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OIG advisory bulletin on gifts to Medicaid/Medicare beneficiaries
Pharmacies that offer freebies to Medicare or Medicaid patients better watch out. The practice could get you in trouble with the feds.
The Office of Inspector General issued a special advisory bulletin in late August, warning against the offer of gifts to beneficiaries. OIG explained that remunerating patients so they would select a certain provider could raise healthcare costs or result in lower-quality services. Remuneration could involve waivers of co-pay or the offer of items or services for free or for other than fair market value. Exceptions are inexpensive gifts or services, which are allowed if their retail value does not exceed $10 individually and $50 annually per patient. OIG gave notice that those who violate these constraints might be liable for civil penalties of up to $10,000.
Asked to comment, Daniel Ernsberger, an attorney with Behrend & Ernsberger, P.C., Pittsburgh, said the feds have always been leery of practices steering patients to certain providers. He added that there are also state laws prohibiting bribes or kickbacks in return for patient referrals or other benefits.
The advisory probably won't make too many R.Ph.s lose sleep, said Joseph Lettrich, a pharmacist with QOL Meds in Pittsburgh. The way third parties are squeezing prescription margins these days, he doesn't see how pharmacies can afford to waive their co-pays and still survive, he explained. He noted that one practice that could pose a problem is the offer of a coupon to entice patients to transfer their Rxs from one pharmacy to another. But those coupons are usually for $10safe by OIG standards.
Lettrich added, in chain stores, R.Ph.s usually do what their corporate office orders, since they figure the directives have been checked out by their legal department. He feels it's the independents who don't have benefit of legal counsel or are flying by the seat of their pants who should be extra careful about the new OIG advisory.
Judy Chi. OIG issues warning: Beware of gifts to patients. Drug Topics 2002;18:20.