Podcast

Dec 4, 2025

Roetzel HealthLaw HotSpot: Holiday Gifts in Health Care: Are You Breaking the Rules?

On this episode of the HealthLaw Hotspot, host Ericka Adler is joined by Roetzel shareholder Christina Kuta to break down what health care providers need to know about holiday gift giving. They explain how federal and state laws apply, what’s considered low risk, and how to avoid unintentionally violating kickback rules when showing appreciation to patients, vendors or referral sources.

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Transcript

Ericka Adler:
Hi, everyone. Welcome to the Health Law Hotspot. I'm Erica Adler, shareholder and leader of the health care practice of Roetzel & Andress. I'm joined by Christina Kuta, also shareholder and member of our health care practice, and today we're going to talk about something that comes up every year, and we've probably done this podcast several times, but it is such a hot topic that we want to do it again, which is gift-giving, especially around holiday times. What can practices do? What can't practices do? What should you give your referral sources? What shouldn't you accept from those to whom you refer? We want to answer all these questions and give you a little guidance if you're thinking about what you're going to be doing to help celebrate the holidays. So, Christina, jump right in and tell us what kind of laws are we talking about that provide guidance on this topic?

Christina Kuta:
Sure. So as you said, it's holiday time, it comes up every year. You want to show tokens of appreciation, right? To your patients, vendors you work with, people you generate business with, and unfortunately, once again, this is an area where everybody does it, but if you're in health care, you gotta worry about it.

So, there are federal and state laws that impact this. The first one is really kind of the biggest one, which is the anti-kickback statute. The anti-kickback statute’s a federal law that says you can't give or receive anything of value related to referrals or generating business to or from another individual or entity.

It applies to everybody. So, I can't violate the anti-kickback statute, you can't violate the anti-kickback statute, even though we're not providers, it still applies to us.

Under the kickback statute, when you're thinking of giving items to people who are patients who could come back to you for services, and these services are payable under any federal health care program (Medicare, Medicaid, TRICARE, Department of Labor patients) you've got to be concerned.

If you're going to give something to a vendor or give something to a referral source, maybe you're a gastroenterology practice with a primary care practice on the third floor of your office building, and they refer a lot of patients to you. Maybe you want to show a token of appreciation. That’s okay, but the kickback statute makes you do it meeting certain requirements.

Ericka Adler:
Okay, great. So what are the limitations you should be thinking about? So, you're thinking, I want to drop off, you know, coffee to my best referral sources, I want to give bottles of champagne to all my best referral sources, I want to give hockey tickets to all my referral sources. So how do we decide what kind of gift is okay, what isn't, or is it best just not to give any gift at all?

Christina Kuta:
Yeah. So, if we lived in a world where we wanted to do everything with the least amount of risk possible, I'd say don't give anything, don't take anything. And we don't live in that world, right? We want to have some reasonableness.

The kickback statute actually has something they call the de minimis exception. So that’s what I call the 15/75 rule. So, if you give something of value at one time that isn’t more than $15, and not more than $75 in the annual aggregate, you're probably okay, and you meet that de minimis exception.

So, in my example of the primary care practice that refers to a gastroenterology practice, if the gastroenterology practice wants to send a plate of cookies to the primary care practice or, like you said, bring some coffee, you know, that's okay, it probably falls within the de minimis exception.

If they want to treat the entire primary care practice to a really expensive dinner, or take them to the suite at the Blackhawks game (we live in Chicago, that’s our hockey team) or a suite at some other kind of sporting event, that may be seen as problematic, because the kickback statute may view that as potentially trying to buy a referral or buy continuing business.

Same with patients. A lot of practices want to do something, a little token to their patients at the end of the year. If you want to put out candy at the front desk, if you want to give everybody a pen that’s got the practice name on it, things like that, that’s probably fine. But, you know, giving your patients $30 gift cards might be an issue.

Absolutely no cash for anybody. Any referral source, any patient: you can't give or receive anything related to cash. The 15/75 rule for any kickback does not apply to cash. Cash is definitely something you should not be doing.

Ericka Adler:
Okay, so one important thing to note is that not fitting within that de minimis safe harbor does not mean you're in violation of the law. It’s very unlikely somebody’s going to come and ask you to show your receipts. However, there are some things that are a little bit more extravagant than others, so you should use good judgment, and if you're not sure, talk to your lawyer. We give this kind of advice all the time.

