Ways and Means Committee Seeks Information Regarding OPO Activities

On April 16, 2025, the Committee on Ways and Means in the U.S. House of Representatives issued a letter to the public requesting information regarding Organ Procurement Organizations (OPOs)—the nonprofit, tax-exempt entities responsible for procuring and preserving transplantable organs and directing them to hospital transplant centers. The Committee’s inquiry follows public reporting, congressional investigations, and ongoing federal investigations that raise questions as to whether OPOs are operating in a manner consistent with the laws and regulations that govern such organizations and whether taxpayer funds are paying for activities that are outside these organizations’ tax-exempt purpose. The request for information seeks to solicit input from stakeholders and the public to more effectively evaluate the conduct of certain tax-exempt OPOs under Section 501(c)(3) of the Internal Revenue Code.

By statute, qualified OPOs must operate as nonprofit entities, and all fifty-five OPOs currently hold tax-exempt status under Section 501(c)(3) of the Internal Revenue Code. OPOs also receive reimbursement from Medicare at 100% of cost for certain costs classified as allowable under program regulations. Specifically, the Medicare program reimburses OPOs for the cost of procuring kidneys. OPOs do not bill Medicare directly for organ procurement services related to kidneys. Instead, they are paid a standard acquisition charge from the transplant center (or other OPO) that acquires that kidney. The payment of the standard acquisition charge from the transplant center also serves as an interim payment to the OPO until the end of the cost year. At the end of the cost year, the OPO will submit its Medicare cost report to reconcile the interim payments and the OPO’s kidney-related costs. Any overpayments or underpayments relative to the kidney costs are settled and the Medicare contractor will either recoup or make a payment to the OPO. In sum, Medicare will cover 100% of the OPO’s costs of procuring kidneys, but will not reimburse an OPO for more than its kidney procurement costs.

The Committee’s public letter states that it is aware of several reports and investigations alleging that certain OPOs are engaging in non-mission critical activities, seeking Medicare reimbursement for those activities, and misallocating financial resources in ways that undermine their core mission and harm patient care. The Committee purportedly seeks to ensure that taxpayer dollars allocated to organ transportation and donation services are not subject to waste, fraud, and abuse or otherwise directed to the private benefit of OPO executives and donors.

The Committee’s letter identifies the following wide-ranging questions related to OPO activities:

1. Are you aware of any OPOs that are reporting unallowable costs?
   1. For example, are you aware of any OPOs that have received Medicare reimbursement for organs that were sent to foreign countries?
2. Are you aware of OPOs that have used organ-transport jets for personal use?
   1. If so, are you aware if the OPO(s) included the trip(s) on their MCRs?
   2. If so, are you aware of whether the individual(s) who benefited from the use of the jet is affiliated with the organization?
   3. If so, are you aware of whether the individual(s) who benefited from the use of the jet paid a reasonable value for the use of the jet?
   4. If so, are you aware of whether the private use of the jet made the OPO(s) unable to properly deliver organs for transplant?
3. Do you have knowledge of OPOs that have used the organization’s assets to provide private benefit(s) to executive officers, employees, or donors?
   1. If so, are you aware of whether the OPO(s) included the use of the asset(s) on their MCRs?
   2. If so, are you aware of whether the individual(s) who benefited from the use of the asset(s) is affiliated with the organization?
   3. If so, are you aware of whether the individual(s) who benefited from the use of the asset(s) paid a reasonable value for the use of the asset(s)?
4. Does the private use of an asset controlled by a 501(c)(3) organization, such as an OPO, correlate to an excess benefit or excess benefit transaction under 26 U.S.C. § 4958?
5. Does the IRS sufficient authority to oversee and collect information from OPOs related to the use of assets for non-mission-critical activities?
6. Are you aware of any OPO that provides benefits to its executive officers that are unreported in the organization’s Form 990?
7. Are you aware of any OPOs whose CEO or other executives received reported income that would cause the OPO to be taxed under 26 U.S.C. § 4960?
   1. If so, does that income correlate to a well-run OPO? Does that CEO provide a reasonable benefit to the OPO to call for that specific salary?
8. Are you aware of the executive salary for tax-exempt organizations that are similarly situated to OPOs, with the same educational and experiential requirements?
9. Should the salary of an OPO executive officer be subject to the performance of the OPO as a whole?
   1. If so, is the CMS tier rating system for OPOs the appropriate metric for determining salary caps for OPO CEOs?
   2. If so, and if the CMS tier rating system for OPOs is insufficient, what recommendations can you provide related to what would be the appropriate metric to connect CEO salary to an OPO’s performance?
10. Are you aware of OPOs that are organized as 501(c)(3) tax-exempt entities that have made asset purchases or other transactions that would raise concern regarding their tax-exempt status?
11. Are you aware of OPOs that are organized as 501(c)(3) tax-exempt entities that have been approved for a merger by CMS, while failing to comply with the merger standards set by CMS, the requirements for OPO designation, or to enrich the organization, board members, or executives or otherwise operating outside of the purpose of their tax-exempt status?
12. Are you aware of OPOs that perform business dealings or activities that could be considered financial conflicts of interest?
    1. Specifically, do any of these financial conflicts of interests directly conflict with an OPOs standing goal to procure organs for patients in need?
    2. Are there any requirements in the IRC or federal tax regulations that prohibit tax-exempt organizations from taking part in activities that create financial conflicts of interest for the organization?
13. Are you aware of the business structure of OPOs that operate independent donor care units or organ recovery centers and whether those are separate entities that receive the OPO’s tax-exempt status?

Comments are due to the Committee by May 16, 2025.

The Committee’s letter is available here.