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Hospice Audits

Husch Blackwell LLP

Hospice Insights Podcast - Controlling the Narrative: A New Tactic for Auditors and ALJs

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Hospices that have gone through audits are familiar with certain recurring reasons why auditors deny claims. Two common reasons are the lack of support for a six-month prognosis and the insufficiency of the physician...more

King & Spalding

OIG Report Finds that the Medicare Program Improperly Paid Acute-Care Hospitals for Outpatient Services Provided to Hospice...

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On November 12, 2024, OIG published a report concluding that the Medicare program overpaid acute-care hospitals an estimated $190 million over five years for outpatient services provided to hospice enrollees....more

Husch Blackwell LLP

Hospice Insights Podcast - Meet the New Laws, Same as the Old Laws: Overpayment Recoupment Update

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Hospices that have been audited have to decide how to address any alleged overpayment identified by the auditor, whether through a voluntary repayment, recoupment, or applying for an extended repayment schedule. CMS recently...more

Arnall Golden Gregory LLP

AGG Talks: Home Health & Hospice Podcast - Episode 6: Navigating the Audit Maze: Insights From Northeast Georgia Health System

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring is joined by Kathy Barton and Natalie McNeal of Northeast Georgia Health System. Kathy and Natalie share insights on navigating the complexities of hospice...more

Husch Blackwell LLP

Hospice Insights Podcast - What's the Latest on UPICs? Highlights From Recent Audit Activity, Part II

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UPIC activity is picking up, and the UPICs are reviving some old tactics. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki continue the discussion on these trends which include extrapolation, Medicaid nursing...more

Morgan Lewis - Health Law Scan

Hospice in the Crosshairs: Medicare’s Enhanced Oversight and Newly Announced Audit Pilot

For over a year, the hospice industry, legislators, and state and federal regulators have expressed concerns about the fast growth and potentially unscrupulous activities of new hospices in several states in particular. Those...more

Arnall Golden Gregory LLP

AGG Talks: Home Health & Hospice - Reimbursement Audits and Appeals

In this episode, Jason Bring, AGG Healthcare partner and co-chair of the Post-Acute & Long-Term Care team, and Lanchi Nguyen Bombalier, AGG Healthcare partner and member of the Post-Acute & Long-Term Care, Hospitals & Health...more

Husch Blackwell LLP

After ALJ: Options and Opportunities in the Face of an Unfavorable ALJ Decision

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In the five-step audit appeals process, hospices often stop their appeal efforts after finding success at the third step, a hearing before an administrative law judge (ALJ). However, if an ALJ issues an unfavorable decision,...more

Husch Blackwell LLP

UPIC Report Card: The OIG’s Evaluation of the UPICs Provides Insight Into the Future of Hospice Audits

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The Department of Health and Human Services Office of the Inspector General (OIG) recently released a report detailing its evaluation of CMS’s primary fraud, abuse and waste investigators—the Unified Program Integrity...more

Arnall Golden Gregory LLP

Hospices Audited for Provider Relief Fund Payments

After more than two years since the initial Provider Relief Fund (“Fund”) disbursement, hospices are beginning to see audits of their Fund expenditures by the U.S. Department of Health & Human Services (“HHS”) Office of the...more

Morgan Lewis - Health Law Scan

OIG Hospice Audits of Provider Relief Fund Use Have Arrived

The HHS Office of Inspector General (OIG) has, for the last several years, been actively auditing hospices regarding their Medicare regulatory and billing compliance, with a national hospice audit in the works. Recently, OIG...more

Husch Blackwell LLP

COVID-19 Hospice How-To Series | Pulling the Strings: New OIG Audits Scrutinize How Hospices Used Provider Relief Funds

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For the last two-and-a-half years, hospices and other providers have been using billions in Provider Relief Fund (PRF) payments to prepare for, respond to and recover from the COVID-19 pandemic. The Office of Inspector...more

