Medical practice giveaway and sweepstakes rules

A giveaway looks like the easiest post a practice can run: pick a prize, ask people to enter, draw a name. For a health care business it touches more law than it seems. Lottery law decides whether the entry rules are allowed at all. Mail and state game promotion laws decide what the rules have to say. Health care fraud and abuse laws decide what you can give to patients with Medicare or Medicaid, and to people who send you patients. The FTC review rule decides whether a review can be part of the entry. HIPAA decides what you can say about the winner.

This guide walks through each of those in the order you meet them when you plan a promotion. If your giveaway is part of an opening event, our grand opening guide covers door prizes and food at the event. For points cards and refer-a-friend offers that run all year, see our patient loyalty rewards guide. For gift cards offered as prizes or sold as gifts, see our gift card promotion guide. Branded items given to each visitor, with no drawing, are covered in our guide to branded promotional items. Promotions that donate per new patient follow different rules; see charity donation promotions for practices.

This is general information, not legal advice. Sources cited were checked on October 30, 2026: 18 U.S.C. 1302 and 1307, 39 U.S.C. 3001(k), 26 U.S.C. 74, 42 U.S.C. 1320a-7a and 1320a-7b, the OIG Policy Statement Regarding Gifts of Nominal Value (December 7, 2016), Florida Statutes 849.094, 16 CFR 465.4 and 45 CFR 164.508 (eCFR). Promotion and gaming laws are set state by state, they differ, and they change. Have a health care attorney licensed in each state where people can enter review the rules and the prize before launch.

Prize, chance and consideration

Federal law describes an illegal lottery by three parts. For broadcast stations, the FCC rule at 47 CFR 73.1211(b) lists them: a prize, selection dependent in whole or in part on lot or chance, and a requirement to furnish money or another thing of value to compete. State gaming laws use their own wording, so read your state’s definition with counsel. The three parts are a useful way to plan: remove one of them and the promotion is a different kind of promotion.

Sweepstakes: a prize and chance, with no consideration. 39 U.S.C. 3001(k)(1)(D) defines a sweepstakes as a game of chance for which no consideration is required to enter.
Skill contest: a prize and an outcome that depends on skill, such as a judged photo or essay. 39 U.S.C. 3001(k)(1)(C) describes a skill contest as one where the outcome depends predominately on the skill of the contestant.
Raffle or lottery: a prize, chance and a paid entry. Whether one is allowed at all is decided under state law. Leave paid-entry drawings out of practice marketing.

For a practice, consideration is the part to watch. A paid visit, a booked appointment, a product purchase or a required review can each count as giving something of value to enter, which is why the safe design is a free entry that anyone can use.

No purchase necessary, and what that means for a practice

A free method of entry has to be real. If the poster says to book a visit to enter and the free method is hidden in the fine print, the promotion reads as paid entry.

Use: one entry method open to anyone, such as a short form on your website or a card at the front desk that people can fill in without being patients.
Use: the same odds for each entry, whether the person is a patient or not.
Use: wording that says no purchase or visit is necessary to enter or win, and that a purchase or visit does not improve the chances of winning.
Avoid: extra entries for booking a treatment, buying a product or bringing in a new patient.
Avoid: entry limited to people who are patients on the day of the drawing.

If you send entry materials by mail, federal mail law sets specific disclosures. Under 39 U.S.C. 3001(k)(3)(A), a mailing with sweepstakes entry materials is nonmailable unless it discloses in the mailing, in the rules and on the entry form that no purchase is necessary to enter, and that a purchase will not improve an individual’s chances of winning. The same paragraph requires the mailing to state all terms and conditions, disclose the sponsor and an address, and give rules that state the estimated odds of winning each prize and the quantity, estimated retail value and nature of each prize.

Lottery law and the mail

Under 18 U.S.C. 1302, it is a federal crime to knowingly mail a circular or publication containing an advertisement of a lottery, gift enterprise or similar scheme offering prizes dependent in whole or in part on lot or chance. Under 18 U.S.C. 1307(a)(2), those provisions do not apply to information about a lottery or similar scheme that is authorized or not otherwise prohibited by the state where it is conducted and that is conducted as a promotional activity by a commercial organization that is clearly occasional and ancillary to its primary business.

For a practice, that points to two habits: keep giveaways occasional, not a standing feature, and make sure your state does not prohibit the design before any postcard or mailed newsletter mentions it.

Official rules: what to write down

Write the rules before you announce the giveaway, and post them where entrants can read them in full. A rules page on your website, linked from each post and sign, keeps them in one place. A working list, to adapt with counsel:

Sponsor name, address and how to contact the practice about the promotion.
Start and end dates and times, with a time zone.
Who can enter: age, location, and exclusions such as staff and their households.
Each free method of entry, and the entry limit per person.
Each prize, its quantity, its estimated retail value and what it does not include.
How and when the winner is chosen, and how they are told.
Odds of winning, or how the odds depend on the number of entries.
That no purchase, visit or review is necessary, and that none improves the chances of winning.
What happens if the winner does not respond, and by when.
How entrant information is used, and a link to your privacy policy.
That the prize winner is responsible for any taxes on the prize.

