Branded promo items for practices: gift rules

A practice orders a box of pens with its logo, a few dozen mugs for the front desk and tote bags for a health fair. It feels like the smallest marketing spend of the year. Federal law treats each of those items as remuneration, a term that for the beneficiary inducement rule includes transfers of items for free (42 USC 1320a-7a(i)(6)), and what the law asks depends on who takes the item home: a patient with Medicare or Medicaid, a physician who refers to you, that physician’s front desk, or a member of the public at an event.

This guide covers branded promotional items only: pens, mugs, water bottles, tote bags, calendars, magnets, lip balm, toothbrushes and similar goods with your name or logo on them. Lunches and holiday gifts for referring offices are covered in our guide to gifts and meals for referring physicians, points cards and rewards in our guide to patient rewards and loyalty programs, prize drawings in our guide to giveaways and sweepstakes, and free visits in our guide to free consultation offers. Rules for the liaisons who hand out items to referring offices are in our guide to physician liaison programs.

This is general information, not legal advice. Sources cited were checked on October 31, 2026: 42 USC 1320a-7a(a)(5), (i)(6) and (i)(7); the HHS OIG Policy Statement Regarding Gifts of Nominal Value to Medicare and Medicaid Beneficiaries (December 7, 2016); 42 USC 1320a-7b(b); 42 CFR 1001.952; 42 CFR 411.357(k) and the CMS CPI-U Updates page (page last modified February 19, 2026); 45 CFR 164.501 and 164.508(a)(3); and 15 USC 45 and 52. We found no federal rule or agency guidance written for branded promotional items as such. State law can add its own gift, inducement and advertising rules, so have a health care attorney review your plan.

The short version

For people with Medicare or Medicaid, OIG reads nominal value as a retail value of no more than 15 dollars per item and 75 dollars in total per patient per year, with no cash or cash equivalents (OIG policy statement, December 7, 2016). Items at or below those figures need not fit an exception to 42 USC 1320a-7a(a)(5).
The 15 and 75 dollar figures are measured at retail value, not at your bulk unit cost.
For a physician who refers to an entity that furnishes designated health services, branded items count toward the Stark nonmonetary compensation limit, which CMS lists as 535 dollars per physician for calendar year 2026 (42 CFR 411.357(k); CMS CPI-U Updates).
The federal anti-kickback statute reaches remuneration to any person, in cash or in kind, offered to induce referrals or recommendations of federally covered services (42 USC 1320a-7b(b)(2)). That includes a referring physician’s staff. We found no safe harbor in 42 CFR 1001.952 written for promotional items.
Mailing a branded item to patients is fine under HIPAA when the item is a promotional gift of nominal value from the practice itself (45 CFR 164.508(a)(3)(i)(B)).
What is printed on the item is advertising. A health claim on a water bottle has to be true and supported like any other ad (15 USC 45, 52).

The same pen is a different gift depending on who gets it

Start with the recipient, because the rule that applies changes with each one.

A patient or member of the public with Medicare or Medicaid: the beneficiary inducement provision, 42 USC 1320a-7a(a)(5), and the OIG nominal value policy.
A physician who refers to you: the anti-kickback statute, 42 USC 1320a-7b(b), and, if your practice or facility furnishes designated health services, the Stark exception for nonmonetary compensation at 42 CFR 411.357(k).
Staff at a referring office: the anti-kickback statute.
A patient whose name and address come from your records: the HIPAA Privacy Rule’s marketing provisions, 45 CFR 164.501 and 164.508(a)(3).
Anyone who reads the item: federal advertising law, 15 USC 45 and 52, and your state’s rules on titles and claims.

One box of mugs can touch all five. That is why we recommend deciding who each item is for before you order, and keeping the items meant for referral sources separate from the ones in the waiting room.

Patients and the public: the beneficiary inducement rule

Under 42 USC 1320a-7a(a)(5), a person who offers or transfers remuneration to someone eligible for Medicare or a State health care program, such as Medicaid, 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 is subject to civil monetary penalties. “Should know” covers deliberate ignorance and reckless disregard, and no proof of specific intent to defraud is required (42 USC 1320a-7a(i)(7)).

The statute protects the person, not the setting. A branded tote bag handed to a 70 year old at a community health fair is offered to a Medicare beneficiary even though they are not your patient yet. Our health fair guide covers the rest of an event plan.

