Hospice Insights: The Law and Beyond

In this episode, Meg Pekarske is joined by Jody Rudman, the leader of Husch Blackwell’s White Collar, Internal Investigations & Compliance group, where they explore the enforcement and privacy issues surrounding artificial intelligence. Jody shares insights on the most common types of cybersecurity issues and how to prevent them. A cutting-edge conversation to help ground you in this emerging area.

Recovery Audit Contractors (RACs) have played a relatively limited role in the hospice space, often overshadowed by UPICs, SMRCs, and Center for Program Integrity audits. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki talk about a recent wave of record requests issued by a RAC named Performant that focus on GIP and Continuous Home Care, and some ideas about how to respond.

Hospice Targeted Probe and Educate reviews (TPEs) continue to be initiated all over the country. That means it’s time to check in with Husch Blackwell's Hospice team on the latest developments. In this episode, Meg Pekarske and Bryan Nowicki discuss a new TPE topic and describe both the time-tested and emerging strategies hospices can use to respond to these reviews.

It came as a surprise to our team when we learned that the Centers for Medicare & Medicaid Services (CMS) was ending the hospice component of Value-Based Insurance Design (VBID) on December 31, 2024. Upon learning this, Husch Blackwell’s Meg Pekarske contacted Chris Comeaux, the president and CEO of Teleios Collaborative Network, to see if he wanted to share his thoughts on this unexpected turn of events and what may be on the horizon. This is a forward-looking conversation where we explore how the lessons learned can galvanize new advocacy on the best ways to care for patients with advanced illnesses.

Five years ago, the U.S. Department of Health and Human Services Office of Inspector General (OIG) initiated audits of 13 hospices and published its findings in 13 separate reports. It appears that the OIG is at it again, as multiple hospices recently have received “engagement letters” from the OIG with directions to produce medical records for 100 randomly selected claims. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss these OIG audits, strategies for responding, and their implications for the hospice community.

The owner of a Louisiana hospice was indicted and then convicted of healthcare fraud. How did that happen? In this episode, Husch Blackwell's Meg Pekarske and Jonathan Porter talk about how a routine audit led to a whistleblower complaint by a hospice employee, which then led to the hospice owner’s criminal conviction following trial in November 2023. Most importantly, the pair discuss how other hospices can avoid that fate. Additional resource: Jury Convicts Hospice Owner for Defrauding Medicare

In this episode, Husch Blackwell’s Meg Pekarske is joined by friend and industry veteran Kim Skehan. In this wide-ranging conversation, they explore not only the recent survey reforms but the ways in which Kim’s decades of work as a survey consultant to hospices and home health agencies shape how she approaches her new role leading accreditation at CHAP. Kim’s perspective is truly unique. This is a must listen for everyone looking to successfully navigate the survey process.

The hospice industry saw many regulatory changes in 2023. In this episode, Husch Blackwell's Meg Pekarske, Andrew Brenton, and Adam Royal discuss some of the main regulatory changes from 2023 and what hospices should expect in 2024.

Traditional hospice transactions are receiving increased regulatory scrutiny and headwinds. Amidst these challenges, many hospices are considering management services organizations as an alternative to traditional transactions. In this episode, Husch Blackwell's Meg Pekarske and Adam Royal discuss how management services organizations can help hospices achieve economies of scale while minimizing regulatory scrutiny.

An effective compliance program is the bedrock of any successful healthcare organization and behind every successful compliance program is a trusted relationship between the Compliance Officer and CEO. In this episode, Husch Blackwell’s Meg Pekarske is joined by Avow Hospice’s CEO, Jaysen Roa, and its Compliance Officer, Kerri Ervin, who share how they built their relationship and how it has evolved over time. Jaysen and Kerri provide insights on what it means to have a collaborative relationship, how they see the big picture and ways to navigate different perspectives. There are so many good nuggets in this conversation like “relentless reliability” that remind us trust is earned, leadership is action, and success is a reflection of the quality of our relationships.

Centers for Medicare & Medicaid Services (CMS) devised a “Special Focus Program” to identify poor performing hospices and help them improve through more frequent surveys and technical assistance. CMS would also impose enforcement remedies and fines to further incentivize improvement. How to identify poor performing hospices, however, has sparked concern among the hospice community. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the Hospice Special Focus Program and what hospices can expect from that program as it rolls out in 2024.

For a variety of unfortunate reasons, some hospices found themselves facing a 4% rate reduction for non-compliance with either Hospice Item Set (HIS) or Consumer Assessment of Healthcare Providers & Systems (CAHPS) requirements. For the third year in a row, the Husch Blackwell hospice team successfully advocated that the penalty not be imposed on its clients and CMS agreed! In this episode, Husch Blackwell’s Meg Pekarske and Jacob Harris share more about how they achieved these thrilling results. This is a good listen and reminder for all of us that good advocacy can make a difference and CMS does keep an open mind.

CMS has criticized hospices for underutilizing general inpatient care (GIP) but has also specifically targeted GIP claims for audit and medical review. In addition to CMS’s standard tools for reviewing GIP claims, such as UPIC audits and TPEs, the OIG is now getting involved with a GIP audit of its own. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the divergent approaches to GIP care and what this may mean for the hospice benefit.

Join Husch Blackwell’s Meg Pekarske and Wendy Arends as they explore the new draft Merger Guidelines and what enforcement may look like in the future. Given the number of hospices looking to consolidate through mergers, joint ventures, and other types of affiliations, you won’t want to miss this episode.

While not new, the number and scope of Targeted Probe and Educate (TPE) reviews have soared to new heights. At the same time, more hospices are facing the uncomfortable position of moving to a second and sometimes third round of review. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki share how they have successfully navigated clients through the TPE process. In addition, they offer tools and tips for staying organized while advocating for your organization throughout the process.

In the midst of consolidation and restructuring among hospices, the Centers for Medicare & Medicaid Services (CMS) is scrutinizing initial enrollments and changes in ownership and management. In this episode, Husch Blackwell’s Meg Pekarske and Adam Royal discuss new and proposed changes to CMS’s provider enrollment screening and why it matters to hospices.

It’s been hard to keep track of all the new changes related to government oversight of hospices. This growing list now includes an expansion of the 36-month rule to hospices, which will limit the frequency that hospices can change ownership. There are important exceptions to the rule that all hospices will need to closely consider when evaluating all types of organizational changes, including traditional acquisitions and other types of consolidations. Listen in as Husch Blackwell’s Meg Pekarske and Ragini Acharya share their insights.

Hospices have been the target of increased government scrutiny in 2023, and the Centers for Medicare and Medicaid Services (CMS) is planning to take further aim in 2024 through surveys. Join Husch Blackwell’s Meg Pekarske, Emily Solum, and Erin Burns as they talk about a cautionary survey tale and proposed changes to the hospice survey process, including the introduction of an informal dispute resolution (IDR) process, and a special focus program for poor performing hospices.

Hospices are increasingly looking to buy, consolidate, or merge to achieve administrative efficiencies and expand operations for growth. A common approach among nonprofit hospices is to combine through a member substitution. In today’s episode, Husch Blackwell’s Meg Pekarske and Adam Royal discuss key considerations and strategies for hospice member substitutions.

A study published by NORC at the University of Chicago, a nonpartisan research organization, concluded that the Hospice Benefit saved Medicare $3.5 billion in 2019. The data behind that figure, and the study’s related findings, show that the value of the Medicare Hospice Benefit appears to be at odds with CMS’s regulatory priorities. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki dig into the numbers, talk about the NORC study, and its potential impact on hospices and the Hospice Benefit.