On taxes: under 26 U.S.C. 74(a), gross income includes amounts received as prizes and awards, with the exceptions listed in that section. Ask your accountant whether a prize triggers an information return to the winner, and collect what the accountant needs before you hand the prize over.

State filing and bonding: Florida as an example

A state law can add registration and bonding for larger promotions. Florida’s game promotion law is one example, quoted from the Florida Statutes site.

Section 849.094(2)(e) makes it unlawful for an operator to require an entry fee, payment or proof of purchase as a condition of entering a game promotion.
Section 849.094(3) says the operator of a game promotion where the total announced value of the prizes offered is greater than 5,000 dollars shall file the rules and a list of all prizes with the Department of Agriculture and Consumer Services at least 7 days before the promotion begins, with a nonrefundable filing fee of 100 dollars, and that the rules may not be changed after filing.
Section 849.094(4)(a) says the same operator shall set up a trust account with enough to pay the total value of all prizes, or obtain a surety bond in that amount, and file it with the department at least 7 days before the promotion begins.
Section 849.094(5) says the operator shall give the department a certified list of winners of prizes valued at more than 25 dollars within 60 days after the winners are determined, or publish the list in a Florida newspaper of general circulation, and shall hold winning entries for 90 days.

Section 849.094(3) also says the rules must be posted where the promotion can be entered and published in advertising, and that advertising may give only the material terms if it includes a website address, toll-free number or mailing address where the full rules can be read. A promotion open online can reach entrants in states with their own filing rules. Limit eligibility to the states your counsel has reviewed, and keep total prize value low unless counsel has cleared the filings.

Prizes for patients with Medicare or Medicaid

A prize is a gift. Under 42 U.S.C. 1320a-7a(a)(5), a person who offers or transfers remuneration to an individual eligible for Medicare or a State health care program, and who knows or should know it 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. Under 1320a-7a(i)(6), remuneration includes transfers of items or services for free or for other than fair market value.

In its policy statement dated December 7, 2016, the HHS Office of Inspector General 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, and that the items may not be cash or cash equivalents. OIG said it will monitor these thresholds and announce any future increases, so check the current statement on the OIG site before you choose a prize.

Use: prizes at or below the per-item figure when the promotion is open to people with Medicare or Medicaid, and count them toward each winner’s annual total with your other patient gifts.
Use: prizes that are not health care services, such as a branded item or a donation made in the winner’s name, cleared by counsel.
Avoid: a free treatment, free visit, free test or credit toward services as a prize when people with Medicare or Medicaid can enter, unless counsel has reviewed it.
Avoid: cash, prepaid cards or gift cards as prizes in an open promotion. The policy statement excludes cash and cash equivalents at any value.
Avoid: assuming that a cosmetic prize is outside the rule. The question is whether the prize is likely to influence the choice of provider for covered services, which is a question for counsel.

Referral contests

A contest that rewards people for sending new patients is a referral payment. Under the Anti-Kickback Statute at 42 U.S.C. 1320a-7b(b)(2), whoever knowingly and willfully offers or pays any remuneration, in cash or in kind, to any person to induce that person to refer an individual for an item or service payable in whole or in part by a federal health care program commits a felony. A raffle entry is something of value, so an extra entry for each referred patient is remuneration tied to a referral.

Avoid: entries, points or prizes for each new patient someone refers, whether the referrer is a patient, a business or another professional.
Avoid: contests for staff or outside partners based on the number of patients booked, unless counsel has reviewed them.
Use: a giveaway that anyone can enter for free, with no link to referrals or bookings.

State laws can reach cash-pay patients too. Our referral marketing guide covers the federal and state rules in more depth.

Reviews, follows and shares as entry

Under the FTC rule at 16 CFR 465.4, it is an unfair or deceptive act or practice for a business to provide compensation or other incentives in exchange for, or conditioned expressly or by implication on, the writing or creation of consumer reviews expressing a particular sentiment, whether positive or negative. A giveaway entry is an incentive.

Avoid: entries for a review, a star rating or a changed review. Review platforms may also remove reviews tied to incentives. Our patient review guide covers how to ask for reviews.
Use: entry methods that do not depend on a review, such as a form or a comment on your own post.
Use with care: entry by following or sharing on social media. Each platform you run a promotion on may have its own promotion terms, and they change. Read the current terms of each platform before launch, and keep a free entry method off the platform.
Avoid: asking entrants to tag friends who are patients, or to comment about their treatment. That invites people to share health details in public.

Entrant data and announcing the winner

An entry form collects names and contact details. When entrants are also patients, the practice holds that information alongside their records, so treat the entry list with the same care.

