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Advisory Opinions

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In accordance with section 1128(D)(b) of the Social Security Act (42 U.S.C. 1320a-7d(b)) and 42 CFR part 1008, OIG issues advisory opinions about the application of OIG's fraud and abuse authorities to the requesting party's existing or proposed business arrangement. As required by the statute, these advisory opinions are being made available to the public through this OIG Web site.

One purpose of the advisory opinion process is to provide meaningful advice on the application of the anti-kickback statute and other OIG sanction statutes in specific factual situations. Please note, however, that advisory opinions are binding and may legally be relied upon only by the requestor. Since each opinion will apply legal standards to a set of facts involving certain known persons who provide specific statements about key factual issues, no third parties are bound nor may they legally rely on these advisory opinions.

We have redacted specific information regarding the requestor and certain privileged, confidential, or financial information associated with the individual or entity, unless otherwise specified by the requestor.

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Advisory Opinions for 2011

12-20-2011
Advisory Opinion 11-19
(concerning the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies.)
12-07-2011
Advisory Opinion 11-18
(concerning an online service that would facilitate the exchange of information between health care practitioners, providers, and suppliers.)
11-23-2011
Advisory Opinion 11-17
(concerning a proposed arrangement under which an entity would furnish allergy testing and immunotherapy laboratory services within various primary care physicians' medical offices.)
11-15-2011
Advisory Opinion 11-16
(concerning a hospital's domiciliary services program that provides transportation, lodging, and meal assistance to certain patients and their family members.)
10-18-2011
Modification of Advisory Opinion 07-18
(modifying Advisory Opinion No. 07-18, which was issued on 01-03-2008, to allow a patient assistance program to generally limit its funds to specialty pharmaceuticals and to enroll pharmacies as "Participating Pharmacies".)
10-11-2011
Advisory Opinion 11-15
(concerning a proposal under which physicians would invest in a company that would provide pathology laboratory management services to a third party.)
10-07-2011
Advisory Opinion 11-14
(concerning a proposal for ophthalmologists in a group practice to co-manage cataract surgery patients, including Medicare beneficiaries, with optometrists external to that group practice who would separately charge the beneficiaries for services related to premium refractive intraocular lenses that are not covered by the Medicare program.)
09-30-2011
Modification of Advisory Opinion 07-06
(concerning Advisory Opinion No. 07-06 which was issued on 07-23-2007 regarding the management by a health care industry consultancy of a charitable organization's arrangement to subsidize patient cost-sharing and premium obligations.)
09-06-2011
Advisory Opinion 11-13
(concerning a proposal for a county which provides emergency medical services ("EMS") transportation through its fire department, to treat revenue received from taxes as payment of otherwise applicable cost-sharing amounts owed by bona fide county residents for EMS transportation to hospitals.)
Advisory Opinion 11-12
(concerning a health system's proposal to enter into arrangements to provide neuro emergency clinical protocols and immediate consultations with stroke neurologists via telemedicine technology to certain community hospitals.)
08-04-2011
Advisory Opinion 11-11
(concerning two proposals by a supplier that furnishes medical supplies, equipment, and related services to enter into a contract with a skilled nursing facility to provide such items and services.)
08-01-2011
Advisory Opinion 11-10
(concerning an arrangement under which a company that sells a variety of health care management services will disburse pay-for-performance financial incentives on behalf of a state's Medicaid program.)
07-21-2011
Advisory Opinion 11-09
(concerning the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies.)
Advisory Opinion 11-08
(concerning an existing arrangement and a proposed arrangement involving contracts between a durable medical equipment ("DME") supplier and various independent diagnostic testing facilities ("IDTF"), pursuant to which IDTF staff members perform certain services on behalf of the DME supplier.)
06-08-2011
Advisory Opinion 11-07
(concerning the expansion of a vaccine reminder program to include entities that insure and treat patients covered by a fee-for-service Federal health care program.)
05-26-2011
Modification of OIG Advisory Opinion No. 10-07
(concerning Advisory Opinion No. 10-07 which was issued on 05-26-2010 regarding a nonprofit, tax-exempt, charitable organization's proposal to provide assistance with cost-sharing obligations to financially needy individuals, including Medicare and Medicaid beneficiaries, diagnosed with certain specified diseases.)
05-20-2011
Advisory Opinion 11-06 (PDF)
(concerning an online referral service whereby post-acute care providers would pay a fee to electronically receive and respond to referral requests from hospitals for post-discharge care.)
Advisory Opinion 11-05 (PDF)
(concerning a tax-exempt charitable organization's: (1) proposal to provide financial assistance with cost-sharing obligations for certain genetic tests to financially needy individuals, including but not limited to Medicare and Medicaid beneficiaries, and (2) current practice of providing vouchers for free genetic tests to individuals who are uninsured or whose insurance does not cover genetic tests.)
05-13-2011
Advisory Opinion No. 11-04 (PDF)
(concerning a Training Affiliation Agreement between a military medical group and a public community hospital.)
04-14-2011
Advisory Opinion 11-03 (PDF)
(concerning the formation of a new long-term care pharmacy and the agreement to manage all of its day-to-day operations and provide all personnel and related services necessary for its operation.)
03-24-2011
Advisory Opinion 11-02 (PDF)
(concerning a complimentary local transportation arrangement whereby a hospital would transport patients from physician offices located on, or contiguous to, the hospital's campus to the hospital if the patients require further treatment and cannot transport themselves.)
01-10-2011
Advisory Opinion 11-01 (PDF)
(concerning a network of pediatric charity hospitals plan to: (1) begin billing third-party payers, including Federal health care programs, for services rendered, and waive all cost-sharing amounts without regard to patients' financial need; (2) adopt a new financial need-based policy of providing lodging assistance, in limited circumstances, to patients, including Federal health care program beneficiaries, and their families; and (3) adopt a new financial need-based policy of providing transportation assistance, in limited circumstances, to patients, including Federal health care program beneficiaries, and their families.)

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