OIG Issues Advisory Opinion 25-03, A Roadmap for Compliant Telehealth Staffing Models

Caption: On June 6, 2025, the US Department of Health and Human Services’ Office of the Inspector General issued Advisory Opinion 25-03, offering key compliance guidance for telehealth arrangements involving the leasing of health care providers and other administrative services to a physician-owned professional corporation (PC). Learn more about the opinion and what it tells us about the future of telehealth regulatory compliance.

On June 6, 2025, the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) issued Advisory Opinion 25-03 (“AO 25-03”). The opinion offers key compliance guidance for telehealth arrangements that involve the leasing of healthcare providers and other administrative services to a physician-owned professional corporation (PC). This advisory opinion is a significant development for telehealth staffing and administrative service models, highlighting the growing role that Management Services Organizations (MSOs) play in supporting telehealth care delivery.

The Basics

AO 25-03 analyzes a proposed arrangement between two "Requestors" (Requestor Inc. and Requestor PC) and "Platform Entities" (Platforms and Platform PCs).

• Requestor Inc. and Requestor PC: Requestor Inc. is a management support organization that provides non-clinical management services to Requestor PC. Requestor PC is a physician-owned PC with multiple commercial health plan contracts, including Medicare Advantage and Medicaid managed care plans. Notably, Requestor PC does not directly employ or contract with clinical staff.
• Platform Entities: Platforms are MSOs that offer management services to telehealth providers, known as Platform PCs. These Platform PCs employ or contract with health care professionals (HCPs) who deliver various telehealth services, including those reimbursable by Federal health care programs, to patients through the Platform's website.

Under the proposed arrangement, Requestor PC would lease HCPs from a Platform PC. These leased HCPs would then provide telehealth services to Platform Patients covered by Requestor PC's insurance contracts. Additionally, a Platform would provide specific administrative services to Requestor PC, such as accounting, marketing, administrative support, and information technology services, including a HIPAA-compliant telehealth platform. Requestor PC would pay the Platform Entities a "Service Fee," comprising an hourly "HCP Lease Fee" (based on the HCP's licensure), and an "Administrative Fee" for the non-clinical administrative services.

OIG’s Analysis

The OIG's analysis focused on whether this proposed arrangement would generate prohibited remuneration under the Federal Anti-Kickback Statute (AKS). The AKS makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce, or in return for, the referral of an individual for services reimbursable under a Federal health care program.

The Requestors certified that the Service Fee's methodology would be set in advance, consistent with fair market value in arm's-length transactions, and crucially, would not be determined based on the volume or value of any referrals or business generated between the parties where payment could be made, in whole or in part, under a Federal health care program. Furthermore, the HCP Lease Fee would be paid regardless of whether Requestor PC was ultimately reimbursed by third-party payors.

The OIG ultimately concluded that the proposed arrangement, if undertaken as described, would not generate prohibited remuneration under the AKS. This favorable opinion was based on the Requestors' certification that the arrangement would meet all the conditions of the safe harbor for personal services and management contracts and outcomes-based payment arrangements.

Why It Matters

This advisory opinion is a positive step forward for telehealth staffing and administrative service models. It provides valuable insights for telehealth providers and organizations considering similar arrangements. However, it's crucial to remember that OIG opinions are tailored specifically to the parties involved, and should not be relied upon as legal guidance for those seeking to design similar arrangements.

Key Takeaways

For telehealth providers and organizations considering or participating in similar arrangements, a robust compliance framework is essential to reduce legal risk. Before entering into any agreement, consider the following:

• Monitor Regulatory Changes: The telehealth regulatory landscape is constantly evolving. Staying up to date on the latest guidance from the OIG and other federal regulators is critical to ensure ongoing compliance.
• Review All Agreements Thoroughly: Not all telehealth arrangements are created equal. A meticulous review of the specifics of any proposed arrangement, particularly the provider payment structure, is essential to ensure compliance with federal fraud and abuse laws, including the Anti-Kickback Statute.
• Make a Plan for Ongoing Oversight: Compliance isn't a destination; it's an ongoing journey. Having a robust compliance plan in place is the best way to proactively identify risks. Regularly reviewing referral agreements is key to ensuring continued compliance as healthcare regulations change.
• Engage Legal Counsel: Navigating telehealth regulations has become vastly more complicated for telehealth providers. Engaging knowledgeable, trusted compliance attorneys can provide the peace of mind you need to practice with confidence.

At Health Law Alliance, our compliance experts have decades of experience developing and managing compliance programs, from small practices to Fortune 100 healthcare companies. With our attorneys, you can trust that your practice will be prepared for anything. Call us today and see how we can help you.