DEPARTMENT OF HEALTH & HUMAN SERVICES
Office of Inspector General
Office of Counsel to the Inspector General
Cohen Building- Room 5527
330 Independence Ave., S.W.
Washington, D.C. 20201
[We redact certain identifying information and certain potentially privileged, confidential, or
proprietary information associated with the individual or entity, unless otherwise approved by the
August 17, 2001
August 24, 2001
[name and address redacted]
Re: Final Notice of Modification of OIG Advisory Opinion No. 98-5
Dear [name redacted]:
I am writing in reference to Office of Inspector General (“OIG”) Advisory Opinion No. 98-5,
which was issued to [name redacted] (the “Requestor”) on April 17, 1998. In OIG Advisory
Opinion No. 98-5, we concluded that the Requestor’s contract with a managed care organization
(in particular, its coordination of benefits provision, hereafter the “COB provision”) could violate
the anti-kickback statute, and we could not conclude that the COB provision posed little or no risk
of Federal health care program fraud and abuse.
In a more recent advisory opinion request involving the same contract and same managed care
organization, but a different requesting party, we were provided with additional information that
was not available at the time of the advisory opinion request for OIG Advisory Opinion No. 98-5.
The newer advisory opinion reaches a conclusion that requires a modification of OIG Advisory
Opinion No. 98-5. By letter dated February 12, 2001, the OIG provided the Requestor with a
Notice of Intent to Modify OIG Advisory Opinion No. 98-5 (the “Notice”). Pursuant to §
1008.45(a) of Title 42 of the Code of Federal Regulations, the OIG also provided the Requestor
with a reasonable opportunity to respond to the Notice. Accordingly, after issuance of the Notice,
the Requestor and the OIG exchanged several letters, documents, and telephone discussions over
the course of several weeks.
For the reasons more fully set forth in OIG Advisory Opinio