In the ongoing healthcare revolution, the preference for home care aligns with government and payor desire to reduce costs. This convergence, coupled with growing technological support, fuels interest in convalescing at home. New care delivery models and consumer demand stoke tectonic shifts in the competitive landscape, creating challenges and opportunities for home health agencies to collaborate with other healthcare providers to extend patient care into alternative care settings. Nelson Hardiman’s solution-oriented experience across the full spectrum of alternative care issues offers home health agencies the regulatory oversight and strategic vision to accomplish their business goals in an evolving healthcare universe.

Our Work Includes:

  • Audit Defense Defended Zone Program Integrity Contractor (“ZPIC”), Recovery Audit Contractor (“RAC”), and Program Integrity Safeguard (“PSC”) audits for home health agencies.
  • Business Advised a L.A. based home health agency on the full range of business needs, from entity formation, business structure, and purchase and sale agreements to professional, executive, payor and vendor contracts and service, employment and independent contractor agreements.
  • Compliance Handled licensing, operational, and reimbursement compliance, Medicare and Medi-Cal enrollment, corrective action plans and other compliance strategies for a home health agency.
  • Data Privacy Advised on HIPAA and state patient data privacy and security requirements, including program development, for a large home health agency.
  • False Claims Act Handled compliance for marketing and business development activities and qui tam whistle-blower litigation defense.
  • Fraud and Abuse Investigations Defended investigations by government payors and their contractors including 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 for various home health agencies.
  • Litigation Defended home health agencies in litigation matters including licensure defense, payor and reimbursement disputes, overpayment appeals, business and employment defense, Medicare and Medi-Cal exclusions and suspensions by government entities including CMS, Office of the Inspector General, and California Department of Health Care Services.
  • Regulatory Defense Handled Department of Public Health (“DPH”) licensure investigations and appeals, reimbursement audits by private and governmental payors and their contractors, including CMS, Medicare, Medi-Cal and National Government Services, for several home health agencies.