BUSINESSGift rap: Be careful when handing out holiday largesseIt may be more blessed to give than to receive, but being on either end of the gift can be problematic for physicians.By Cheryl Jackson, amednews staff. Nov. 25, 2002. Holiday gift-giving is fraught with peril -- especially when it involves your staff and colleagues. After all, your family may not like your gift, but they probably won't stop liking you, or ensnare you in an investigation of anti-kickback violations. If you want to give gifts at holiday time to recognize a job well-done, go ahead. But take care that what you're buying, and for whom, strikes the right chord, not only with the recipient, but also with everyone around the recipient. For instance, will your staff resent you if you give one employee a better gift than everyone else? Or, if you're a specialist, will a gift to your friend the internist be seen by others as a potential kickback? And is it a good idea to let a pharmaceutical company or outside vendor pay for your office holiday party? If you're tempted to just bah-humbug the whole gift-giving scene, be advised that may not be the answer either. Consultants say a small gift for employees at holiday time -- even in a rough financial year -- can be a big factor in which physicians get and keep quality employees and which don't. "I strongly encourage [physicians] to find the money someplace. Word spreads very quickly among the health care community who the cheapskates are," said Kate Kocevar, a consultant with the Health Care Group in Plymouth Meeting, Pa. Not surprisingly, staffers generally prefer gifts of money, along with a holiday luncheon, dinner or other social gathering, she said.
A gift can be seen as a kickback.
How much money? The value of the gift should correspond to the length of time the employee has worked with the physician, Kocevar said. "A lot of practices can't afford to give annual raises." she said. "So this way they can say 'We recognize your work ethic to our practice, and we'd like to reward you somehow.' " Fairness is key. The Oregon Medical Group in Eugene gives workers cash bonuses of $50 to $100, but discourages individual physicians from giving individual gifts. Family physician Sylvia Emory, MD, said that practice has been in effect about seven years. Previously, the clinic grapevine had taken note of which doctors were more generous than others, and the disparity caused hard feelings among some staff members. "It ended up being too divisive," Dr. Emory said. Still, doctors there continue to give personal gifts to staff members who work directly with them. Dr. Emory, who makes beaded jewelry, usually gives a present to the assistant who works with her. And she takes some staffers out to lunch. So, you're going to give holiday gifts. Do you withhold employment taxes? The answer depends on the type of gift and its value, according to CCH Inc., a provider of tax and business law information and software. A holiday gift won't be considered wages subject to employment taxes if the gift is of nominal value, such as a fruit basket or ham. Such noncash gifts are provided merely as a means of promoting the goodwill or contentment of employees and are not subject to employment taxes. Gift certificates of nominal amounts may be considered wages subject to employment taxes. But cash gifts are generally considered taxable. The quandary doesn't stop within your practice. Even giving gifts outside of the office can be touchy legally. Under Stark laws regulating referral patterns, gifts could be viewed as inducements or incentives to refer patients. "I'd be very leery of providing gifts to referrals because of Stark issues, and very leery of accepting," said Philadelphia health care attorney Alice Gosfield. "What's the likelihood that the government is going to go after the cardiologist who gives physicians a bottle of Jack Daniels? Not great," she said. "The real concern is not the occasional Christmas gift, but if there's another reason for the government to be looking at you. If these kinds of relationships exist, it can make you look worse." Gosfield said there are three questions a physician might want to ask before giving anyone any gift: "Would you want this on the front page of the newspaper? "What kind of a snapshot should an overzealous prosecutor make of this story to a jury of 12 people who haven't graduated from high school? "If you told your mom, what would she think?" Paul Risner, a health care attorney with Akerman Senterfitt in Orlando, Fla., said it's easier to simply stick to a card for conveying appreciation for referring physicians. "We generally encourage physicians not to appear to be giving gifts to their referral folks," Risner said. "A holiday card is probably an appropriate thing. But any items of value changing hands, you're going to have to explain why they're changing hands." For every giver, there's a getter. And for physicians, it can be just as confusing on either end. The past year has brought an increased number of inquiries from physicians regarding what can be accepted, Gosfield said, especially concerning gifts from prescription drug companies. Pharmaceutical companies have footed the bill for physicians' office holiday parties. That can cause problems, even when the parties are funded through educational grants from the drug companies, Gosfield said. "Ix-nay," she suggests. "The fact that everybody is singing Christmas carols while they're doing it doesn't change it." Before the holidays get too much closer, practices should have compliance plans in place laying out what office policies are regarding accepting gifts, Christmas trees and parties from drug company representatives. "It's so that people don't have to make decisions in the moment," she said. "It's very unpleasant to everybody to say, 'Please take your Christmas tree away.' " ADDITIONAL INFORMATION:Holiday cheer
Source: BNA Inc. Copyright 2002 American Medical Association. All rights reserved.
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