Free rides for patients: what you can advertise

Patients miss appointments because they cannot get there, cannot pay to park, or have no one to watch their children. A practice that solves those problems helps patients and fills its schedule. The trouble starts when the help turns into an ad. Under federal fraud and abuse law, a free ride or a paid parking ticket is something of value, and offering something of value to Medicare or Medicaid patients to win their business can be unlawful even when the intent is kind.

This guide is for owners and marketing staff at independent practices, clinics and facilities that see Medicare or Medicaid patients. It covers the local transportation safe harbor, the exception for items that promote access to care, the financial need exception, how to tell patients about help without advertising it, and how to word a shuttle schedule or a website page. Gifts and points programs are covered in our patient loyalty and rewards guide, and transportation companies have their own NEMT and ambulance marketing guide. A free first visit or free consultation as an advertised offer is covered in our guide to free consultation offers.

This is general information, not legal advice. Sources cited were checked on October 30, 2026: 42 U.S.C. 1320a-7a(a)(5) (Cornell LII), 42 U.S.C. 1320a-7b(b) (Cornell LII), 42 CFR 1001.952(bb) and 42 CFR 1003.110 (eCFR text as of October 28, 2026), the OIG final rule at 81 FR 88368 (December 7, 2016), the OIG final rule at 85 FR 77684 (December 2, 2020), and 16 CFR 251.1 (eCFR). State rules on patient inducements differ, so check yours, and have a health care attorney review any patient support program before you offer it or mention it in marketing.

The short version

Help for patients counts as remuneration. Under 42 U.S.C. 1320a-7a(a)(5), offering remuneration to a Medicare or Medicaid patient that you know or should know is likely to influence them to choose your practice can bring civil money penalties. The definition in 42 CFR 1003.110 includes items or services given free or below fair market value.
Free local rides have a safe harbor. 42 CFR 1001.952(bb) protects free or discounted local transportation for established patients when all of its conditions are met, and one condition is that you do not publicly market or advertise it.
Other help can fit an exception. 42 CFR 1003.110 excludes items or services that improve a patient’s ability to obtain covered care and pose a low risk of harm. In 2016, OIG gave parking reimbursement and child care during appointments as examples that could fit.
Telling a patient is not advertising. OIG wrote in 2016 that informing patients that transportation is available is not marketing if it is done in a targeted manner, such as asking a patient who needs a safe ride home whether they have one.
Keep the perks out of the ads. Do not put free rides, parking, child care or other patient help in ads, on public web pages or in mailers meant to bring in new patients. A shuttle may post its route and schedule.

Why a ride or a parking ticket is a legal question

Two federal laws apply when a practice gives something to patients with Medicare or Medicaid. The first is the beneficiary inducement provision of the civil monetary penalties law. 42 U.S.C. 1320a-7a(a)(5) reaches a person who offers or transfers remuneration to an individual eligible for Medicare or a state health care program that the person knows or should know is likely to influence that individual to order or receive covered items or services from a particular provider, practitioner or supplier.

Under 42 CFR 1003.110, remuneration for this purpose includes waivers of copayments, coinsurance and deductibles and transfers of items or services for free or for other than fair market value. A ride, a parking voucher, a meal or an hour of child care is an item or service given for free.

The second law is the federal anti-kickback statute, 42 U.S.C. 1320a-7b(b), which makes it a crime to knowingly and willfully offer or pay remuneration to induce a person to purchase or order items or services paid for by a federal health care program. The safe harbors in 42 CFR 1001.952 describe practices that are not treated as an offense under that statute. The transportation safe harbor is one of them, and 1003.110 also treats a practice permitted by a safe harbor as outside the definition of remuneration for the civil penalty law.

Neither law asks whether the help was generous or well meant. What matters is whether it fits an exception, and how it is offered. Advertising is where a support program that would otherwise fit can fall out of the exception.

The local transportation safe harbor

OIG added the local transportation safe harbor in its final rule of December 7, 2016 (81 FR 88368) and changed it in its final rule of December 2, 2020 (85 FR 77684).

