OIG Publishes Its First Advisory Opinion of 2026
The Department of Health and Human Services Office of Inspector General (“OIG”) published its first Advisory Opinion of 2026. Advisory Opinion 26-01 involves a Requestor’s proposed waiver of applicable cost-sharing amounts for eligible commercially insured individuals who receive the Requestor’s colorectal cancer screening laboratory test and who do not otherwise qualify for its financial assistance program. The Requestor would not offer or pay any remuneration to any provider ordering the test, and the cost-sharing waiver would be uniformly applied to all eligible individuals regardless of the provider ordering the test and would not be tied to any other health care item or service. Additionally, the OIG noted that since the Requestor would only offer the proposed waivers to commercially insured individuals, the risk of any costs associated with those waivers being shifted onto federal healthcare programs would be minimized, further distinguishing the Requestor’s proposal from other arrangements that attempt to “carve out” federal health care program business. The OIG ultimately concluded that the Requestor’s proposed waiver would not generate prohibited remuneration under either the federal anti-kickback or the prohibition on beneficiary inducements statutes, and, accordingly, the OIG would not impose administrative sanctions under either statute.
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