Alerts4.21.26
HHS-OIG Issues Favorable Advisory Opinion on Cost-Sharing Waivers by Domestic Crisis Provider Serving Domestic Violence Survivors
Highlights
- The HHS-OIG issued a favorable opinion on whether a state-designated domestic crisis provider could bill Federal health care programs for mental health therapy services to domestic violence survivors while waiving cost sharing for those services.
- The agency determined that although the proposed arrangement — if undertaken with the requisite intent — would generate prohibited remuneration under the AKS and Beneficiary Inducements CMP, it would present low risk of fraud and abuse based on several context-specific factors, including because the proposed arrangement was consistent with the provider’s historical mission to deliver its services to domestic violence survivors free of charge.
- However, HHS-OIG cautioned that this opinion does not upend its longstanding concerns about blanket cost sharing waivers.
The U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) released Advisory Opinion No. 26-06, a favorable opinion concluding that although a proposed arrangement in which a state-designated domestic crisis provider (the “Requestor”) would bill Federal health care programs for mental health therapy services furnished to domestic violence survivors — and waive any cost sharing for such services — would generate prohibited remuneration under the Federal Anti-Kickback Statute (“AKS”) and the Beneficiary Inducements Civil Monetary Penalty (“CMP”) if the requisite intent were present, HHS-OIG would not impose administrative sanctions given the low risk of fraud and abuse.
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