In August 2002, the United States Health and Human Services Office of Inspector General (HHS-OIG) issued a Special Advisory Bulletin relating to offering gifts and inducements to beneficiaries of Title XIX (Medicaid) programs. Since the States operate their Medicaid programs under the direction of HHS-CMS, it has generally been considered in the health law community that the HHS-OIG Advisory Bulletin could be relied upon in advising healthcare providers. The Health and Human Services Commission Office of Inspector General (HHSC-OIG), however, last month issued its own advisory bulletin in which it states that it will take an even more restrictive approach in enforcement of its fraud and abuse regulations. For instance, while HHS-OIG will allow gifts to beneficiaries of up to $10 at one time and not more than $50 for the year, HHSC-OIG caps it at $10 per instance and $25 per year. Further, any items offered by a provider to a beneficiary must be directly related to the provider’s profession. For example, a dentist may offer tooth decay prevention items (a toothbrush, toothpaste and floss), but it is not acceptable to give beneficiaries gift cards (even if intended for the purchase of tooth decay prevention items). This more restrictive interpretation of its regulations now creates a double standard between Medicare and Medicaid, which must be considered prior to offering anything of value from a healthcare provider to a beneficiary.