Hospices need to understand the range of risks involved in qui tam cases and how best to navigate whistleblower concerns amid an evolving regulatory landscape. Qui tam actions occur when a whistleblower, called a “relator” by the courts, files a False Claims Act suit on behalf of the government. The relator has the potential to […]
Utilization of the general inpatient level of care (GIP) is frequently the subject of audits by Medicare Administrative Contractors (MACs), and avoiding or responding to that scrutiny requires strict compliance to a complex web of rules. Audits are becoming more frequent in the hospice space, and GIP is an increasing focus, including for the most […]
Hospice providers and stakeholders are carefully examining the proposed changes included in the recently introduced Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act as the bill begins its journey through the legislative process. Leading concerns in the industry include the bill’s suggested regulatory reforms to address program integrity in the hospice industry, along with […]
Fraudulent operators in the hospice space have misspent millions of Medicare dollars in recent years. This problem has become so severe that it has become one of the defining issues facing the hospice industry, with providers and other industry stakeholders expressing concern about significant impacts to future payment, access, sustainability and utilization. This is the […]
Two individuals in California have been arrested for their roles in a $54 million scheme to defraud Medicare for hospice and diagnostic testing. One of the alleged perpetrators, Sophia Shaklian, has been charged with 16 counts of health care fraud and four for transactional money laundering. A second, Alex Alexsanian, is charged with one count […]
A federal judge has struck down the whistleblower provisions of the False Claims Act, with broad implications for hospice and other health care enforcement actions. The ruling centers on the law’s qui tam clauses, which the court found unconstitutional. In a qui tam action, a whistleblower, called a “relator” by the courts, files a False […]
Community Healthcare of Texas CEO Viki Jingle has kept her finger on the pulse of potential hospice fraud occurring in her home state. She and her colleagues recently brought a range of concerns to a discussion with Rep. Beth Van Duyne (R-Texas) in Community Healthcare’s second meeting with the Congress member. Van Duyne has been […]
“Shady” brokers allegedly continue to facilitate “license flipping” among fraudulent hospices, though new regulations have started bearing down on the practice. Some hospice owners have been selling their licenses soon after obtaining them, or before regulators can act on alleged malfeasance, according to several industry sources who spoke with Hospice News. The practice appears to […]
A coalition of hospice, home health and palliative care organizations has called on Congress to extend temporary telehealth flexibilities implemented during the pandemic. Doing so would help ensure continued access to quality care among vulnerable patient populations, according to the organizations. A group of 39 organizations recently penned a letter urging congressional leaders to reconsider […]
Fraudulent operators’ marketing strategies are morphing the competitive landscape, making it difficult for legitimate hospice providers to maintain visibility among patients and families. A mounting concern is that fraudsters stepping into the hospice industry have been implementing marketing and outreach practices that at times mirror strategies utilized by quality providers, according to Jeanne Chirico, president […]
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