Browse Advisory Opinions

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 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 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 donations by Company X ("Company X") to Organization A ("Organization A") (an independent, 501(c)(3) charitable organization) for the purpose of funding a program to pay for Supplementary Medical Insurance ("Medicare Part B") or Medicare Supplementary Health Insurance ("Medigap") premiums for financially needy Medicare beneficiaries with end-stage renal disease.

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.

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)].

Asks whether a state-funded program that pays for insurance premiums for financially needy Medicare beneficiaries with end-stage renal disease would constitute grounds for the imposition of a civil monetary penalty under Section 231(h) of the Health Insurance Portability and Accountability Act of 1996.

It is permissible for a charitable organization partly funded by kidney dialysis providers to pay Medicare Part B, Medigap and other health insurance premiums for end-stage renal disease patients who are financially needy.