In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss recent OIG guidance on hospice and skilled nursing facility relationships, focusing on anti-kickback risks and fraud concerns. They cover key issues such as the importance of documenting fair market value for any services or space provided, being cautious of payments exceeding Medicaid room and board rates, and avoiding arrangements that appear to be made solely to secure referrals. Bill and Jason also touch on increased oversight and enforcement in the healthcare sector under a new presidential administration.

In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss the role of managed care, artificial intelligence, and prior authorizations in home health and hospice. Bill and Jason examine a recent lawsuit filed against a major Medicare Advantage plan in the United States District Court for the District of Minnesota challenging the use of AI-driven claims reviews in Medicare Advantage coverage decisions. They also address concerns around prior authorization denials, their high reversal rates, and potential consequences for providers and patient care.

In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss the hospice special focus program and CMS’ announcement that it will cease implementing the program in the face of litigation filed by providers and state associations.

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring is joined by AGG Healthcare partner Alex Foster to discuss a recent OIG report highlighting Provider Relief Fund compliance issues within the hospice industry. Jason and Alex break down the origins of provider relief funds during the COVID-19 pandemic, the common pitfalls identified in the OIG report, and the importance of maintaining proper documentation. As government scrutiny increases, they provide practical steps for providers to prepare for potential audits, such as strategies for navigating lost revenue reporting, tracking expenses, and engaging legal counsel to ensure compliance under privilege.

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 audits, discuss their experiences with the appeal process, and offer practical strategies for success. They also delve into lessons learned, the importance of thorough documentation, and how to effectively prepare for administrative hearings.

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring is joined by AGG Healthcare attorney Charmaine Mech Aguirre to discuss the latest developments in the palliative care industry across the country. Jason and Charmaine talk through the key differences between hospice and palliative care, various models and approaches providers are adopting, and regulatory and reimbursement challenges. From state licensure requirements to compliance with the Anti-Kickback Statute, they provide valuable insights and practical advice for providers looking to expand or refine their palliative care services.

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring is joined by Megan Turby and Lisa Barker, MD, of Gulfside Healthcare Services in Land O' Lakes, Florida. AGG represented Gulfside in a series of hospice audit appeals before multiple administrative law judges ("ALJs"). Megan and Dr. Barker share their experiences in the ALJ hearings, as well as lessons learned. Their discussion also emphasizes how to prepare for hearings and prevent denials from the outset.

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 Systems, and Healthcare Private Equity industry teams, discuss “Home Health and Hospice: Reimbursement Audits and Appeals.” Jason and Lanchi provide a high-level overview of the audit environment and how to better prepare and navigate the process.