Hospice providers can face legal repercussions if they don’t strike the right balance in their payroll practices. Miscalculated compensation or miscommunicated policies are among the most common reasons that hospices are facing legal concerns related to staff compensation, according to Russell Bruch, partner at Morgan Lewis. Bruch assists employers with legal wage and salary matters […]
Hospice program integrity has been in the spotlight for at least the past two years, often with high financial stakes for providers. Unified Program Integrity Contractor (UPIC) and Targeted Probe and Educate (TPE) audits are designed to key regulatory safeguards against bad actors in the hospice industry. Both include oversight measures aimed at ensuring hospice […]
Regulators are keeping a closer watch for possible kickback schemes among hospices. Along with False Claims Act cases, anti-kickback violations are among the most commonly occuring forms of hospice fraud and abuse. Hospices need to have a careful eye on compliance when it comes to structuring referral arrangements to ensure they in compliance with the […]
As California pursues hospice licensing reform, some providers in other states are watching for similar actions closer to home. In December, California Gov. Gavin Newsom (D) approved legislation that tightened hospice oversight in the state. This includes establishing a moratorium on new hospice provider licenses until the California Department of Public Health (CDPH) sets emergency […]
The next episode of our podcast, Elevate, is now available! Hospice News sits down with Meg Pekarske, partner at law firm Husch Blackwell, to discuss the hospice regulatory outlook in 2023 and what compliance challenges and concerns are on the horizon. Apple PodcastsSoundcloud
Regulatory attention heating up in the hospice industry could be impacting buyers’ mergers and acquisitions decisions. Nuances in the regulatory environment can be difficult to navigate, perhaps more so for private equity and venture capital investors that are new to the industry. Changes to federal enforcement practices during the next year could bring some additional […]
The U.S. Department of Health & Human Services (HHS) Office of the Inspector General (OIG) recently began to probe hospices in its initial phase of Provider Relief Fund (PRF) audits. More than two years after the CARES Act established the $175 billion PRF, federal regulators are moving forward on audits that closely examine the ways […]
Hospices that are meticulous and vigilant with documentation see the best results when appealing payment cuts associated with Hospice Item Set (HIS) audits. The U.S. Centers for Medicare & Medicaid Services (CMS) developed HIS as a tool to gauge a patient’s overall care experience. The agency requires hospices to submit HIS data for each patient […]
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 […]
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