Nelson Hardiman has a firm grasp on the complex Medicare regulations for hospice care providers. We leverage our understanding of these complicated reimbursement requirements to provide seamless counsel on the myriad legal issues involved in caring for terminally ill patients.

Our experienced team of healthcare attorneys has decades of experience in all aspects of long term care. The two biggest reasons why Nelson Hardiman defends Medicare recovery audits are inadequate understanding of Medicare coverage requirements and documentation practices. We tackle these issues up front, working with hospices and physicians to chart the very specific qualifying criteria and timing requirements for certification and re-certification. Nelson Hardiman steers a steady regulatory course for hospice care providers, skillfully navigating the dual goals of patient care and business operations.

Our Work Includes:

  • Audit Risk Assessment Reviewed the medical necessity of hospice claims, length of stays and number of nursing home patients, physician certifications and re-certifications to the audit risk for a hospice.
  • Business Formation, Structure and Contracts Advised on entity formation and business structure, professional and executive contracts, purchase and sale agreements, payor and vendor contracts, service, employment and independent contractor agreements for a hospice.
  • Compliance Handled licensing, operational, and reimbursement compliance, Medicare and Medi-Cal enrollment and enrollment errors, corrective action plans and other compliance strategies, prepayment review, licensure citations and deficiencies for various hospices.
  • Compliance with Hospice Cap Counseled on HIPAA and state patient data privacy and security requirements for several hospices.
  • Fraud and Abuse Investigations and Defense Managed and defended investigations by government payors and their contractors including Safeguard Services, Office of the Inspector General, Office of the Attorney General, U.S. Department of Justice, Department of Health Care Services, Bureau of Medi-Cal Fraud and Elder Abuse for several California hospices.
  • Local Coverage Advised on determination compliance and documenting medical necessity for skilled nursing services, physician certifications, and physician face-to-face encounters for a hospice.