Browse Advisory Opinions

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 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.

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

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."

Whether waiving Medicare Part A and Part B copayment and deductible obligations for participants in a clinical study sponsored by the Health Care Financing Administration and the National Heart, Lung, and Blood Institute.

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 across-the-board waiver of any out-of-pocket beneficiary copayments for medical services covered by the national Eye Care Project constitutes grounds for the imposition of a sanction under section 1128A(a)(5) of the Act.

Whether an arrangement whereby an independent physician association would acquire an equity interest in a managed care organization would constitute grounds for the imposition of sanctions under the anti-kickback statute, section 1128B(b) of the Social Security Act (the "Act"), the exclusion authority for kickbacks.

Whether Company A ("Company A"), a wholly-owned subsidiary of Company B ("Company B") (collectively referred to as "Company AB") would be subject to exclusion from Federal health care programs pursuant to 42 U.S.C. § 1320a-7(b).

Whether waiving coinsurance obligations for participants in a clinical study sponsored by the Health Care Financing Administration and the National Heart, Lung, and Blood Institute (the "Proposed Arrangement").

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.