The current text of 42 CFR 1001.952(bb)(1) protects free or discounted local transportation made available by an eligible entity to federal health care program beneficiaries when all of these conditions are met:

A written policy, applied the same way each time. Availability is set out in a policy the entity applies uniformly and consistently, and it is not determined in a manner related to the past or anticipated volume or value of federal health care program business.
No air, luxury or ambulance-level transportation.
No public marketing. The entity does not publicly market or advertise the free or discounted transportation, no marketing of health care items and services happens during the ride or at any time by the drivers, and drivers and others arranging rides are not paid per beneficiary transported.
Established patients only. The rider has to be an established patient of the entity offering the ride, if that entity is a provider or supplier, and of the provider or supplier the rider is going to or from. The rule defines an established patient as a person who has selected and initiated contact to schedule an appointment, or who has already attended an appointment.
Local distances. The ride is within 25 miles of the provider or supplier, or within 75 miles if the patient lives in a rural area as the rule defines it. The mileage limits do not apply to a ride home after discharge from an inpatient admission, or after at least 24 hours in observation status at a hospital.
Medically necessary care. The ride is for the purpose of obtaining medically necessary items and services.
The entity pays. The entity bears the cost and does not shift it to a federal health care program, other payers or individuals.

Under 1001.952(bb)(3), an eligible entity is any individual or entity except those, or family members or others acting on their behalf, that primarily supply health care items. A physician practice, clinic or hospital can be an eligible entity. A company whose main business is selling equipment or supplies cannot use this safe harbor.

The 2020 rule raised the rural limit from 50 to 75 miles, removed the mileage limit for patients going home after an inpatient discharge, and added the 24-hour observation case. In the same rule, OIG said it sees no difference between taxis and ride-sharing services for this safe harbor, and it declined to extend protection to transportation for nonmedical purposes. A ride to a covered appointment can fit. A ride to the grocery store is outside this safe harbor.

In the 2016 rule, OIG said the policy does not have to require individual paperwork for each rider, though keeping records of how the policy was applied would be a best practice. It gave sample policies: asking each patient who schedules a procedure that keeps them from driving home whether they need a ride, or offering rides to each patient with a history of missed appointments. OIG also said a program may use vouchers instead of providing rides directly, as long as the other conditions are met.

Shuttles: the one place you can post details

A shuttle is treated differently. Under 1001.952(bb)(3), a shuttle service is a vehicle that runs on a set route on a set schedule. Under (bb)(2), a free or discounted shuttle can be protected if it is not air, luxury or ambulance-level transportation, it stays within the local area, the entity bears the cost, and the shuttle “is not marketed or advertised (other than posting necessary route and schedule details)”. The same rule against marketing health care services during the ride or by drivers, and against paying drivers per beneficiary, applies.

The local area for a shuttle means no more than 25 miles from any stop on the route to any stop where health care items or services are provided, or up to 75 miles from a stop in a rural area. A shuttle does not have the established patient limit that applies to individual rides.

In practice, a shuttle page can list the stops, the times and how to board. It should not describe the shuttle as a reason to choose your practice, sit next to an offer for a new patient visit, or appear in paid ads. A line such as “Free shuttle to our new clinic, book your first visit today” turns schedule details into an advertisement.

What “do not advertise” means in practice

The 2016 preamble is the clearest guidance on where informing ends and advertising begins. At 81 FR 88387, OIG responded to commenters who asked whether transportation could be mentioned on a website or in printed materials. OIG agreed that “informing patients that transportation is available is not marketing, if it is done in a targeted manner.” Its example: when a patient learns they need a follow-up appointment, or is scheduling a procedure that may require a safe ride home, staff can ask whether the patient has reliable transportation.

In the same passage, OIG said providers and suppliers “should not advertise the availability of free or discounted transportation (including on Web sites or in printed materials distributed to the public).” That rules out a public web page announcing free rides, a mailer to the neighborhood, a social post, a paid search ad or a sign on the street.

Targeted ways to tell patients that fit OIG’s description include:

Front desk or scheduling staff asking about transportation when a patient books a procedure, under the written policy.
A care coordinator offering a ride to a patient who has missed visits because of transportation, if your policy covers that case.
A line in a pre-procedure instruction sheet given to patients who are already scheduled, telling them to ask staff if they need help getting home.
A discharge planner arranging a ride home under the policy.

Each of these reaches a patient who has already chosen you and has a specific need. Keep the same wording out of anything meant to reach people who are not yet patients.

Parking, child care, devices and other help: the access to care exception

Rides are only one kind of help. 42 CFR 1003.110 lists exceptions to the definition of remuneration for the civil penalty law. One covers items or services that improve a beneficiary’s ability to obtain items and services payable by Medicare or Medicaid, and pose a low risk of harm to patients and the programs by being unlikely to interfere with or skew clinical decision making, being unlikely to increase costs through overutilization or inappropriate utilization, and not raising patient safety or quality of care concerns.

