Hospices

Nelson Hardiman represents California hospices in their business, regulatory, and strategic challenges, including:

  • Business Transactions
    • Formation of entities and business structure
    • Physician and Medical Director contracts
    • Purchase and sale agreements
    • Negotiation of payor contracts
    • Service agreements and vendor contracts
    • Employment and independent contractor agreements
  • Regulatory Defense
    • Department of Public Health (“DPH”) licensure investigations and appeals
    • Reimbursement audits by private and governmental payors and their contractors
      • CMS
      • Medicare
      • Medi-Cal
      • National Government Services
    • Fraud and abuse investigations by government payors and their contractors
      • Safeguard Services
      • Office of Inspector General
      • Federal Bureau of Investigations
      • Department of Justice
      • Department of Health Care Services
      • Bureau of Medi-Cal Fraud and Elder Abuse
    • Audit defense
      • Zone Program Integrity Contractor (“ZPIC”)
      • Recovery Audit Contractor (“RAC”)
      • Program Integrity Safeguard (“PSC”)
  • Compliance
    • Licensing, operational, and reimbursement compliance
    • Medicare and Medi-Cal enrollment and changes of ownership
    • Corrective action plans and other compliance strategies
      • Prepayment review
      • Licensure citations and deficiencies
      • Medicare and Medi-Cal enrollment errors
    • Audit risk assessment
      • Medical necessity of hospice claims
      • Length of stays and number of nursing home patients
      • Physician certifications and re-certifications
    • Local Coverage Determination compliance and documenting medical necessity
      • Terminal status in routine hospice claims
      • Special physician service claims
      • Inpatient hospice claims
    • Compliance with hospice cap
    • HIPAA and state patient data privacy and security requirements
    • False Claims Act compliance for marketing and business development activities
  • Litigation
    • Licensure defense and appeals
    • Medicare and Medi-Cal provider enrollment appeals
    • Payor and reimbursement disputes
    • Overpayment appeals
    • False Claims Act/qui tam whistle-blower litigation defense
    • Business and employment litigation
    • Medicare and Medi-Cal exclusions and suspensions by government entities
      • CMS
      • Office of the Inspector General
      • California Department of Health Care Services