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Advisory Opinions

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In accordance with section 1128(D)(b) of the Social Security Act (42 U.S.C. 1320a-7d(b)) and 42 CFR part 1008, OIG issues advisory opinions about the application of OIG's fraud and abuse authorities to the requesting party's existing or proposed business arrangement. As required by the statute, these advisory opinions are being made available to the public through this OIG Web site.

One purpose of the advisory opinion process is to provide meaningful advice on the application of the anti-kickback statute and other OIG sanction statutes in specific factual situations. Please note, however, that advisory opinions are binding and may legally be relied upon only by the requestor. Since each opinion will apply legal standards to a set of facts involving certain known persons who provide specific statements about key factual issues, no third parties are bound nor may they legally rely on these advisory opinions.

We have redacted specific information regarding the requestor and certain privileged, confidential, or financial information associated with the individual or entity, unless otherwise specified by the requestor.

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Advisory Opinions for 2014

02-20-2014
Advisory Opinion 14-02
(concerning the use of "preferred hospital" networks as part of certain Medicare Supplemental Health Insurance ("Medigap") policies.)
01-22-2014
Advisory Opinion 14-01
(concerning contracts under which a placement agency is compensated for referring new residents to senior communities where they may eventually receive services paid for by Federal health care programs.)

Advisory Opinions for 2013

12-02-2013
Advisory Opinion 13-19
(concerning patient assistance programs that provide funding for premium assistance and certain other medical expenses to [disease redacted] patients in financial need.)
11-27-2013
Advisory Opinion 13-18
(concerning an ambulance supplier's response to a request for proposals for the provision of all emergency ambulance services.)
11-21-2013
Advisory Opinion 13-17
(concerning a proposal to use tax revenues to cover out-of-pocket amounts owed for county-operated emergency ambulance services received by non-residents.)
11-14-2013
Advisory Opinion 13-16
(concerning a health insurer's proposal to pay the Medicare Part B premium costs for Medicare-eligible individuals with End-Stage Renal Disease who are enrolled in a group health plan offered by the insurer and receiving dialysis services.)
11-12-2013
Advisory Opinion 13-15
(concerning an anesthesia services provider's proposal to contract with a psychiatry practice group to provide anesthesia services in connection with electroconvulsive therapy procedures at a hospital.)
10-22-2013
Advisory Opinion 13-14
(concerning a proposal whereby a county would not bill bona fide county residents otherwise applicable cost-sharing amounts due in connection with emergency ambulance services provided by the local fire department and a volunteer rescue company, but would instead use tax revenues to cover the unpaid cost-sharing amounts.)
10-15-2013
Advisory Opinion 13-13
(concerning a non-profit community health services organization's proposal to begin billing Medicaid for dental services provided to its patients, while continuing to provide free dental services to uninsured and underinsured financially needy children.)
08-27-2013
Advisory Opinion 13-12
(concerning use of a "preferred hospital" network as part of certain Medicare Supplemental Health Insurance ("Medigap") policies.)
08-21-2013
Advisory Opinion 13-11
(concerning two proposed arrangements involving the provision of emergency medical services for a township.)
08-16-2013
Advisory Opinion 13-10
(concerning a proposal to contract with hospitals to provide services to patients with certain diagnoses following hospital discharge with the goal of reducing preventable hospital readmissions.)
07-23-2013
Advisory Opinion 13-09
(concerning a proposal to offer members of a group purchasing organization ("GPO") an equity interest in the GPO's parent organization in exchange for the member: (1) extending its contract with the GPO for five to seven years; (2) committing not to decrease purchasing volume; and (3) relinquishing its right to a portion of the administrative fees that would otherwise have been passed through to the members.)
07-09-2013
Advisory Opinion 13-08
(concerning a fire protection district's policy of billing only individuals who reside outside the fire protection district for emergency medical services.)
07-01-2013
Advisory Opinion 13-07
(concerning a tiered rebate program in which the rebate tiers would be reached based on the combination of purchases of both Federally reimbursable products and non-Federally reimbursable products.)
06-27-2013
Advisory Opinion 13-06
(concerning the proposed use of a preferred hospital network as part of Medicare Supplemental Health Insurance ("Medigap") policies.)
06-21-2013
Advisory Opinion 13-05
(concerning an exclusive contract for emergency medical services and transports between a municipality and an ambulance company. The opinion addresses the aspect of the contract that requires the ambulance company to reimburse the municipality for a portion of the costs of providing emergency dispatch services.)
06-14-2013
Advisory Opinion 13-04
(concerning an arrangement among a county, a county health district, and various municipalities concerning the provision of non-emergency ambulance transportation services by the county health district.)
06-13-2013
Advisory Opinion 13-03
(concerning a clinical laboratory company’s proposal to establish a subsidiary that would contract with physician practices to enable the practices to provide laboratory services to the physicians’ patients who are not Federal health care program beneficiaries.)
06-11-2013
Advisory Opinion 13-02
(concerning a proposal to establish a limited liability company that would enter into arrangements with manufacturers and other entities to provide industrial orthotics for use by these entities' employees.)
03-26-2013
Advisory Opinion 13-01
(concerning the use of a hospital network as part of a Medicare Supplemental Health Insurance policy.)

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