In the 2016 rule at 81 FR 88394, OIG gave examples. It said that reimbursing parking expenses or providing free child care during appointments could promote access to care, and that a hospital sending a patient home with an inexpensive device to record weight or blood pressure for the care team could too. It also drew a line: offering movie tickets each time a patient attends an appointment would not fit, because it is a reward for receiving care rather than help getting to it.

That line is the test for any perk. Ask whether the item removes a barrier to covered care for this patient, or whether it rewards them for showing up. A parking validation for a patient at a downtown office removes a barrier. A gift card for each visit is a reward.

This exception is in the civil penalty regulation only. It is not an anti-kickback safe harbor, so the anti-kickback statute still applies to the arrangement. Technology given to patients may also be looked at under the patient engagement and support safe harbor at 42 CFR 1001.952(hh), which has its own conditions and is covered in our patient loyalty and rewards guide. Meals, lodging and telehealth equipment for patients each turn on the facts, so get counsel’s view on the item, the value and the patients who receive it.

Help based on financial need

A separate exception in 42 CFR 1003.110 covers items or services given for free or below fair market value when they are not offered as part of any advertisement or solicitation, are not tied to the provision of other covered items or services, have a reasonable connection to the medical care of the patient, and are provided after the person determines in good faith that the patient is in financial need.

OIG explained this exception in the 2016 rule at 81 FR 88402. It said the exception protects remuneration given case by case when a need is identified, and is not meant to encourage patients to seek care. It also said that providers relying on it “cannot advertise in the media, or post information for public display or on Web sites about the availability of free items or services” they want the exception to protect. OIG gave the example of a physician who learns that a financially needy patient lives alone and has trouble remembering which medication to take when, and offers a tool or service to help.

For marketing, the rule is the same as for rides. Staff can offer help to a patient once they learn of the need. Value matters too. Discussing the reasonable connection condition, OIG said an expensive electronic tablet with a weight loss app would not be reasonable for a patient being treated for obesity, while a less expensive item with similar information might be. The website, the ads and the brochures for prospective patients should not mention help of this kind.

Waived copays are a separate question

A practice that offers to cover a patient’s share of the bill is waiving cost sharing, which is listed separately in the definition of remuneration. Under 1003.110, a waiver of coinsurance and deductible amounts falls outside that definition only if it is not offered as part of any advertisement or solicitation, the person does not routinely waive these amounts, and the waiver follows a good faith determination of financial need or reasonable collection efforts that failed. “We waive your copay” in an ad does not fit. Our guide to marketing to Medicare patients covers waivers and gifts in more detail.

Patients without Medicare or Medicaid

The beneficiary inducement provision and the federal anti-kickback statute concern federal health care programs. A practice that sees only cash-pay or privately insured patients is outside the federal provisions above, but state laws can apply. State anti-kickback and insurance fraud laws can reach privately insured patients, and private payer contracts can have their own terms on waived copays. Check your state’s rules with counsel before you treat a program as cash-pay only.

A program advertised to the public reaches patients of each kind. If any of your patients have Medicare or Medicaid, a public offer of free rides reaches them too. Our patient and physician referrals guide covers the anti-kickback statute more broadly.

If you do mention a free service, the FTC rule on “free” applies

Where an offer can lawfully appear in marketing, such as a shuttle schedule or a perk for cash-pay patients under your state’s law, the FTC guide on the word “free” applies. Under 16 CFR 251.1(c), all the terms, conditions and obligations on which receipt of the free item depends should be set out clearly and conspicuously at the outset of the offer, in close conjunction with it. A footnote reached by an asterisk does not count as disclosure at the outset. Under 251.1(b), when a free item depends on a purchase, the buyer should pay no more than the regular price for the item purchased.

Questions to answer before you offer or mention patient help

Do any of our patients have Medicare, Medicaid or another federal health care program?
Is the help written into a policy that staff apply the same way each time, without regard to how much business the patient brings?
For rides: are riders established patients, within 25 or 75 miles, going to medically necessary care, in something other than an air, luxury or ambulance vehicle?
Are drivers or schedulers paid per patient transported? If so, change that.
For other help: does the item remove a barrier to covered care, or does it reward the visit? Is its value modest?
Where does the help appear in writing? List each public page, ad, post, mailer and sign, and remove it from each one meant for prospective patients.
Do drivers, shuttle staff or ride vendors talk about services or hand out promotional material? Their instructions should say not to.
Has a health care attorney reviewed the policy, and our state’s rules for privately insured and cash-pay patients?