Use: an entry form that asks for name, contact details and age or eligibility only. Do not ask about conditions, treatments or reasons for visiting.
Use: a clear line on the form about what the practice will do with the details, and a separate opt-in for marketing messages. Texting entrants for marketing raises its own consent rules, covered in our text message guide.
Use: a written signed release from the winner before posting their name or photo, and a separate HIPAA authorization if anything posted shows or implies they are a patient.
Avoid: a winner post that says or shows the winner is a patient, such as a photo in the treatment room, without that authorization.

The authorization point comes from 45 CFR 164.508(a)(1): except as otherwise permitted or required by the Privacy Rule, a covered entity may not use or disclose protected health information without a valid authorization. 45 CFR 164.508(a)(3) adds that a covered entity must obtain an authorization for any use or disclosure of protected health information for marketing, except for a face-to-face communication or a promotional gift of nominal value provided by the covered entity. Our patient photo consent guide covers the authorization form.

Specialty notes

Med spas and cosmetic practices: a free treatment is a prize people ask for, and it is a health care service. Keep it out of promotions that people with Medicare or Medicaid can enter unless counsel has reviewed it, and check your state’s rules on who may perform the treatment and on advertising it.
Dental: a free whitening or exam as a prize is a free service. The same beneficiary inducement analysis applies when the entrant pool includes people with Medicaid dental coverage.
Chiropractic: a free first adjustment as a prize is a free service. See our chiropractic new patient offers guide for the rules on free and discounted first visits.
Pediatric practices: children under the age set in your rules should not be entrants. Our pediatric dentist marketing guide covers marketing to parents.

An illustration

This example is invented to show the reasoning. It does not describe a real practice.

[Practice name], a family dental office, planned a holiday giveaway: book a cleaning in December to be entered to win a free whitening treatment, with bonus entries for leaving a review and for each friend who books. Read against this guide, each part of that plan raises a problem. Booking a cleaning to enter is paid entry. The bonus for a review is an incentive under 16 CFR 465.4. The bonus for each booked friend is a referral reward. The prize is a free service offered to a pool that includes people with Medicaid dental coverage.

The revised plan used a free entry form on the website and at the front desk, open to adults in the practice’s state, with one entry per person and no link to bookings, reviews or referrals. The prize became a small branded gift basket at or below the OIG per-item figure, with no services or gift cards. The rules page listed the sponsor, dates, eligibility, prize and value, odds, how the winner would be chosen and told, and a no-purchase line. The winner signed a release, and the winner post named them without saying they were a patient. Counsel reviewed the rules and the prize before launch.

Checklist

Write official rules before announcing, and post them in full where entrants can read them.
Offer a free entry method open to anyone, with equal odds.
Say that no purchase, visit or review is necessary and that none improves the chances of winning.
Keep the prize below the OIG nominal value figures, with no cash, cards or free services, when people with Medicare or Medicaid can enter.
Give no entries for referrals, bookings or reviews.
Limit eligibility to states your counsel has reviewed, and check filing and bonding rules for the total prize value.
Read each platform’s current promotion terms before running a giveaway on it.
Collect only the entrant details you need, with a separate opt-in for marketing.
Get a signed release, and a HIPAA authorization where needed, before posting the winner.
Keep the rules, entries, winner selection record and prize value on file.
Have a health care attorney review the promotion before launch.

If you promote a giveaway by text, the texting consent rules apply as well. See our guide to marketing texts from your practice.

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 promotions, that means a rules page on your site, an entry form that asks only for what the drawing needs, a separate marketing opt-in and campaigns that point to the rules, ready for your attorney to review. 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 hub.

Can a medical practice run a giveaway?

It can, with care. Offer a free entry method open to anyone, write official rules, keep the prize modest and not a health care service when people with Medicare or Medicaid can enter, and give no entries for referrals, bookings or reviews. Have a health care attorney review it before launch.

What makes a giveaway an illegal lottery?

A prize, chance and consideration together. 47 CFR 73.1211(b) lists those three parts for broadcast stations, and state laws use their own wording. A sweepstakes removes consideration, so entry must be free and open to anyone.

Can the prize be a free treatment?

A free treatment is a transfer of services for free under 42 U.S.C. 1320a-7a(i)(6). When people with Medicare or Medicaid can enter, that raises the beneficiary inducement law. Use a small non-service prize unless counsel has cleared the treatment.

How much can a prize be worth?

For promotions open to people with Medicare or Medicaid, the OIG policy statement of December 7, 2016 reads nominal value as no more than 15 dollars per item or 75 dollars per patient per year, with no cash or cash equivalents. Check the current statement before choosing a prize.

Can we give extra entries for reviews or referrals?

No. 16 CFR 465.4 bars incentives conditioned on reviews expressing a particular sentiment, and an entry for each referred patient is remuneration tied to a referral under the Anti-Kickback Statute when federal programs pay for the care.

Can we post the winner’s name and photo?

Get a signed release first. If the post shows or implies the winner is a patient, 45 CFR 164.508 calls for a valid HIPAA authorization. Keep winner posts free of treatment details.

Medical practice giveaways and sweepstakes: entry rules, prizes and patient law