OIG Advisory Opinion No. 25-02
Favorable opinion regarding an arrangement whereby Requestor— designated as a community health center pursuant to Section 330 of the Public Health Service Act—proposes, during the provision of certain social services to individuals, to: (1) identify individuals in need of primary care services; (2) inform them of the availability of such services; and (3) schedule an appointment for them to receive primary care services from Requestor or refer them to a local primary care provider.
🔍 What’s the Issue?
A federally designated Community Health Center (the “Requestor”) asked the Office of Inspector General (OIG) if it could legally do the following as part of its community outreach:
- Identify individuals in need of primary care during their visits for social services (like childcare, food, or safety support).
- Inform them about available primary care providers.
- Help them schedule appointments—either with the Health Center itself or another local provider.
They wanted to make sure this setup wouldn’t violate federal anti-kickback laws or other rules meant to prevent improper patient referrals.
🏥 Background on the Health Center
- Offers free or low-cost medical and social services to underserved communities.
- Also gives out non-healthcare goods, like diapers, books, and help for crime victims.
- Many people come for the social services but don’t realize they can also get affordable medical care there.
⚖️ Legal Concerns
two key laws at play:
- Anti-Kickback Statute – Prohibits giving something of value to induce someone to use federally funded healthcare services.
- Beneficiary Inducements CMP – Prohibits offering free stuff to patients to influence their choice of healthcare provider.
✅ OIG’s Conclusion: Allowable with conditions
OIG said they will not impose penalties because:
- The Health Center does not push patients to choose them—they provide a neutral list of providers in alphabetical order.
- Other providers can be included on the list (“any willing provider” rule).
- People can still get social services even if they don’t want or need healthcare.
- The goal is to connect underserved people with care they might otherwise skip due to cost or confusion.
OIG found the setup aligns with the Health Center’s mission to help underserved populations and isn’t a scheme to inappropriately gain more patients.
🚦 Bottom Line
The arrangement is legally allowable as long as it’s carried out fairly and transparently. The Health Center must stick to the safeguards they promised—neutral lists, no pressure to choose them, and full freedom for individuals to pick any provider or none at all.
Data Privacy
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- HIPAA compliance faces significant changes in 2025 as HHS implements new security measures following a 264% increase in ransomware attacks in 2024. The Office for Civil Rights is enforcing stricter security risk analysis requirements while proposing updates to the HIPAA Security Rule that would mandate technical improvements like encryption and multifactor authentication. Patient access rights remain a priority with multiple enforcement actions in 2024-2025, alongside new information blocking rules effective December 2024. Additionally, HHS issued a final rule protecting reproductive health care information privacy in December 2024, though this faces legal challenges from Texas in federal court.
False Claims Act
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Medicare Reimbursement
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Mergers & Acquisitions
- The U.S. Department of Health and Human Services is closing six of its ten Office of the General Counsel regional offices and reducing its workforce by 20,000 employees. This consolidation will likely cause disruptions to Change of Ownership approvals needed for healthcare mergers and acquisitions, as well as delays in enforcement actions and compliance determinations. The four remaining OGC offices will redistribute workload across larger geographic areas, potentially resulting in loss of localized expertise and creating challenges for Medicare contractors. Healthcare investors and providers are advised to consult with experienced attorneys to navigate these changes and minimize transaction disruptions.
- The Texas House of Representatives introduced House Bill 2747, requiring health care entities to provide 90-day advance notice to the Texas Attorney General for transactions resulting in material ownership, operations, or governance changes. The bill, which would take effect September 1, 2025 if passed, applies to a broad range of health care entities including providers, facilities, provider organizations, and pharmacy benefit managers. The legislation grants the Texas Attorney General power to conduct market studies on health care market conditions and transaction impacts, with violations potentially resulting in a $10,000 civil penalty. Texas joins numerous states implementing increased oversight of health care transactions, with common focus on competition, market concentration, and care quality.