Use and avoid

Use, said by a scheduler to a patient booking a colonoscopy: “You will need someone to drive you home. Do you have a ride? If not, we can help under our transportation policy.” Avoid, in a search ad: “Free rides to your colonoscopy.”
Use, on a shuttle page: “Shuttle stops: [stop 1], [stop 2], [clinic address]. Runs [days] at [times].” Avoid, on the same page: “Free shuttle, so there is no reason to go anywhere else.”
Use, on a parking sign inside the office: “Ask the front desk about parking validation for today’s visit.” Avoid, on the website home page: “Free parking and free child care for new patients.”
Use, in a care coordinator’s call: “I see you missed your last two visits because of transportation. Our policy lets us arrange a ride for your next one.” Avoid, in a text to the full patient list: “Come back in and the ride is on us.”
Use, in a driver’s instructions: “Drivers do not discuss services, offers or appointments beyond the trip.” Avoid: drivers handing out coupons or flyers.

An illustration

This example is invented. [Practice name] is a gastroenterology practice in a suburban county. Patients cancel procedures because they have no one to drive them home after sedation. The practice manager proposes three things: a free ride program for procedure patients, a banner on the website reading “Free rides home after your procedure, book today”, and a search ad for “colonoscopy near me” with the line “Free ride home included.”

Dr. [Name] reviews the plan with the practice’s health care attorney. The ride program goes ahead under a written policy: staff ask each patient who books a procedure with sedation whether they have a ride home, and offer a ride by a contracted car service within 25 miles if they do not. The car service is paid by the mile, not per patient, and its drivers are told not to discuss the practice’s services. The website banner and the ad line are dropped, since both publicly advertise the rides. The pre-procedure instruction sheet sent to scheduled patients gains one sentence: “If you do not have a ride home, call us at [number] and we will talk about options.”

Checklist

Written policy for each kind of patient help, applied the same way to each patient who meets it
Rides limited to established patients, local distances and medically necessary care, with no air, luxury or ambulance-level service
Drivers and schedulers not paid per patient transported, and told not to market services
No free rides, parking, child care or other patient help in ads, public web pages, social posts, mailers or street signs
Shuttle pages limited to route and schedule details
Other perks checked against the access to care test: removes a barrier, modest value, no reward for the visit
Financial need help offered case by case after a good faith need determination, never advertised
No copay waiver offers in any marketing
State law checked for privately insured and cash-pay patients
Attorney review of the policy and of any patient-facing wording

How we help

We build websites, local search, Google Ads and lead generation and AI front desk tools for independent practices and health businesses. For patient support programs, that means keeping perks off public pages and out of ad copy, writing shuttle pages that stick to route and schedule details, and setting up scheduling scripts and patient instructions that offer help in a targeted way, with your attorney reviewing the policy. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Can a medical practice offer free rides to patients?

Yes, within limits. 42 CFR 1001.952(bb) protects free or discounted local transportation for established patients going to medically necessary care when the program follows a uniform written policy, stays within 25 miles or 75 miles in rural areas, is not air, luxury or ambulance-level service, is paid for by the practice, and is not publicly marketed or advertised.

Can we put free transportation on our website?

For individual rides, no. In its December 7, 2016 rule, OIG said providers should not advertise free or discounted transportation, including on websites or in printed materials distributed to the public. For a shuttle on a set route and schedule, the rule allows posting necessary route and schedule details.

Can we validate parking or offer child care during appointments?

In its 2016 rule, OIG said reimbursing parking expenses or providing free child care during appointments could promote access to care under the exception in 42 CFR 1003.110, if the help poses a low risk of harm. It is not an anti-kickback safe harbor, and the help should not be advertised as a reason to choose your practice.

Can we pay a ride service per patient it brings in?

Not under the safe harbor. 42 CFR 1001.952(bb) requires that drivers and others arranging the transportation are not paid on a per-beneficiary-transported basis. OIG said in 2016 that paying on a mileage or other fixed-rate basis is acceptable.

Do these rules apply if none of our patients have Medicare or Medicaid?

The federal beneficiary inducement and anti-kickback provisions concern federal health care programs. State anti-kickback and insurance fraud laws and private payer contracts can still apply, so have counsel check your state before you advertise patient perks.

Free rides and patient support perks: what a practice can offer and what it can advertise