Browse Advisory Opinions

Concerning a proposal by a municipal corporation that owns and operates an ambulance service to treat revenue received from local real estate taxes received from its residents as payment of otherwise applicable copayments and deductibles due from these residents for emergency ambulance services.

Concerning whether a proposed arrangement involving financial assistance by a non-profit foundation, which a pharmaceutical company proposes to establish and fund in order to subsidize cost-sharing amounts incurred by financially needy patients using its drug, would violate the administrative authorities related to the anti-kickback statute.

Concerning a proposed arrangement involving an internet-based chronic disease management business that would (1) contract with managed care organizations and employer-based health plans to enroll their members in an on-line clinical compliance program that includes awarding points redeemable for goods and services to members and their physicians for undertaking compliance activities, and (2) sell advertising on its web site to advertisers, including pharmacies and pharmaceutical companies.

Concerning whether a State-chartered hospital authority, which owns and operates a large teaching hospital, can make substantial charitable contributions to an endowment fund affiliated with the university in order to support and promote education and research at the university's school of medicine through developing a clinical cardiology services program, and whether this grant would violate the administrative authorities related to the anti-kickback statute.

Concerning whether the offering of discounts to customers, based on their purchases of dialysis equipment and supplies - some of which 05/be reimbursed under different Medicare part B methodologies - would violate the administrative authorities related to the anti-kickback statute.

Concerning whether a proposed single-specialty ambulatory surgical center that would be wholly-owned by a physician would violate the administrative authorities related to the anti-kickback statute.

Concerning whether a political subdivision of a State that owns and operates an ambulance service can treat operating revenues received from local taxes as payments of applicable copayments and deductibles due from residents.

Concerning the proposed waiver of coinsurance for portable x-ray services provided to nursing facility residents who are eligible for Medicare and Medicaid, but who do not meet the eligibility requirements for Qualified Medicare beneficiaries.

Concerning whether a proposal to offer a refund program to hospital consumers who purchase the hospital's blood-filtering device for treatment of rheumatoid arthritis would constitute grounds for the imposition of sanctions under the OIG's exclusion and civil money penalty authorities.

Concerning whether the proposed reorganization of an existing radiation oncology group practice would violate the administrative authorities related to the anti-kickback statute.

Concerning a durable medical equipment company's proposal to place its portable oxygen systems onsite at certain local hospitals, clinics, and physician offices for distribution to certain departing patients.

Concerning an ambulance restocking program that will satisfy the criteria for a "general replenishing" arrangement within the terms of the recently issued ambulance restocking safe harbor.

Concerning an ambulance restocking program that will satisfy the criteria for a "general replenishing" arrangement within the terms of the recently issued ambulance restocking safe harbor.

Concerning a medical center's proposed acquisition of an ownership interest in an operating ambulatory surgical center that is currently owned by a group of gastroenterologists.

Concerning a hospital's proposed donation of free office space to an entity that provides free end-of-life services to patients with terminal illnesses. Specifically, whether that donation would constitute grounds for the imposition of sanctions under the exclusion authority at section 1128(b)(7) of the Social Security Act (the "Act") or the civil monetary penalty provision at section 1128A(a)(7) of the Act, as those sections relate to the commission of acts described in section 1128B(b) of the Act.

Concerning a payment arrangement between a Medicare-certified hospice and certain nursing facilities for services provided to residents of such facilities who are eligible both for Medicaid and Medicare hospice benefits ("Dually Eligibles"). Specifically, for Dually Eligibles, the hospice pays the nursing facilities the full Medicaid nursing facility per diem rate for non-hospice patients, which covers pharmacy services, plus a separate payment for drugs used by Dually Eligibles in connection with their terminal illness. You have asked whether such an arrangement would constitute grounds for the imposition of sanctions under the exclusion authority at section 1128(b)(7) of the Social Security Act (the "Act") or the civil monetary penalty provision at section 1128A(a)(7) of the Act, as those sections relate to the commission of acts described in section 1128B(b) of the Act.

Concerning an exclusive contract for emergency ambulance services between County A, State B and Medical Center C under which County A has assumed the obligation to pay otherwise uncollected coinsurance amounts on behalf of County A residents. Specifically, whether such an arrangement would constitute grounds for the imposition of sanctions under the exclusion authority at section 1128(b)(7) of the Social Security Act (the "Act") or the civil monetary penalty provision at section 1128A(a)(7) of the Act, as those sections relate to the commission of acts described in section 1128B(b) of the Act, or under the civil monetary penalties provision for illegal remuneration tobeneficiaries at section 1128A(a)(5) of the Act.

Concerning whether an existing ambulatory surgical center ("ASC") joint venture between a hospital-affiliated entity and an entity owned indirectly by five ophthalmologists, together with the execution of three related ancillary agreements (the "Arrangement"), constitutes grounds for the imposition of sanctions under the exclusion authority at section 1128(b)(7) of the Social Security Act (the "Act") or the civil monetary penalty provision at section 1128A(a)(7) of the Act, as those sections relate to the commission of acts described in section 1128B(b) of the Act).

Concerning a managed care organization's employment of an excluded individual and potential sanctions under section 1320a-7a(a)(6) of the SSA.

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.