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Ericka L. Adler, JD, LLM has practiced in the area of regulatory and transactional healthcare law for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.
This time of year, there are a lot of inquiries about physicians receiving gifts from patients. Here’s some guidance.
I receive many questions this time of year regarding physicians receiving gifts from patients. When responding to these inquiries, I typically consider the following:
1. What is the reason behind the gift?
When a patient gives a gift, it can be part of their routine of gifting everyone which includes their doctor, their hairdresser, and the paper delivery person. It can be to show appreciation for the care provided by the physician to the patient or a family member. Sometimes, however, the gift can be intended to create a closer personal relationship with the physician for the purpose of obtaining special treatment, such as a quicker appointment, additional attention, or access to other practice benefits. It’s important to understand the intent of the gift in determining how best to handle it. It’s also important for physicians to understand if and how they may treat patients differently who do provide a holiday gift.
2. What gifts are appropriate?
Among my clients, the most common gifts appear to be cards, baked treats, chocolates, or fruit baskets. Sometimes a homemade item or book may be given. Items of small or no value do not typically create too much concern, especially when they are holiday-specific (fruitcake anyone?). Gifts which are more expensive such as sports tickets, silk scarves, or electronic items may require a closer examination regarding appropriateness and intent of the patient. My one personal rule for my clients is that cash and cash cards are not appropriate (I know some people disagree). Likewise, most physicians would find lingerie or other personal items to also be inappropriate. How do you feel about a certificate for a massage or a bottle of wine?
3. Should you have a policy of NOT accepting gifts?
Every practice should put into place a policy of giving and accepting gifts with which it is comfortable. If a practice does not desire to assess the nature and intent of gifts received (should an issue arise), a policy of accepting cards only may be appropriate. Perhaps only baked goods or gifts under $10 may be permitted? Some practices choose to direct patients who desire to give gifts to make donations instead to a charity related to the physician’s specialty (breast cancer, diabetes, etc.). One practice I work with encourages patients to donate blood as a holiday gift! Whichever approach is taken, make the practice’s policy clear to physicians and patients. Keep in mind that even with a “no gift” policy, there will always be patients who still send gifts. Make sure your policy includes a procedure for returning and/or responding to such outliers.
4. Is it ever wrong to refuse a gift?
Many people were raised to believe it’s rude to refuse a gift and will accept the gift, no matter what it is, perhaps donating it if appropriate. Some physicians have suggested that refusing a gift can hurt the physician-patient relationship, if the patient feels rejected. This may depend on the type of patient relationship involved (i.e., patient-therapist) as well as how any rejection is handled. Of course, every practice and specialty needs to assess its policy in light of its specific patient population. Sometimes exceptions may be necessary and advisable.
It’s also important to remember that, at any time of year, a physician’s relationship with a patient must at all time remain professional. The key is to make sure that personal gifts and those of value (or both) are not an indication of inappropriate feelings or intent on the part of either party. You might be surprised how often gift-giving from some patients can reflect improper emotions or attachment by a patient, rather than just sincere appreciation. If this does occur, it is something that needs to be properly addressed.
Finally, if you are thinking of giving gifts to referral sources or patients, see my earlier blog on this topic for the legal limitations.
Hopefully the holidays are a happy time for all.
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