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The hospice and home health agency faces complex and dynamic regulatory requirements. This puts a major strain on these agencies. Many of the home health and hospice providers are majorly small business or individuals. It therefore becomes very hard for these business to meet their profit targets in the light of these ever changing regulations. To prevent a license revocation or suspension, home health agencies must remain compliant with the stream of changing regulations. There are several compliance issues that a hospice home health agency lawyer can help you with, among them:
• Medicare and Medicaid compliance and certification
• Federal and state requirements
• Government investigations
• Licensure issues
• OIG compliance requirements
• Stark and Anti-Kickback
• Compliance policies and programs
• HIPAA compliance
• Medicaid and Medicare audits
• Private audits
• Contractual and transactional support
Recently, hospice and home health caregivers have become a target of various investigation issues such as fraud, hospice compliance, and OIG compliance requirements. It is crucial to address they key areas in light of the law and how hospice agencies can remain compliant.
Hospice and Home Health Agency Fraud
The government and OIG are increasingly becoming suspicious of the relationships between nursing homes and hospices. It has become apparent that some hospices are providing certain benefits to nursing homes in an effort to gain referrals. Another reason for the heightened investigations is that many Medicare patients die while in home health and hospice facilities. As such, the government is monitoring federal expenses in the hospice care entities. The two main fraud concerns for the government are certifications and unnecessary services.
Certification and Qualification Errors
According to the government, many of the hospice patients who are admitted do not need the expensive hospice care offered. Home health and hospice agencies are therefore under scrutiny for allegedly working with nurses, business owners and doctors to certify certain hospice needs so as to gain from Medicare reimbursements. Hospice officials are constantly facing charges of fabricating and falsifying hospice certifications. Fraud charges are also made on the basis of unnecessary services offered to Medicare and Medicaid patients. Medicare and Medicaid audits continue to indicate that hospice and home health agencies are admitting people who are not terminally ill. The government argues that most of the patients admitted fail to meet the eligibility criteria.
If you have been accused on any of these allegations, you will need the legal expertise of a lawyer who specifically deals with hospice and home health agencies.
Hospice and home health agency fraud and violations can be investigated by the Federal Bureau of Investigation (FBI), the Department of Justice (DOJ), the General Services Administration (GSA), Office of the Inspector General (OIG), Medicaid Fraud Control Units (MFCU), and the Health Care Fraud Prevention and Enforcement Action Team (HEAT). If found liable by any of these agencies, you can face criminal fines, recoupment requests, non-payment of any future claims, removal from federal healthcare programs, treble damages, and civil fines. To avoid any of these serious penalties, it is wise to seek the counsel of a hospice and home health agency lawyer.