Browse Advisory Opinions

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.

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.

Regarding the "coordination of benefits" provisions of a provider agreement between a nursing home and a health care plan.

Concerning the "coordination of benefits" provisions of a provider agreement between ... a health maintenance organization or "HMO", and the skilled nursing facilities in its provider network (the "Nursing Facilities".)

Concerning a proposed grant from a hospital to a community health center to defray the costs of providing services to uninsured patients.

Concerning a political subdivision of a State that owns and operates an ambulance service and that treats the operating revenues received from local taxes as payment of otherwise applicable copayments and deductibles due from the residents.

Concerning a municipal corporation that owns and operates an ambulance service and that treats the operating revenues received from local taxes as payment of otherwise applicable copayments and deductibles due from the residents.

Concerning an exclusive contract between a city and an ambulance company for the provision of emergency medical services for city residents that includes a requirement that the contracting ambulance company waive out-of pocket Medicare copayments for city residents.

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 the practice of accepting reimbursement from third-party payors plus certain payments.

Concerning "payments by vendors to a group purchasing organization (GPO) owned by entities affiliated with health care providers that purchase items covered by the GPO's vendor contracts."