By: Christopher Parrella, Esq., CPC, CHC, CPCO
Parrella Health Law, Boston, MA
A Health Care Provider Defense and Compliance Firm

A new advisory opinion from the HHS Office of Inspector General (OIG) offers critical clarity for healthcare entities leveraging telehealth platforms through management services organizations (MSOs). Advisory Opinion 25-03 (June 6, 2025) concludes that a leasing and administrative services arrangement between a physician-owned professional corporation and telehealth platform MSOs would not generate prohibited remuneration under the federal Anti-Kickback Statute (AKS)—but only because it met every condition of the personal services and management contracts safe harbor.

This opinion is a major win for telehealth stakeholders and MSOs alike, particularly those navigating the murky waters of federal healthcare program compliance. However, it also underscores the importance of structuring these models meticulously particularly when federal payors are involved.

The Arrangement: Leasing Providers + Admin Services

In the proposed model, a physician-owned PC (Requestor PC) enters into agreements with third-party MSO platforms (Platform Entities) to:

• Lease healthcare professionals (HCPs) from a telehealth provider affiliated with the platform.
• Receive non clinical administrative services, such as scheduling, patient communications, IT support, marketing, and billing assistance.

Requestor PC then bills federal payors (e.g., Medicare Advantage, Medicaid managed care) under its own contracts for services rendered by these leased HCPs. In exchange, Requestor PC pays a fixed, hourly “HCP Lease Fee” and a separate “Administrative Fee.” Importantly, these fees are:

• Set in advance,
• Consistent with fair market value, and
• Not tied to the volume or value of referrals.

Why the Arrangement Passed OIG Scrutiny

The OIG’s approval hinges entirely on the arrangement’s alignment with the AKS safe harbor for Personal Services and Management Agreement under 42 C.F.R. § 1001.952(d)(1). Among other things, Requestors:

• Executed written agreements lasting at least one year;
• Defined all services in detail;
• Used an independent third-party to validate fair market value;
• Paid the lease fee regardless of whether the services were reimbursed; and
• Excluded any arrangement that would steer patients or compensate based on business generated between parties.

OIG emphasized that compliance with these conditions significantly reduces fraud and abuse risk particularly because the payment methodology doesn’t incentivize referrals.

What This Means for the Health Care Industry

If you’re running an MSO that leases clinical staff or provides turnkey infrastructure to a telehealth platform or you’re a provider billing federal programs under a similar model this opinion provides a potential defensible path forward. But it also serves as a reminder:

• Leasing models involving federal payors must be airtight. Any deviation from the required elements of the safe harbor (e.g., performance-based incentives or variable fee schedules tied to claim volumes) could trigger liability.
• Always validate FMV independently. The OIG can’t opine on valuation, so it’s critical to use reputable valuation firms and to document the FMV rationale.
• Document everything. From written agreements to credentialing processes to internal audits, your paper trail matters in a compliance audit or enforcement action.

Telehealth + MSO + AKS = Proceed with Caution

This advisory opinion is particularly relevant for digital health companies that integrate telehealth into MSO or platform structures. Given increasing DOJ and OIG scrutiny of arrangements between MSOs, provider networks, and payors, this green light offers a roadmap but not a free pass. It also signals a subtle but important policy stance: as long as the structure is lawful, doesn’t induce referrals, and adheres to compliance guardrails, regulators will give you breathing room.