Browse Advisory Opinions

Concerning a volunteer services program for the provision of specialty medical care and professional development in rural areas, through which volunteers' travel costs would be covered.

Concerning a proposed arrangement for a durable medical equipment ("DME") manufacturer to provide advertising assistance and reimbursement consulting services to some of its customers.

Concerning a proposal by a municipality, which provides emergency medical services through a municipally owned and operated ambulance service, to treat revenue received from local taxes as payment of otherwise applicable cost-sharing amounts due from municipal residents.

Concerning a proposal by a municipal corporation that provides emergency medical services (EMS) through its fire department to treat revenue received from certain local taxes as payment of otherwise applicable cost-sharing amounts due from residents and nonresident taxpayers who receive EMS within the municipality.

Concerning an exclusive contract for ambulance services between a municipality and ambulance company that provides for an in-kind exchange of dispatch services and billing services between the parties.

Concerning a municipality that owns and operates an ambulance service and that proposes to treat revenue received from local income taxes as payment of otherwise applicable cost-sharing amounts due from taxpayers who receive ambulance services within the municipality.

Concerning a proposal by a physician group practice to develop and own a comprehensive physical therapy center and to lease the center's space, equipment, and personnel to physicians with patients requiring physical therapy services.

Concerning an arrangement between a hospital and an ambulance company providing emergency air ambulance services to trauma victims in a rural setting, and whether the provision of free helipad and crew resting quarters would violate the anti-kickback statute.

Concerning a proposed arrangement under which a renal dialysis facility would provide acute hemodialysis services to a hospital district's inpatients, provide outpatient chronic hemodialysis services to some of the hospital district's indigent patients, and purchase certain hemodialysis equipment from the hospital district.

Concerning an arrangement involving a medical center providing physician services to a county-owned women's health clinic for an annual below fair-market value fee, along with inpatient hospital services for the county clinic's primarily indigent and low-income, self-paying patients at no charge.

Concerning a proposed program by a provider of home health care services to provide free medical-alert pagers and pager monitoring service to homebound patients during the period such patients are receiving the company's home health services.

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 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 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 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 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.

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.