Building in redundancies around patient admission processes may help hospices withstand regulatory scrutiny, according to legal experts in the space. Patient eligibility is a frequent focus of hospice audits as regulators sharpen oversight in the industry. In recent years, the U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health & […]
Knowing their rights, risks and responsibilities in the appeal process can be key for hospices to weather a regulatory audit. Hospice providers have grown increasingly concerned about the financial and operational impacts of heightened auditing activity in the industry. Some have faced reimbursement suspension when auditors suspect potential overpayment or fraud. Hospices rely heavily on […]
The recently extended COVID-19 public health emergency (PHE) will not last forever. When it does expire, hospices need to be aware of potential legal risks. The U.S. Department of Health & Human Services (HHS) once again extended the COVID-19 PHE until Oct. 6. While the agency has the option to keep extending the emergency, hospices […]
Patient eligibility is a frequent focus of hospice audits, but it can be a challenging point for providers to prove. With that in mind, providers should proactively prepare for patient-eligibility questions, especially as government watchdogs crack down on bad actors. Aside from strong documentation, insight from hospice physicians around patient conditions is a key defense […]
Unified Program Integrity Contractor (UPIC) audits are on the rise among hospices, with some seeing penalties like reimbursement suspension or repayments. The U.S. Centers for Medicare & Medicaid Services (CMS) contracts UPIC entities to conduct investigations and audits related to potential fraud, waste or abuse. While these audits have rooted out some bad actors, they […]
Private equity and venture capital investors continue to flock to the hospice space. When negotiating with investors that are new to the industry, providers in some cases are coming to the table with parties that are not familiar with the regulatory environment, even as federal enforcement activity ramps up. Of the 23 hospice-related deals in […]
Recently proposed amendments to the False Claims Act (FCA) could spell choppy regulatory waters for the hospice industry. Senators introduced a bill that would, among other provisions, shift the burden of evidence and potentially make it easier for whistleblowers to call out hospices on fraud and harder for providers to defend themselves, according to Bryan […]
The pandemic continues to ruffle feathers for hospices nationwide, most recently due to uncertainties about the future of federal vaccine mandates recently halted by the courts. Regardless of how the scales tip on those emergency regulations, hospices remain troubled about ensuring their access to patients, according to legal advisors in the health care sector. Hospices […]
The coronavirus pandemic took a heavy toll on communities across the country as many fell ill and lost loved ones to the deadly disease. Hospices reached deeper into their communities with collaborations to procure and provide resources amid heavy COVID-19 headwinds. To date, COVID-19 has claimed 595,301 lives since the outbreak first hit the United […]
Hospice providers have remained on high alert as regulators increasingly hone in on the industry. While regulatory enforcement activity temporarily stalled last year due to the coronavirus pandemic, audits have since resumed. These events can be expensive and time consuming for providers. Complete and accurate documentation will be key for hospices to ward off and […]
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