Husch Blackwell LLP

Beyond Hospice: The OIG Renews Its Scrutiny of Home Health Agencies

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As many hospices continue to diversify into new business lines, staying abreast of enforcement trends outside of hospice is more important than ever. Home health in particular, is receiving significant government scrutiny. In...more

Husch Blackwell LLP

Hospice Audit Series | Painting the Picture: How to Advocate for Clinical Hospice Eligibility in the Audit Appeal Process

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The core of most hospice audits has been, and continues to be, whether the medical record supports the patient’s hospice eligibility. In this episode, Husch Blackwell’s Meg Pekarske talks with Bryan Nowicki and Zaina Niles...more

Husch Blackwell LLP

Hospice Audit Series | Turning the Screws: UPIC Enforcement Tactics and What They Mean for Your Hospice

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Unified Program Integrity Contractor (UPIC) audits are on the rise, and the UPICs are embracing the full array of enforcement tools at their disposal. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss...more

Husch Blackwell LLP

Hospice Audit Series | Audit Overlap: Connections and Contradictions Among Audits, Auditors and What to Do About Them

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As audit activity escalates, hospices are getting increasingly familiar with the alphabet soup of audits and auditors, including OIG, UPIC, CMS, CPI, SMRC, MAC, TPE and more. Unfortunately, there are times when hospices are...more

Morgan Lewis - Health Law Scan

OIG Planning Nationwide Audit of Hospice Eligibility – What You Should Know

The HHS Office of Inspector General (OIG) recently announced its Office of Audit Services plans to conduct a nationwide review of hospice eligibility, focusing on those Medicare hospice beneficiaries who haven't had an...more

Husch Blackwell LLP

Hospice Audit Series: A Beginning and an End from CMS - TPE Resumes While QIC Demonstration Ends

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In today’s episode, Husch Blackwell’s Meg Pekarske talks with team members Bryan Nowicki and Erin Burns about two recent developments in the hospice audit arena. First, the Centers for Medicare & Medicaid Services (CMS)...more

Arnall Golden Gregory LLP

The “Vacation” Is Over: CMS Resumes Hospice Targeted Probe and Educate Audits

On September 1, 2021, as hospice providers continue to grapple with the demands of the ongoing pandemic, the Centers for Medicare & Medicaid Services (CMS) ended its temporary suspension of the Targeted Probe and Educate...more

Health Care Compliance Association (HCCA)

[Webinar] 2021 Mid-Year OIG Work Plan and Other Important Updates: – Hospitals, Physician Practices, Home Health, and Hospice -...

Learning Objectives: - Discuss OIG work planning process, work plan items, and other government reports - Provider insights into COVID-19 audits, reviews, and monitoring... During this program, we will provide an...more

Husch Blackwell LLP

Hospice Audit Series: CMS Program Integrity Audits Are Back!

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In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the new wave of CMS Center for Program Integrity (CPI) audits that have been issued during the past couple weeks. These CPI audits remain focused on...more

Husch Blackwell LLP

Hospice Audit Series: Spring Audit Bloom—Medicaid UPICs and MAC ADRs

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Today's Episode: Spring Audit Bloom—Medicaid UPICs and MAC ADRs Today, Husch Blackwell's Meg Pekarske is joined by colleagues Bryan Nowicki and Erin Burns to discuss the recent flurry of audit activity, specifically the...more

Husch Blackwell LLP

Hospice Audit Series: The Latest Developments and Strategies for Success in the Ever-changing Audit Landscape

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Hospice Audits Series Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the...more

Husch Blackwell LLP

Enforcement Relief: What New Regulatory Reforms Could Mean for Hospices

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The Trump Administration has shown an interest in regulatory reform with the goal of reducing the burden on regulated parties such as hospices. This has recently come to the forefront as part of the administration’s efforts...more

Arnall Golden Gregory LLP

OIG to Initiate New Hospice Investigations and Audits

More than one year after two major hospice reports raised concerns ranging from billing to patient safety, the U.S. Department of Health & Human Services Office of the Inspector General (OIG) continues its review of the...more

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