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Advisory
Opinions
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2004
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10/12/04
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Advisory
Opinion 04-13 PDF (concerning
a municipal corporation that owns and operates an
ambulance service and that
proposes to treat revenue received from local real
estate taxes as payment of otherwise applicable cost-sharing
amounts due from residents)
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09/28/04 |
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Advisory Opinion 04-12 PDF (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) |
09/09/04
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Advisory Opinion 04-11 PDF (concerning
a proposed arrangement to subsidize malpractice insurance expenses for four community-based obstetricians)
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08/11/04
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Advisory Opinion 04-10 PDF (concerning
a county's proposal to enter into an exclusive arrangement for emergency ambulance services, with
payment by the second responder to the first responder for the first responder's services)
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07/22/04
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Advisory Opinion 04-09 PDF (concerning
a geriatric group practice’s proposal to employ certain primary care physicians to serve
as consultants in connection with the group’s nursing home patients)
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06/30/04
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Advisory Opinion 04-08 PDF (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)
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06/24/04
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Advisory Opinion 04-07 PDF (concerning
a health system’s provision of professional consultative
services to low-income schoolchildren in predominantly rural areas through a sponsored telemedicine
network)
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06/14/04
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Advisory Opinion 04-06 PDF (concerning
a municipal corporation that is proposing to reduce
its fees for ambulance
services for residents by an amount consistent with
their cost-sharing obligations)
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06/09/04
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Advisory
Opinion 04-05 PDF (concerning
participation as a volunteer pathology laboratory
for a charitable foundation’s medical assistance
program for low-income, uninsured patients)
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06/02/04
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Advisory
Opinion 04-04 PDF (concerning
a proposed program to provide free vision screening
tests for infants)
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06/01/04
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Advisory
Opinion 04-03 PDF (concerning
a marketing company’s arrangement to design,
develop, and implement physician surveys conducted
on behalf of pharmaceutical firms)
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03/08/04
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Advisory
Opinion 04-02 PDF (concerning
a proposal by a political subdivision of a municipality
that owns and operates an ambulance service to treat
revenue received from a special utility assessment
as payment of otherwise applicable cost-sharing amounts
due from residents)
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02/09/04
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Advisory
Opinion 04-01 PDF(concerning
the waiver of Part B cost-sharing obligations for
equipment and supplies used by Medicare beneficiaries
to monitor blood glucose levels in a clinical trial
sponsored by the National Institutes of Health)
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2003
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12/18/03
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Advisory
Opinion 03-15 PDF (concerning
a proposal to reintegrate a medical group and a hospital
that were originally a single entity and whether
the proposed arrangement would violate the anti-kickback
statute)
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07/03/03
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Advisory
Opinion 03-14 PDF (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)
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06/23/03
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Advisory
Opinion 03-13 PDF (concerning
whether a joint venture ownership of a freestanding
magnetic resonance imaging center in a rural area
could potentially violate the anti-kickback statute)
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05/29/03
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Advisory
Opinion 03-12 PDF (concerning
a proposed joint venture between a medical center
and a radiology group to own and operate an outpatient
open magnetic resonance imaging facility)
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05/28/03
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Advisory
Opinion 03-11 PDF (concerning
an ambulance company's proposed arrangement to collect
a fixed annual subscription fee in lieu of Medicare
Part B cost-sharing amounts from its members)
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05/15/03
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Advisory
Opinion 03-10 PDF (concerning
a proposed arrangement by which a Medigap plan would
indirectly contract with hospitals for discounts
on the otherwise applicable Medicare inpatient deductibles
for its policyholders and would also, at the time
of the next policy renewal, reduce the premium for
policyholders utilizing a network hospital for an
inpatient stay)
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04/25/03
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Advisory
Opinion 03-9 PDF (concerning
a proposed arrangement by which a municipal corporation
that owns and operates an ambulance service would
treat revenue received from local real estate taxes
as payment as applicable copayments/deductibles due
from residents)
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04/10/03
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Advisory
Opinion 03-8 PDF (concerning
a proposed arrangement that would involve a company
developing and managing distinct part inpatient rehabilitation
units located within general acute care hospitals
in exchange for a management fee calculated on a
per patient per day basis)
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03/26/03
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Advisory
Opinion 03-7 PDF (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)
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03/26/03
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Advisory
Opinion 03-6 PDF (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)
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02/13/03
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Advisory
Opinion 03-5 PDF (concerning
a proposed ambulatory surgical center (ASC) arrangement
that would be jointly owned by a hospital and a multi-specialty
group practice with a substantial number of physician
members who would not personally use the ASC.)
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02/12/03
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Advisory
Opinion 03-4 PDF (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)
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02/12/03
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Advisory
Opinion 03-3 PDF (concerning
a proposed modification to a drug company's patient
assistance program to pay Medicare Part B cost-sharing
amounts for financially needy beneficiaries following
surgery)
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01/21/03
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Advisory
Opinion 03-2 PDF (concerning
a medical center's proposed acquisition of an ownership
interest in an established single-specialty [orthopedic]
ambulatory surgery center, together with the execution
of a series of related ancillary contracts.)
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01/21/03
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Advisory
Opinion 03-1 PDF (concerning
the potential for the imposition of sanctions against
a company which has made a good faith offer of employment
to an excluded individual.)
