Optional_2023 Board Resources

(q)

Remuneration between a cooperative hospital service organization (CHSO) and its patron-hospital where the CHSO is wholly owned by multiple patron-hospitals; Returns on investment interests in an ambulatory surgical center; Price reductions offered to eligible managed care organizations; Price reductions offered by contractors with substantial financial risk to managed care organizations; Referral arrangements for specialty services;

(r) (s) (t) (u) (v) (w) (x)

Ambulance replenishing;

Certain remuneration to a federally qualified health center; Nonmonetary remuneration consisting of items and services in the form of hardware, software, or information technology and training services used solely to receive and transmit electronic prescription information; Nonmonetary remuneration used predominantly to create, maintain, transmit, or receive electronic health records; Remuneration between a federally qualified health center and a Medicare Advantage organization; (aa) Discounts for certain beneficiaries under the Medicare Coverage Gap Discount Program; and (bb) Free or discounted local transportation provided to certain beneficiaries. 1.4 Advisory Opinion Process . Given the breadth of the statute, Congress authorized the OIG to produce advisory opinions regarding whether particular transactions would run afoul of AKS. 7 The OIG provides a checklist for advisory opinion requests on its website. 8 OIG has issued scores of advisory opinions, each of which is published on the agency's website. 9 OIG is not authorized to opine on whether remuneration reflects fair market value or whether a person is a bona fide employee. Technically, an advisory opinion is binding only on HHS and the party requesting the opinion. Practically, however, the analysis and guidance set forth in the opinions functions as informal guidance offering useful insight into how OIG interprets the AKS and applies its facts and circumstances analysis. Since DOJ also participates in the review of advisory opinions, the opinions likewise provide helpful insight into the AKS positions DOJ may take in an investigation. Following the approach and safeguards in an advisory opinion would assist in negating the government's ability to establish a knowing and willful AKS violation. 1.5 OIG Bulletins, Fraud Alerts, Compliance Program Guidance, and Other Guidance . Periodically, OIG issues various forms of guidance to the health care industry on fraud and abuse issues and risk areas. 10 Some of these guidance documents, such as Special Fraud Alerts and Bulletins, are based on practices or trends identified in investigations or other 7 42 U.S.C. § 1320a-7d(b). 8 “Preliminary Checklist for Advisory Opinion Requests,” Office of Inspector General: U.S. Department of Health and Human Services , available at https://oig.hhs.gov/fraud/docs/advisoryopinions/precheck.htm (last accessed August 8, 2017). 9 https://oig.hhs.gov/compliance/advisory-opinions/index.asp (last accessed August 28, 2017). 10 https://oig.hhs.gov/compliance/alerts/index.asp (last accessed August 28, 2017). (y) (z)