Cms Premium Iol

DEPARTMENT OF HEALTH & HUMAN SERVICES

Office of Inspector General

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 requestor.]

Issued: Posted:

September 30, 2011 October 7, 2011

[Name and address redacted] Re: OIG Advisory Opinion No. 11-14 Dear [Name redacted]: We are writing in response to your request for an advisory opinion regarding a proposal for ophthalmologists in a group practice to co-manage cataract surgery patients, including Medicare beneficiaries, with optometrists external to that group practice who would separately charge the beneficiaries for services related to premium refractive intraocular lenses that are not covered by the Medicare program (the “Proposed Arrangement”). Specifically, you have inquired whether the Proposed Arrangement would constitute grounds for the imposition of sanctions under the exclusion authority at section 1128(b)(7) of the Social Security Act (the “Act”), or the civil monetary penalty provision at section 1128A(a)(7) of the Act, as those sections relate to the commission of acts described in section 1128B(b) of the Act, the Federal anti-kickback statute. You have certified that all of the information provided in your request, including all supplemental submissions, is true and correct and constitutes a complete description of the relevant facts and agreements among the parties. In issuing this opinion, we have relied solely on the facts and information presented to us. We have not undertaken an independent investigation of such information. This opinion is limited to the facts presented. If material facts have not been disclosed or have been misrepresented, this opinion is without force and effect.

Page 2 – OIG Advisory Opinion No. 11-14 Based on the facts certified in your request for an advisory opinion and supplemental...