physicians, and other providers.

As we’ve discussed in the past, when giving gifts to referral sources, the primary area of concern is the Anti-Kickback Statute (AKS). That’s because this statute has a broad definition of who is considered a referral source. AKS prohibits providers from offering any type of enticement with the intent of generating Medicare patient referrals. Per AKS, anyone who refers a Medicare patient to your clinic can be considered a referral source, especially if you have given that person an incentive—such as a gift—for making those referrals. And keep in mind that referral sources don’t necessarily have to be healthcare providers; patients can act as referral sources, too. So, if you’re rewarding patients for referring other patients to your practice—and those other patients happen to have Medicare—then you could potentially be in violation of AKS unless you follow a set of specific gift-giving guidelines, as outlined below.

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Office of Inspector General (OIG) Guidelines for Gifts

The OIG has been consistent in its guidance on providing gifts to potential referral sources:

  • No more than $10 per gift
  • No more than $50 in aggregate over the course of a calendar year

If you follow the above rules, you will be fairly safe. The key is to maintain documentation that proves you have adhered to these guidelines.

A final word on AKS: Many states have their own AKS laws, and it’s your responsibility to know the laws for your state. Here’s a link to find out more about state laws.

Patient Gifts to Employees

Here’s a little twist on our theme today: this time of year, patients often like to give gifts to their therapists to express gratitude for the care they’ve received. To avoid compliance issues, I recommend establishing a written policy to guide employees on how to handle these situations. Here are some examples of rules to include in such a policy:

  • Employees may not accept personal gifts such as jewelry or clothing.
  • Employees may accept food gifts as long as they share those gifts with all employees.
  • If a patient wants to give cash, employees should ask the patient to donate the amount to the charity his or her choice. (You also have the option of providing patients with a list of preferred charities.)

If you don’t want to worry about enforcing this type of policy, you may simply want to implement a blanket policy that the clinic and its employees do not accept gifts. In any case, be sure to encourage employees to ask questions when they are unsure about whether they should accept certain gifts.


The holidays should be a time for joy and cheer—not legal violations and fines. So, be mindful of how your clinic gives and receives gifts, implement the proper processes and policies in advance, and know the laws that apply to you. And above all, have a wonderful holiday season and a happy new year!

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