The IRS ruled that the organization’s management and facilitation of the database furthers its exempt purposes under section 501(c)(3) and, therefore, is not an unrelated trade or business and does not result in prohibited private inurement or private benefit to the participating health care plans and providers.
Read the letter ruling: PLR 201250025 [PDF 795 KB]
*Private letter rulings are taxpayer-specific rulings furnished by the IRS National Office in response to requests made by taxpayers and can only be relied upon by the taxpayer to whom issued. It is important to note that, pursuant to section 6110(k)(3), such items cannot be used or cited as precedent. Nonetheless, such rulings can provide useful information about how the IRS may view certain issues.
The organization was formed to operate a regional health information exchange.
The organization’s database—created in collaboration with several health plans and health care providers—combines claims data from multiple health plans and electronically submitted clinical data from providers to assist and evaluate performance and practice across an entire patient population, not just among patients who are members of a particular health plan. Providers used the information in the database to provide patient-specific information for diagnoses and preventive care procedures.
The database also provides physicians with alerts and reminders regarding the posting of laboratory results and the need to schedule upcoming patient treatments.
The organization provides reports to health care providers documenting their performance, and also provides similar reports to participating health insurers to allow them to evaluate providers against quality and efficiency measures.
Participating commercial and government health plans pay a service fee to participate in the organization’s program. The fee is approximately 50% lower for some government health plans. Participating health plans compensate physicians for participating in the program, based on their performance against quality and efficiency measures.
The IRS ruled that the American Recovery and Reinvestment Act of 2009 (ARRA), which includes the provision of various economic incentives to encourage the use of health information technology, and its legislative history indicate that activities that make use of health information technology to improve health care quality and reduce health care costs lessen the burdens of government and further charitable purposes.
The IRS further ruled that payments by participating health plans to physicians do not result in inurement of the organization’s net earnings to private shareholders or individuals.
In addition, citing the legislative history of ARRA, the IRS ruled that the private benefit to participating health plans and private physicians is incidental to the benefit to the general public through improved health care outcomes.
For more information, contact:
Rick Speizman, National Partner-In-Charge, KPMG’s Exempt Organizations Tax Practice (ExoTax)
+1 (202) 533-3084