Hospice & Home Health Agency
The attorneys of Wachler & Associates have significant experience in the vast legal and regulatory issues impacting hospice and home health agencies (“HHAs”). We regularly assist hospice and home health clients in issues relating to Medicare and Medicaid certification, enrollment and payment regulations, compliance with federal and state requirements, HIPAA compliance, Fraud and Abuse compliance, corporate governance, licensure, Medicare, Medicaid and private payor audits, transactional arrangements, and other federal and state regulatory matters. Our attorneys understand the unique regulatory environment pertaining to hospices and HHAs and we have the knowledge and expertise necessary to represent hospices and HHAs in all aspects of their legal needs. Examples of matters that Wachler & Associates regularly counsels hospice and HHA clients on include:
- Medicare and Medicaid certification and recertification
- Compliance with Medicare Conditions of Participation and Conditions for Coverage
- Assistance with accreditation surveys, corrective action plans and termination appeals
- Compliance with Medicare and Medicaid documentation, coding and payment regulations
- Hospice beneficiary elections, plans of care, face-to-face documentation, terminality certification and lengths of stay
- HHA face-to-face encounter, documentation and physician signature requirements
- Documentation requirements regarding homebound status and skilled nursing services.
- RAC, Medicare, Medicaid, ZPIC or third party / private payor audits and appeals
- HIPAA compliance
- Contractual and transactional arrangements
- Operations, corporate governance and compliance policies
- Licensure issues
- Fraud and Abuse counseling including compliance with the Stark law and federal Anti-Kickback Statute
- Drafting of compliance programs and policies, such as marketing policies, self-auditing and monitoring policies and investigation policies
- Compliance training
- Other regulatory and health care law matters
Compliance – Our firm completed comprehensive compliance work for the largest Hospice provider in a major state, including the adoption of an “Index of Policies” that assist employees in satisfying billing requirements, medical necessity determinations, and certification rules as required by state and federal regulations.
Fraud and Abuse: Investigations – We have counseled numerous hospice providers in criminal and civil investigations regarding services claimed to be not medically necessary, services not provided as billed, or services billed incorrectly. In each case, we work with the government to resolve Fraud & Abuse concerns while maintaining the functionality of the hospice provider’s business. We often implement a compliance plan to ensure compliance and avoid future liability.
Fraud and Abuse: Permissible Relationships – Our firm has experience resolving fraud & abuse claims arising from physician ownership issues, relationships between hospices and medical directors, as well as referral relationships. Recently, we represented a hospice that received referrals from a nursing home and, due to the cross-over in responsibilities and payments received, were accused of improper remunerations. We received a favorable result and enacted compliance measures that allowed the relationship to proceed with proper safeguards.
Vendor Issues – We also have significant expertise handling vendor contractual agreements and vendor compliance issues. We draft contracts that serve the hospice’s business needs and also ensure compliance with Fraud & Abuse laws. We also implement vendor/supply chain compliance protocols to alleviate the possibility of improperly billing Medicare or Medicaid.
Audits – Medicare and third party payors often target hospice providers in audits covering a variety of risk areas. Our firm is a nationwide leader in RAC, ZPIC, Medicare, Medicaid, and third party payor audit defense.
- Face to Face Certifications (see blog)
- Hospice Recertification Requirements
- Respite Care
- Hospital Hospice Care
- Inpatient Admissions for Hospices with Inpatient facilities
- Clinical Status Determinations
- Conditions of Coverage
- Length of Stay and other non-technical medical necessity requirements
Fraud and Anti-Kickback – Wachler & Associates has significant experience with both criminal and civil suits against home health agencies. We have favorably resolved cases and negotiated settlements related to improper referrals and other alleged anti-kickback statute violations by home health agencies.
Compliance – Our attorneys recently implemented an updated compliance program for a large home health care provider, including measures that addressed face-to-face certification requirements, documentation of medical necessity, and coverage conditions.
Audits – We have appealed thousands of audits and claim denials on behalf of home health care agencies and other providers. Visit our RAC, ZPIC, Medicare, Medicaid, private party payor and other audit website for more information. Potential audit risk areas are listed below.
- Face-to-Face requirements and documentation
- “Homebound” requirement determination
- Documentation Requirements
- Medical Necessity and Coverage of Skilled Nursing Care
- Requirement and provision of Observation and Assessment services
- Coverage Criteria for therapy services
- Plan of care Requirements
Our attorneys have written articles on legal issues relevant to hospices and home health agencies. For a complete list of Wachler & Associates articles, please click here.
The attorneys of Wachler & Associates often speak on issues relevant to hospices and home health agencies. Examples of organizations that we have presented to on hospice and home health issues include:
- National Association for Home Care & Hospice (NAHC)
- National Hospice and Palliative Care Organization (NHPCO)
- National Center for Assisted Living (NCAL)
- Health Care Compliance Association (HCCA)
- American Health Lawyers Association
For a complete list of Wachler & Associates speaking engagements, please click here.
Call us at (248) 544-0888 or send us an e-mail to schedule a meeting to discuss your concerns with ambulatory surgery center legal issues or to address your other healthcare law-related needs.