The HHS Office of the Inspector General explains its criteria for physicians investing in rural MRI centers in a new advisory opinion.
The opinion, issued Monday, responds to a question from physician-investors in an unidentified rural MRI center as to whether their arrangement violates the Medicare anti-kickback statute.
The OIG concludes that the center does not violate the law, even though the center is not protected by a safe harbor from the anti-kickback law applying to rural entities.
Although the center is in a rural area, the OIG says the rural safe harbor applies only to a facility in a medically underserved area and that physicians can own no more than 50% of the facility--two factors that do not apply the applicant.
But the opinion adds that "while the (applicant's) arrangement poses some risk, a combination of factors exists that renders that risk sufficiently low."
In that arrangement, the OIG notes that "all potential investors, both physicians and non-physicians, were offered the opportunity to purchase investment interests on the same terms and conditions."
Also, the center's financial structure does not have "suspect characteristics" that the OIG identified in a 1989 alert, such as nominal capital contributions, disproportionate return on investment or selective investment opportunities based on referral volumes, the opinion states.
Finally, "the arrangement was developed as a community-oriented effort to provide access to MRI services in the rural three-county area and has provided a substantial community benefit," the OIG states.