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2002
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01/03/03
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Advisory
Opinion 02-16 PDF (concerning
the waiver of Part B cost-sharing obligations for
equipment and supplies used by Medicare beneficiaries
to monitor blood glucose levels in a clinical trial
sponsored by the National Institutes of Health)
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10/07/02
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Advisory
Opinion 02-15 PDF (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)
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10/07/02
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Advisory
Opinion 02-14 PDF (concerning
whether a proposed program to provide free safety
equipment to hemophilia patients, as well as free
electronic pagers to the parents of pediatric hemophilia
patients, would violate section 1128A(a)(5) of the
Social Security Act)
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10/04/02
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Advisory
Opinion 02-13 PDF (concerning
whether a proposed arrangement involving financial
assistance by a non-profit foundation, which a pharmaceutical
company proposes to establish and fund in order to
subsidize cost-sharing amounts incurred by financially
needy patients using its drug, would violate the
administrative authorities related to the anti-kickback
statute)
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08/30/02
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Advisory
Opinion 02-12 PDF (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)
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08/20/02
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Advisory
Opinion 02-11 PDF (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)
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08/07/02
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Advisory
Opinion 02-10 PDF (concerning
whether the offering of discounts to customers, based
on their purchases of dialysis equipment and supplies
- some of which 05/be reimbursed under different
Medicare part B methodologies - would violate the
administrative authorities related to the anti-kickback
statute)
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06/21/02
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Advisory
Opinion 02-9 PDF (concerning
whether a proposed single-specialty ambulatory surgical
center that would be wholly-owned by a physician
would violate the administrative authorities related
to the anti-kickback statute)
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06/19/02
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Advisory
Opinion 02-8 PDF (concerning
whether a political subdivision of a State that owns
and operates an ambulance service can treat operating
revenues received from local taxes as payments of
applicable copayments and deductibles due from residents)
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06/11/02
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Advisory
Opinion 02-7 PDF (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)
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05/22/02
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Advisory
Opinion 02-6 PDF (concerning
whether a proposal to offer a refund program to hospital
consumers who purchase the hospital's blood-filtering
device for treatment of rheumatoid arthritis would
constitute grounds for the imposition of sanctions
under the OIG's exclusion and civil money penalty
authorities)
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05/14/02
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Advisory
Opinion No.02-5 PDF (concerning
whether the proposed reorganization of an existing
radiation oncology group
practice would violate the administrative authorities
related to the anti-kickback statute)
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04/26/02 |
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Advisory
Opinion No. 02-4 PDF (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) |
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04/4/02
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Advisory
Opinion No. 02-3 PDF (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)
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04/4/02
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Advisory
Opinion No. 02-2 PDF (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)
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04/4/02
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Advisory
Opinion No. 02-1 PDF (concerning
a non-profit, tax-exempt, charitable corporation
funded largely by drug companies that would provide
financial assistance to subsidize, in whole or in
part, the Part B cost-sharing amounts and Medigap
premiums of financially needy Medicare beneficiaries
suffering from relatively rare chronic diseases)
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2001
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11/26/01
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Advisory
Opinion No. 01-21 PDF(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.)
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11/21/01
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Advisory
Opinion No. 01-20 PDF(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.)
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11/21/01
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Advisory
Opinion No. 01-19 PDF(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.)
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11/7/01
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Advisory
Opinion No. 01-18 PDF(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.)
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10/17/01
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Advisory
Opinion No. 01-17 PDF(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).
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10/5/01
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Advisory
Opinion No. 01-16 PDF(concerning
a managed care organization's employment of an excluded
individual and potential sanctions under section
1320a-7a(a)(6) of the SSA)
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09/27/01
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Advisory
Opinion No. 01-15 PDF(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...)
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09/4/01
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Advisory
Opinion No. 01-14 PDF(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.
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08/24/01
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Advisory
Opinion No. 01-13 PDF(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"...)
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08/24/01
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Final
Notice of Modification of OIG Advisory Opinion No.
98-5 PDF (concerning
Advisory Opinion No. 98-5, which was issued on 04/17,
1998. In OIG Advisory Opinion No. 98-5, we concluded
that the Requestor's contract with a managed care
organization (in particular, its coordination of
benefits provision, hereafter the "COB provision")
could violate the anti-kickback statute, and we could
not conclude that the COB provision posed little
or no risk of Federal health care program fraud and
abuse.
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07/26/01
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Advisory
Opinion No. 01-12 PDF(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...)
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07/26/01
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Advisory
Opinion No. 01-11 PDF(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...)
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07/26/01
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Advisory
Opinion No. 01-10 PDF (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...)
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07/26/01
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Advisory
Opinion No. 01-09 PDF(concerning
a proposed grant from a hospital to a community health
center to defray the costs of providing services
to uninsured patients...)
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07/10/01
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Advisory
Opinion No. 01-8 PDF(...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...)
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07/3/01
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Advisory
Opinion No. 01-7 PDF(
concerning the practice of accepting reimbursement
from third-party payors plus certain payments...)
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05/29/01
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Advisory
Opinion No. 01-6 (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."
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05/23/01
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Advisory
Opinion No. 01-5 PDF(concerning "a
proposed lease of cardiac diagnostic equipment to
emergency medical services providers for a nominal
charge.")
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05/10/01
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Advisory
Opinion No. 01-4 PDF(concerning "a
proposed arrangement between a hospital and a new
physician whom the hospital would like to recruit
to practice within its service area.")
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05/10/01
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Advisory
Opinion No. 01-3 PDF(concerning "whether
proposed contracts for discounted services between
a Federally-recognized Indian tribe and local hospitals
would constitute grounds for the imposition of exclusions
under section 1128(b)(7) of the Act or civil money
penalties under section 1128A(a)(7) of the Act.")
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03/27/01
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Advisory
Opinion No. 01-2 PDF(concerning
an annual charity golf tournament for which some
of its vendors and suppliers pay money as sponsors
and tournament participants...)
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01/18/01
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Advisory
Opinion No. 01-1 PDF(concerning
a proposed arrangement in which a hospital will share
with a group of cardiac surgeons a percentage of
the hospital's cost savings...)
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