What other kinds of laws are out there that we need to be concerned about?

Christina Kuta:
So, there are state laws. Many states have laws similar to the kickback statute, and some relate only to certain types of payors, so they might be just state Medicaid or state-payable services that you need to consider.

There also might be laws that relate to any type of payor. So you can't give or receive anything of value if it's meant to generate referrals for any kind of health care business payable by an insurer, so that could be Blue Cross, Aetna, UnitedHealth care. You've got to look out for those laws.

Also, state practice acts for the particular profession you practice could have disciplinary issues for giving and receiving of gifts or remuneration. So that could even implicate practices that are cash-only. We have an increasing number of practices that are cash-only, they have no ties to insurance. It doesn't mean they couldn't be implicated by giving gifts or receiving gifts under these laws related to their individual practice acts.

Another thing to consider is what the rules are if you work in a hospital, or if you're on a medical staff, if you work in a certain type of facility, if you're employed: what your employer’s rules are. If you're on the staff at an ambulatory surgical center: what those rules are. A lot of times, there are strict internal rules about gift giving and gift receiving, when you have to report to your employer or your facility that you received a gift, note the value of that, and when you can and cannot accept gifts. So you need to make sure you're clear with what those prohibitions might be.

Ericka Adler:
Alright, so now that you're getting ready to celebrate the holidays, what are, kind of, the things that you should be thinking about in terms of the gifts you do end up giving to be on the safe side?

Christina Kuta:
Yeah. So I would say try to stay within de minimis standards if possible, because that takes you out of having to review the intent and do a larger analysis under the kickback statute.

Keep records of the gifts you are sending and what you're receiving. If there's ever a question, you can pull out something that says, hey, this is what I took, or this is what we sent.

Decline gifts where appropriate. If someone wants to send you on a trip, and it may seem odd, but it does happen, or give you and your family a week's stay in a timeshare, those are things you probably should be declining.

Make sure that referrals you make are always based on medical necessity and not influenced by gifts. You know, don’t think to yourself, wow, I got a really nice, maybe, watch or a really expensive bottle of wine last year from X vendor, so I'm going to send all my business to X vendor now. Everything should be done based on medical necessity and what's important for the patient.

And as always, you want to make sure you consult with knowledgeable legal counsel when you're unsure about receiving a gift, or accepting a gift, or setting a policy in your office, which can be important as well.

Ericka Adler:
Right, and I think it's important that even though we’re talking about the holidays, these rules apply year-round. So if you think, you know, I’m not going to do it at the holidays because people are going to notice it too much, I’ll just do it at another time of year, the same rules apply.

And I will say that the way doctors get in trouble for this is a competitor or somebody else complaining or turning them in. So, you know, it's not like you're just going to get randomly audited like you might with the IRS or something. Somebody’s going to make an anonymous phone call because they know that either you're giving or receiving gifts that may be inappropriate.

Christina Kuta:
You just kind of want to be aware of this. So, yeah, in my example of the gastroenterology practice and the primary care practice, it’s the primary care practice on a different floor that didn't get the tickets to the Blackhawks game. “Wait a minute. They're giving them all their business, and they're giving them things to give them all their business. We're getting iced out. That's not legal.” And somebody makes a phone call to the government, and the government, as inefficient as it can be, often follows up on these types of potential kickback complaints.

Ericka Adler:
Yes, I think, you know, in health care people like to turn each other in: a friend, a colleague, a competitor. So just keep that in mind. Don’t brag about anything you do get if you choose to receive it and keep it, right? Even despite our advice.

Alright, well, anything else you want to add?

Christina Kuta:
I will note that there are no rules of which I'm aware that prohibit you from giving your knowledgeable health care lawyer a holiday gift, so if you'd like to give us gifts, we are not prohibited from taking them.

But otherwise, just be mindful of what you're doing, and let common sense rule. You know, if someone gives you a very expensive item who wants business from you, that’s probably not reasonable.

Ericka Adler:
Right?

Alright, well, this has been the Health Law Hotspot. We hope you found this helpful. You can call us with any questions that you have, and you can catch the rest of our podcast at ralaw.com. We'll see you next time.