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Question: In a recent column on how to screen job applicants for fraud and abuse violations, G. Michael Barton, SPHR, corporate vice president of human resources at Regional Medical Center in Madisonville, KY, suggested asking applicants if they knew when it was appropriate to accept gifts and gratuities from patients, vendors, or others. (See Healthcare Risk Management, May 1998, pp. 58-60.) The implied answer was "never," but what are the risk management implications?
Answer: This might seem to be purely an ethical issue at first glance, but there are serious risk management issues involved, Barton says. Accept ing gifts and gratuities could constitute a corporate compliance violation. Any type of tipping or gratuity is inappropriate in a health care setting, he says. Even if it is just a vase of flowers or a movie pass intended purely as a personal thank-you, it can leave the impression that health care workers expect gifts and respond with better care. "Someone can say their neighbor gave Nurse Sally some tickets and got great care, but I can't afford to give her a gift and she was rude to me," he says. "It's not so much that the nurse really would react that way, but that others can get that impression."
The gift becomes a compliance issue when it appears the patient is using it as a payment beyond the standard fee. Barton says his position might seem overly strict but that attitude is necessary when enforcing a corporate compliance program in today's investigation-prone health care environment. "If someone misinterprets the nature of a gift or is just looking for an excuse to make a report to the government, you could be reported to the Department of Justice. With all these agents looking for a reason to keep their jobs, they're going to follow up on any complaint. And if they get inside your facility on this complaint, do you really want them looking around at other things?"
Barton advises having a simple but firm corporate policy on gifts and gratuities: Individuals may not accept gifts with any material value, no matter how small. That includes flowers, movie passes, concert tickets, clothing, and similar items. A thank-you letter is fine, and it's usually OK for a patient or vendor to send a gift to an entire department or unit. Flowers delivered to a nursing unit are acceptable, for instance, mainly because it is nearly impossible to stop them from coming.
The corporate policy on gifts and gratuities should be explained to staff and physicians as part of the corporate compliance program. They should be encouraged to politely refuse such items, and if a gift is delivered without the chance to say no, it should be turned over to human resources or corporate compliance. Representatives there can explain the policy to the giver and offer alternatives, such as donating the item to charity and sending the staff a thank-you letter.