When people think of kickbacks, they imagine envelopes under tables and not cloud-based platforms selling digital ads and scheduling tools. But Advisory Opinion 25-03 shows how gray it really gets.
A management company may lease doctors and provide services like marketing, billing, and tech platforms to a separate physician practice. That practice uses its insurance contracts—Medicare Advantage included—to bill for care provided by the leased docs.
Sounds like a setup that would trigger the Anti-Kickback Statute, right? OIG says: not if it’s structured carefully.
Why does this matter?
Pharma companies, medical device firms, and digital health startups increasingly rely on similar arrangements, especially for direct-to-patient initiatives. If your hub service, PAP program, or telehealth partner contracts resemble this setup, you’re playing in the same compliance sandbox.
Here’s what kept this structure safe:
- Contracts were written, signed, and set for at least a year.
- Fees were fixed in advance, tied to FMV, and not influenced by patient volume.
- Payment was due regardless of reimbursement success.
- Marketing, scheduling, and even IT services were included, but separated from referral behavior.
- The leased HCPs weren’t “steered” based on payor overlap.
So what’s the Takeaway?
This opinion doesn’t say every marketing or leasing arrangement is safe. It says some are—if you check the right boxes. This also creates a roadmap for structuring digital health partnerships without triggering federal enforcement. Still, there’s risk.
The OIG’s analysis stops at federal law. You still need to deal with:
- Stark Law
- State fee-splitting bans
- Corporate practice of medicine doctrines
- Licensing
- Data use and privacy
My take?
This opinion is a green light with a yellow warning. It gives savvy companies room to build patient access programs that scale as long as you bring in legal early. If you’re unsure if your structure passes muster, let’s talk. We help digital platforms, telehealth providers, and pharma companies navigate these waters.
Reach out to the Kulkarni Law Firm, P.C. . Let’s keep your good idea from becoming a government investigation.
