Friday, April 28, 2006
HHS OIG Advisory Opinion: Non-profit's assistance to Part D beneficiaries is not prohibited remuneration
The Office of the Inspector General, HHS, has issued an advisory opinion regarding premium and co-pay assistance provided to Part D beneficiaries by a non-profit entity. Here's a summary from the letter:
We are writing in response to your request for an advisory opinion regarding a nonprofit, tax-exempt, charitable corporation’s proposal to provide financially needy Medicare beneficiaries with assistance with premiums and cost-sharing obligations under Medicare Part B, Medicare Part D, Medigap (as hereinafter defined), and Medicare Advantage (the“Proposed Arrangement”). Specifically, you have inquired whether the Proposed Arrangement would constitute grounds for sanctions under the civil monetary penalty provision prohibiting inducements to beneficiaries, section 1128A(a)(5) of the Social Security Act (the “Act”), or under the exclusion authority at section 1128(b)(7) of 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, the anti-kickback statute.
Based on the facts certified in your request for an advisory opinion and supplemental
submissions, we conclude that: (i) [Requestor’s name redacted’s] Proposed Arrangement would not constitute grounds for the imposition of civil monetary penalties under section 1128A(a)(5) of the Act; and (ii) while [Requestor’s name redacted’s] Proposed Arrangement could potentially generate prohibited remuneration under the anti-kickback statute, if the requisite intent to induce or reward referrals of Federal health care program business were present, the Office of Inspector General (“OIG”) would not impose administrative sanctions on [Requestor’s name redacted] under sections 1128(b)(7) or 1128A(a)(7) of the Act (as those sections relate to the commission of acts described in section 1128B(b) of the Act) in connection with the Proposed Arrangement. This opinion is limited to the Proposed Arrangement and, therefore, we express no opinion about any ancillary agreements or arrangements disclosed or referenced in your request letter or supplemental submissions.
This opinion may not be relied on by any persons other than [name redacted], the requestor of this opinion, and is further qualified as set out in Part IV below and in 42 C.F.R. Part 1008.
The full opinion letter is available at http://www.oig.hhs.gov/fraud/docs/advisoryopinions/2006/AdvOpn06-04A.pdf