Is the OIG coming after you?


The OIG (Office of Inspector General) issued what we consider fair warning on their position regarding Medicaid patients and marketing tactics.  We are often asked about the practice of hiring marketers and providing incentives to get Medicaid patients to come into the office. We always advise against it, and it turns out those who heeded that warning will be happy about that in the coming months.


We are aware that Medicaid allows for gifts of under $10 to be given, however, the way the policy is written and the way the policy is enforced are often two different matters. Medicaid or HHSC is not the only agency that generates complaints and investigates "issues." Other agencies and other legislation prohibit referral fees and kickbacks. So, don't rely just on what the Medicaid provider manuals tell you. There are many other considerations and rules out there governing what you do. As an aside, this is coming from the Texas OIG office, however, this is something to watch for in other states as well. As "Obamacare" is rolled out, the issues will increase in the area of marketing to new patients. 


The OIG is asking patients to report you if you hire marketers to get them to come into the office. The OIG is also asking them to report improper treatment of themselves or their children. The following is what is appearing on their website and in mass e-mails coming from the OIG's office:


"Consumers Urged to Report Improper Solicitation or Treatment by Dentists

The HHSC Office of Inspector General has become aware of dental clinics directly soliciting Medicaid clients. People hired by dental clinics have approached HHSC clients in the parking lots of state benefit offices or neighborhood grocery stores offering a variety of incentives, including free gift cards, pizzas, and manicures, in exchange for taking their children to a specific dentist or clinic.


Offering inducements to Medicaid clients is a violation of state and federal law and is subject to a penalty of up to $10,000 per violation.  In addition, some dentists are believed to have performed unnecessary dental work on children." The notice goes on to ask patients to turn their dentists in to the OIG or state board. This is scary stuff for Medicaid providers.


So what can you do? Refrain from hiring those marketers and implementing programs without carefully vetting them against all the rules. We recommend against looking for loopholes. The thing about loopholes (or perceived loophole) is that they can end up tightening around your neck. 


Try this: Get your talented staff in a room and start brainstorming ways to think about marketing in a creative way! Think outside the box. Think about the purpose of the Medicaid program and find a way to reach potential clients that way. Then make sure you run your plans by someone who knows the rules and has your back. If you use a third party to do your marketing- be careful of their advice. We have found many of them think they are following the rules, but are not. You are the only one liable for any rule breaking. We are hosting some marketing classes that will help you navigate the treacherous waters of Medicaid marketing. Keep an eye on our EVENTS page!


And as always, call us if you have any questions about your marketing program.