In its policy statement of December 7, 2016, OIG noted that Congress intended inexpensive gifts of nominal value to be permitted, and said it interprets nominal value as a retail value of no more than 15 dollars per item or 75 dollars in the aggregate per patient on an annual basis. The items may not be cash or cash equivalents. If a gift is at or below those thresholds, OIG said it need not fit into an exception to section 1128A(a)(5), which is 42 USC 1320a-7a(a)(5). OIG also said it will monitor the thresholds and announce any future increases, so check the statement before you rely on the figures.

Three details matter for branded goods in particular.

Retail value, not your cost. The policy measures retail value. A pen that costs you a fraction of a dollar in a bulk order is still counted at what it would sell for. No federal rule tells you how to price a custom item. We recommend using the price a shopper would pay for a comparable unbranded item and writing that figure down.
The yearly total is per patient, across all gifts. The branded water bottle at the first visit, the calendar in December and the birthday card gift all count toward the same 75 dollars. A practice that runs a rewards program as well as a swag table needs one tally, not two.
No cash equivalents. A gift card with your logo on it is still a gift card. We recommend leaving gift cards and store credit out of any giveaway that can reach Medicare or Medicaid patients.

For a practice with no Medicare or Medicaid patients, this provision does not reach the gift, but state law can. Our guide to marketing to Medicare patients covers the wider rules.

Referring physicians: the Stark limit and the anti-kickback statute

If your practice or facility furnishes designated health services, such as lab, imaging or physical therapy, the Stark exception for nonmonetary compensation at 42 CFR 411.357(k) lets you give a referring physician items or services, not cash or cash equivalents, up to a yearly total. The regulation sets a base of 300 dollars adjusted each calendar year for inflation (411.357(k)(1), (k)(2)), and the CMS CPI-U Updates page, last modified February 19, 2026, lists 535 dollars for calendar year 2026. CMS posts the new figure after September 30 each year. On October 31, 2026, the page did not yet list a 2027 figure, so check it in January.

Two conditions travel with the dollar limit. The items may not be determined in any manner that takes into account the volume or value of referrals or other business the physician generates (411.357(k)(1)(i)), and they may not be solicited by the physician or the physician’s practice, including its employees and staff (411.357(k)(1)(ii)). A branded jacket sent only to the top 10 referrers fails the first condition on its face.

No federal rule exempts low-cost branded items from the 411.357(k) total. We recommend logging each item at retail value next to the meals and holiday gifts for the same physician, since all of it counts toward one limit. Our guide to gifts and meals for referring physicians covers the overage fix in 411.357(k)(3) and how to split a gift shared by an office.

The anti-kickback statute applies whether or not Stark does. It makes it a felony to knowingly and willfully offer or pay any remuneration, directly or indirectly, overtly or covertly, in cash or in kind, to any person to induce them to refer an individual for, or to arrange for or recommend, an item or service payable by a Federal health care program (42 USC 1320a-7b(b)(2)). The safe harbors in 42 CFR 1001.952 do not include one written for promotional items. A small item meant as a thank you is a weak inducement, but the statute turns on intent, and a gift sent because of referrals is the fact pattern it describes.

Referring office staff

Practices also send branded items to the front desk and referral coordinators at a referring office. The anti-kickback statute covers remuneration to any person to induce them to arrange for or recommend a covered item or service (42 USC 1320a-7b(b)(2)(B)), so staff are inside its reach.

We found no federal rule that says how to count a gift to a referring physician’s staff against that physician’s 411.357(k) limit. We recommend asking counsel how your practice will treat staff gifts, keeping the items modest and the same for each office, and logging them under the office with the physician gifts.

Mailing items to patients: what HIPAA adds

Sending a branded calendar or magnet to each patient on your list uses their names and addresses from your patient records. Under 45 CFR 164.508(a)(3), a covered entity needs a patient’s authorization to use protected health information for marketing, except when the communication is face-to-face or is a promotional gift of nominal value provided by the covered entity (164.508(a)(3)(i)(B)).

Two points follow. First, a branded item mailed by your practice fits that exception, and a message describing your own health-related services is excluded from the definition of marketing in the first place, unless a third party pays you to send it (45 CFR 164.501). Second, the Privacy Rule does not define nominal value. We recommend staying within the OIG figures for consistency, since the same patient may also have Medicare. Our HIPAA marketing rules guide covers authorizations.

No federal rule speaks to what a mailed item reveals. We recommend keeping specialty and condition words off the outside of the package and off items likely to sit in view at home or work. A magnet that says only the practice name is safer than one that names a condition.

