Our New York-based law firm has a great deal of experience when it comes to the regulations, which impact both home health agencies and also hospice. We are the ones to call first regarding issues with Medicaid and Medicare certifications. Compliance with these federal and state requirements is stringent; not to mention the importance of remaining HIPPA compliant. Our lawyers know the regulations and have the knowledge to represent both hospice and home health agencies with their legal needs.
We provide the following legal support to hospice:
•Certification and Re-certification for both Medicare and Medicaid
•Compliance with Medicare
•Assistance with Corrective Action Plans
•Coding and Payment Regulations with Medicare and Medicaid
•Beneficiary Elections and Termination of Certification
•Home Health Agency face-to-face Encounters
•Requirements for Nursing Services
•Private Payee Audits
•Fraud and Abuse
•Regulations Regarding Health Care Matters
Fraud and Abuse Claims
Our team of lawyers has handled comprehensive compliance work for some of the largest hospice agencies in New York. We have extensive knowledge of state and federal regulations, as well as certification issues. It is not uncommon to find an agency under civil or criminal investigations these days. This can be due to services billed that were not necessary, or it can be for billing incorrectly. We work with the government agency to resolve any fraud or abuse claims against our clients. We are able to do this while the hospice business remains functional. The goal is to ensure compliance, yet avoid future liabilities for the agency.
Third Party Claims
Physician ownership issues are often the cause of many fraud and abuse lawsuits. This includes the relationship that hospice has with their medical directors. If a third party is brought in as a referral, it can cause all sorts of problems with the billing. A cross-over in responsibilities can look fraudulent on the billing side, but it is a justifiable expense. Most of the problems we handle can easily be explained. We simply enact proper compliance measures to proceed with safeguards in place.
Vendor compliance issues are another area that seems to cause a great deal of debate. Thankfully, we have significant experience in handling these types of claims too. We are able to draft contracts that will help the hospice with their business needs. These contracts are in compliance with the laws and prevent fraud and abuse. We also try to implement compliance with vendors to thwart the problem of improper billing.
Audits are part of the dreaded process that all hospice agencies must face. These audits bring officials in to go through the files with a fine-tooth comb. We use the third party payor audit defense to help our clients. We can help ensure that files are ready for audits. These audits are a big deal, and not being in compliance means the doors could close.
Home Health Support
We provide the following legal support to home health agencies:
•Face-to-Face Necessities and Records
•Criteria for Services
•Medical Necessity Issues
•The Need For Observation and Assessment services
•Therapy Coverage Services
•Requirements for Plan of Care
Anti-kickback Statute Violations
Our knowledgeable team has a great deal of experience when it comes to both civil and criminal suits regarding the home health agency. We can negotiate settlements with a favorable outcome. Some of the cases we resolved have included improper referrals and other anti-kickback alleged statute violations.
In the past decade, we have appealed numerous audits or claims presented on behalf of our home care agency clients. Audit risk areas can be over documentation, coverage criteria, plan of care, “homebound” requirements, and face-to-face documentation.
We understand how difficult it can be to run an agency that deals with government funding. We want to help with your legal issues or to address any other healthcare law related need you may have. Call us today for further assistance.
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Spodek Law Group was incredibly professional and has given me the best advice I could wish for. They had been helpful and empathetic to my stressful situation. Would highly recommend Spodek Law Group to anyone I meet.
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We provide superior service, excellent results, at a level superior to other criminal defense law firms. Regardless of where your case is, nationwide, we can help you.
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