Browse Advisory Opinions

Concerning a managed care organization's proposal to subsidize the Medicare+Choice premiums andcopayments of its members eligible for both Medicare and certain limited Medicaid benefits.

Concerning a hospital's policy of waiving out-of-pocket copayments and deductibles for screening services and certain follow-up services that the hospital offers to promote early detection of breast and gynecological cancers.

Concerns a comprehensive program that a manufacturer of therapeutic mattresses and other support services markets and sells to State-licensed nursing facilities to manage pressure ulcers.

Concerning "a proposed arrangement between a hospital and a new physician whom the hospital would like to recruit to practice within its service area."

Regarding approval of a charitable donation from a hospital to a volunteer emergency medical services provider to pay for new equipment and paramedic training.

Whether a hospital proposal to provide free restocking of medical supplies and drugs for volunteer emergency medical services would violate the anti-kickback statute.

Concerning a lifestyle modification program for individuals with chronic disease that uses physicians to monitor and evaluate the program's participants.

Concerning a consulting firm's contractual payment arrangements for the performance of auditing services to identify hospital undercharges and overcharges associated with private payors.

Regarding rural telemedicine network arrangement implemented and operated pursuant to Federal grants.

A proposed marketing program involving the use of physician practices and health care clinics to distribute coupons redeemable by certain retailers (including grocery stores, pharmacies, and internet companies) for discounts on items or services that are not reimbursable by any Federal health care program.

A proposed contractual arrangement between a self-insured employer health plan and a single-specialty managed care organization to provide managed podiatry benefits for the employer's retirees.

Whether an annual fee imposed by city ordinance on ambulance companies wishing to provide ambulance services in the city (the "Ambulance Fee") constitutes prohibited remuneration under the anti-kickback statute, section 1128B(b) of the Social Security Act (the "Act"), and, if so, whether the Ambulance Fee assessment constitutes grounds for the imposition of sanctions.

Whether a proposed pricing arrangement for a package of therapeutic mattresses for SNF patients to be marketed by a company, and certain commissioned agents, would result in prohibited remuneration under the anti-kickback statute.

Whether certain arrangements for discounted ambulance services provided to residents of Medicare skilled nursing facilities would result in prohibited remuneration and sanctions under the anti-kickback statute.

Whether a proposed arrangement under which [Name redacted] would assign an employee pharmacist to work in designated hospital transplant centers for the purpose of providing pharmacy-related products and services (the "Proposed Arrangement") would constitute prohibited remuneration under the anti-kickback statute.

Whether a proposed joint venture among several orthopedic surgeons and anesthesiologists specializing in pain management to establish an ambulatory surgical center, as described in your request letter and supplemental submissions (the "Proposed Arrangement"), would generate prohibited remuneration.

Whether a compensation arrangement for registered nurses and certain other employees pursuant to a collective bargaining agreement with the nurses' union.

Certain pharmaceutical discount pricing arrangements that are limited to arrangements between a manufacturer and wholesalers (the "Proposed Arrangement") will subject you to sanction under the anti-kickback statute.

Asks whether an outpatient radiology imaging center joint venture owned by a medical group specializing in radiology and a hospital care provider (i) generates prohibited remuneration within the meaning of the anti-kickback statute, Section 1128B of the Social Security Act ("Act"); (ii) constitutes grounds for the imposition of an exclusion under Section 1128(b)(7) of the Act (as it applies to kickbacks); (iii) constitutes grounds for criminal sanctions under Section 1128B(b) of the Act; and/or (iv) satisfies the criteria set out in Section 1128B(b)(3) of the Act or associated regulations, 42 C.F.R. § 1001.952.

Asks whether declining to pursue collection of copayments from certain patients who have employer-sponsored Medicare complementary coverage constitutes grounds for imposition of sanctions under Section 231(h) of the Health Insurance Portability and Accountability Act ("HIPAA") [42 U.S.C. § 1320a-7a(a)(5)] or under Sections 1128B(b) (the anti-kickback statute) or 1128A(7) (relating to payment of kickbacks) of the Social Security Act [42 U.S.C. §§ 1320a-7b(b) and 1320a-7(b)(7)].