What the item says is advertising

A slogan printed on a mug is an advertisement like any other. The FTC Act declares unfair or deceptive acts or practices unlawful (15 USC 45(a)(1)) and bars false advertisements that are likely to induce the purchase of services or devices (15 USC 52(a)). “Boosts immunity” on an IV clinic water bottle or “pain-free” on a dental toothbrush needs the same support it would need on your website.

State title rules follow the logo too. A pen that names a clinician should show the same license type as your sign and website. Our guide to medical office signs walks through the Texas and California naming rules, and our guide to the doctor title for non-physician clinicians covers titles.

Questions to ask before you order

Who will receive this item: patients, the public at an event, referring physicians or their staff?
Can anyone in that group have Medicare or Medicaid?
What is the retail value of one item, and how did we decide it?
Does this item push any patient’s yearly total past 75 dollars when we add our other gifts?
Do we furnish designated health services, and what is this physician’s running total against the current CMS limit?
Did a referring physician or their office ask for these items?
Is the item tied in any way to the number of patients an office sends us?
Does the printed text make a health claim we can support?
Will anything on the package or item reveal a patient’s condition?

Use and avoid

Use: a pen or magnet with the practice name, address and website, offered to each visitor at the front desk.
Avoid: a branded insulated tumbler with a retail value above 15 dollars handed to Medicare patients at check-in.
Use: the same small set of branded office supplies for each referring office, logged by physician.
Avoid: “Our top referring offices get the premium gift box this year.”
Use: “Family dentistry since [year]” on a toothbrush.
Avoid: “Whiter teeth in one week” on a toothbrush, with no support for the claim.
Use: a plain mailer envelope with the practice name only.
Avoid: a mailer that names a condition or treatment on the outside.

An illustration

This example is invented. [Practice name], a family practice with an in-office lab, plans a spring order: 500 pens, 200 tote bags for a health fair and 30 branded fleece vests for the three family physicians and staff at each of its top referring offices.

The practice manager prices each item at retail. The pens and tote bags are well under 15 dollars each, so they go ahead for the waiting room and the fair, and the manager notes the retail figure on the order. The vests are the problem. Choosing the offices by referral volume ties the gift to referrals, which 411.357(k)(1)(i) bars, and the vests have a retail value that would take a real share of each physician’s yearly limit. The practice drops the vests and instead sends the same small box of branded office supplies to each office that refers to it, logged against each physician by name. Their health care attorney reviews the plan before anything ships.

Checklist

Decide who each item is for before you order.
Record the retail value per item, not the bulk unit cost.
Keep items for Medicare and Medicaid patients at or below the OIG nominal value figures, and track the yearly total per patient.
No gift cards, store credit or cash equivalents.
If you furnish designated health services, log items for each referring physician against the current CMS 411.357(k) limit.
Send referral source items on the same terms to each office, never by referral volume and never on request.
Log gifts to referring office staff under the office.
Keep condition words off mailed items and packaging.
Review printed text for health claims and titles.
Have a health care attorney review the plan and your state’s rules.

How we help

We build websites, local and organic search, Google Ads and lead generation and an AI front desk for independent practices. For promotional items, that means keeping the name, titles and claims on your printed items the same as on your website and ads, and building referral outreach that does not depend on gifts. 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 we give branded pens and mugs to Medicare patients?

Yes, within limits. In its December 7, 2016 policy statement, OIG said it interprets nominal value as a retail value of no more than 15 dollars per item or 75 dollars in the aggregate per patient per year, with no cash or cash equivalents. Gifts at or below those figures need not fit an exception to 42 USC 1320a-7a(a)(5).

Do we count the price we paid or the retail price?

The OIG policy statement measures retail value. No federal rule says how to price a custom branded item. We recommend using what a shopper would pay for a comparable item and recording that figure.

Do branded items for referring physicians count toward the Stark limit?

Yes, if your practice or facility furnishes designated health services. The 42 CFR 411.357(k) exception covers items and services, not cash, up to a yearly total that CMS lists as 535 dollars per physician for 2026. No federal rule exempts low-cost branded items from that total.

Can we give promotional items to a referring office’s front desk staff?

The anti-kickback statute reaches remuneration to any person to induce them to arrange for or recommend a federally covered item or service (42 USC 1320a-7b(b)(2)(B)). We found no safe harbor written for promotional items. Keep them modest, the same for each office, unrelated to referral volume, and reviewed by counsel.

Do we need patient authorization to mail branded items?

Not when the item is a promotional gift of nominal value provided by your practice. 45 CFR 164.508(a)(3)(i)(B) excepts it from the authorization requirement for marketing. The Privacy Rule does not define nominal value.

Branded pens, mugs and promotional items: the gift rules for patients and referral sources