On April 9, 2025, OIG posted Advisory Opinion No. 25-02, a favorable advisory opinion allowing a community health center operating under Section 330 of the Public Health Service Act (the Requestor) to ask individuals, to whom the Requestor is providing non-medical services, if they need primary health care services, provide them with a list of primary health care providers that includes the Requestor, and schedule an appointment for them to receive those services from the Requestor.
The Requestor’s Situation
Community health centers that operate under Section 330 of the Public Health Service Act (42 U.S.C. § 254b), like the Requestor, are required to be nonprofit or public entities that provide certain health care services, including primary health care services, and other services to underserved populations, regardless of their ability to pay. Consistent with the Public Health Service Act, the Requestor provides primary health care services and certain non-medical, social, and educational services (e.g., child care, food banks and meals, employment and education counseling, and legal services) to those underserved populations. With formal approval, the Requestor also offers programs that replace locks to address safety concerns for victims of crimes and provide diapers, books, toys, and baby gear for children under age 6. According to the Requestor, individuals that access these programs do not seek health care services from the Requestor, even if they need them, because they do not understand how or do not believe they have the financial means to do so. The Requestor proposed the following Arrangement to address those unmet primary health care needs.
The Arrangement
At the time individuals receive those additional, non-medical services from the Requestor, the Requestor would ask if they have seen a primary care provider within the last year and, if they have not, provide them with a list of providers (that includes the Requestor, but does not promote the Requestor) in alphabetical order. The Requestor would add any willing providers, who request inclusion, to the list. For individuals who elect to receive primary care services from the Requestor, the Requestor would schedule their appointment. For individuals who decline primary care services from the Requestor, the Requestor would continue to provide their additional, non-medical services.
OIG’s Determination
Although the Arrangement would generate—if the requisite intent were present—prohibited renumeration under section 1128B(b) of the Social Security Act (the Federal anti-kickback statute) and prohibited renumeration under section 1128A(5) of the Social Security Act (the Beneficiary Inducements CMP), OIG concluded that it would not impose administrative sanctions on the Requestor in connection with the Arrangement under: sections 1128A(a)(7) or 1128(b)(7) of the Social Security Act, as they relate to the commission of acts described in the Federal anti-kickback statute; and the Beneficiary Inducements CMP or section 1128(b)(7) of the Social Security Act, as it relates to the commission of acts described in the Beneficiary Inducements CMP.
OIG’s Reasoning
The Arrangement includes a variety of safeguards that reduce the risk of steering patients to the Requestor (i.e., objective criteria to identify individual’s need for primary care services; list of primary care providers will be alphabetical and will not promote the Requestor; list will include options beyond the Requestor and the Requestor will add willing providers to the list; refusal to obtain the Requestor’s primary care services will not impact the individuals’ receipt of additional, non-medical services). The Arrangement may increase access to health care services, which aligns with the Requestor’s designation as a community health center pursuant to Section 330 of the Public Health Service Act.
The full text of OIG Advisory Opinion No. 25-02 is available here.
