Understand the facts about marketing and solicitation
The role of the OIG is to ensure Texas Health and Human Services programs are implemented appropriately and effectively. This includes working with providers that participate in Medicaid to help safeguard Texas resources and protect our most vulnerable citizens.
Marketing and advertising are common practices among providers, but some special considerations apply when participating in Medicaid. In this article, the OIG reemphasizes the rules and regulations surrounding marketing and solicitation so providers stay in compliance.
Solicitation overview
Solicitation is defined as the act of offering or accepting any form of payment or benefit, either directly or indirectly, in exchange for obtaining or referring patients to or from a licensed health care provider.
Providers who participate in Medicaid and CHIP are prohibited from soliciting clients. Specifically, Texas Occupations Code Section 102.001 prohibits a person from securing or soliciting business or patients for, or from, an individual or entity licensed, certified or registered by a state health care regulatory agency. Violations of Chapter 102 can result in criminal prosecution by the Texas Attorney General or local authorities.
Title 1 Texas Administrative Code, Section 371.27 requires Medicaid providers to comply with Chapter 102. If a Medicaid provider violates Chapter 102, the rule allows for the termination of the provider’s contract and exclusion from future participation in the Medicaid program as directed by federal law.
HHS marketing guidelines
While solicitation of Medicaid clients is strictly prohibited, more general marketing activities are allowed as long as they do not specifically target Medicaid clients and incentivize them to use one provider over another.
| Permissible | Prohibited |
|---|---|
| Sending direct mail materials to residents who live in a specific zip code advertising general health care services. | Unsolicited personal contact such as direct mail, telephone or door-to-door solicitation targeting individuals solely because they receive Medicaid benefits. |
| Sending refill reminders to a Medicaid client, providing information about the types of services offered by the provider, coordinating care or providing health education. | Offering cash, cash equivalents or gift cards in any amount to influence a client’s choice of provider. |
| Participating at a health awareness educational event and offering branded take-away items valued at no more than $15 per individual (stickers, buttons, pens, etc.). | Providing giveaways or incentives valued at more than $15 per individual or passing out materials to only Medicaid clients. |
| Disseminating general marketing materials via television, radio, newspaper, internet or billboard. | Providing materials and attempting to communicate with Medicaid clients to influence their choice of provider. |
For more information about provider marketing, refer to Title 1 Texas Administrative Code, Section 354.1452(a).
How to report suspected solicitation
If you believe a provider is illegally soliciting Medicaid patients, notify the OIG by calling 800-436-6184, or by using the Report Fraud form found on the OIG website.