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Capabilities / Hospice & Palliative Care

Hospice & Palliative Care

Delivering 360-degree guidance for those supplying hospice & palliative care.

For more than 20 years, our coast-to-coast legal team has monitored continually shifting hospice & palliative care laws. Our hospice law and palliative care attorneys are nationally recognized thought leaders who anticipate industry issues in order to clear pathways for nonprofit and for-profit clients large and small. Our hospice attorneys implement optimal client positioning on proactive compliance, audits and investigations, licensing, corporate transactions, litigation and growth. Familiar with the legal, clinical and operational demands facing hospice & palliative care organizations, our legal teams efficiently address brief questions by phone as well as providing experienced negotiation during complex multimillion-dollar government audits. 

Our hospice & palliative care tools and services include: 

Hospice Medicare & Medicaid Audits 

Our Hospice Audit team has led the way in the vigorous defense of hospices in payor audits for over a decade, with consistently successful outcomes. Whether the audit relates to Medicare, Medicaid or Medicare Advantage programs, the Hospice Audit team has the experience and skill to obtain the best result possible. The Hospice Audit team has also developed a number of analytical tools, including charts, guides, tracking spreadsheets and tip-sheets for use by hospice personnel. These tools, together with our attorneys’ unrivaled experience in hospice audit, allows the Hospice Audit team to vigorously represent hospices in an efficient and cost-effective manner.

Affiliations, Joint Ventures and Acquisitions

Our experienced and multidisciplinary hospice legal team collaborates to negotiate, draft and review sophisticated and customized agreements that allow hospice and palliative care providers to conduct day-to-day business, adapt to regulations and grow their organizations. Frequent services our hospice attorneys provide include:

  • Mergers & acquisitions
  • Joint ventures
  • Strategic alliances
  • Vendor and service agreements
  • Employee and physician agreements

Other resources:

Palliative Care and Other Upstream Service Opportunities

Is your hospice organization considering expanding and diversifying your scope of services or revenue sources into non-hospice palliative care or other opportunities for getting further “upstream” in patients’ illnesses? Are you considering partnering or contracting with a Medicare Advantage plan or other managed care payor for hospice or upstream care services? Our talented and cross-disciplined team of attorneys can help you navigate the various legal considerations that arise from such opportunities, from working through licensure, staffing and other compliance issues to negotiating payment and other contract terms. Recently, our hospice legal team achieved favorable results for a hospice client negotiating a Medicare Advantage Value-Based Insurance Design (VBID) contract with a large national payor, including a nearly 10 percent increase over the originally proposed rates.

Licensing & Regulatory

Our attorneys stay current with the shifting regulatory landscape and how hospice organizations can remain licensed, certified, enrolled and in compliance at a local, state and federal level. Our hospice attorneys work to proactively streamline operations:  

  • Corporate governance
  • Quality Assessment and Performance Improvement (QAPI) programs
  • Medicare licensure, certification and enrollment
  • Reimbursements, repayments and disclosures
  • Risk identification and loss reduction
Litigation & Crisis Management

When unexpected claims destabilize ongoing business, our attorneys serve as fierce advocates and seasoned crisis managers. Our legal team navigates suspended payment, risk and exposure while defending clients before local, state and federal judicial, quasi-judicial, administrative and legislative bodies regarding a wide range of issues including:

  • Whistleblower complaints
  • Anti-Kickback Statute (AKS)
  • Stark Law
  • False Claims Act (FCA)
  • Investigations & audits

Listen to the Hospice and the False Claims Act Series podcast series

Representative Experience

  • Represented hospice in appeal of a Medicare audit that resulted in an extrapolated overpayment of more than $12 million. Advocated for the hospice through the appeal process including a hearing before an administrative law judge. The extrapolation was thrown out and the ALJ returned a fully favorable ruling, resulting in a final overpayment amount of $0.00.
  • Through administrative appeal process, decreased alleged $8.6 million hospice client's overpayment identified during Medicare audit to less than 1 percent: $77,000.
  • Appealed alleged overpayment finding during Medicare audit that placed nonprofit hospice client on brink of ceasing or selling operations, reducing overpayment by approximately $20 million.
  • Successfully argued for hospice client that Unified Program Integrity Contractor (UPIC)'s $25 million extrapolated overpayment was invalid. At first level of appeal, hospice was vindicated leaving mere $70,000 in dispute.
  • Negotiated a $2 million settlement of a $25 million UPIC audit securing the hospice's future and its service to the community.
  • Through advocacy, secured non-intervention decisions by government prosecutors and subsequent case dismissals in numerous qui-tam whistleblower lawsuits across the country.
  • Secured elimination of $4.4 million extrapolated overpayment demand by UPIC. At reconsideration level of appeal, successfully argued that statistical extrapolation was fundamentally flawed and Qualified Independent Contractor (QIC) agreed that methodology was invalid.
  • Secured withdrawal of $15 million extrapolated overpayment demand by UPIC. Prior to filing first-level redetermination appeal, successfully argued that payment demand must be rescinded due to fundamental flaws in statistical extrapolation. Achieving withdrawal at this early stage allowed client to avoid years of costly litigation and, due to appeal backlog, the threat that multimillion recoupment would begin before case was heard by administrative law judge (ALJ).
  • Secured withdrawal of $12 million extrapolated UPIC audit finding before demand letter was issued. Almost immediately persuaded Medicare Administrative Contractor (MAC) and UPIC that fundamental errors were made in audit documentation review, rendering overpayment determinations and statistical extrapolation inaccurate. The hospice was thus able to avoid costly and time-consuming appeal.
  • At first level of appeal, successfully overturned 84% of UPIC claim denials and secured removal of extrapolation, reducing $7 million repayment to nearly $96,000.
  • Secured removal of extrapolation decision for hospice resulting in reduction of overpayment from approximately $6 million to approximately $100,000.
  • Successfully defended one of the first federal hospice Medicaid Integrity Contractor (MIC) audits by obtaining withdrawal of nearly entire $3 million overpayment. Coordinated with local counsel to challenge State's ability to recoup Medicaid nursing home room and board dollars on basis that Medicare hospice services were alleged to have not been medically necessary.
  • Received favorable decisions from ALJ on all beneficiary denials appealed in extrapolated sample, reducing overpayment from approximately $4.6 million to just under $40,000.
  • Successfully defended state Medicaid audit seeking to recover $6+ million in nursing home room and board pass-thru payments. After initial response, recoupment was reduced to ~$82,000.
Podcast | September 24, 2021
Drumroll Please: The Latest on HIS Appeals
Podcast | February 06, 2020
Breaking Down TPEs: Facts and Strategies
Webinar | May 27, 2020
COVID-19 Town Hall for Hospices
Media Mentions | December 14, 2021
IB Madison: Professional of the Week | Meg Pekarske
News Releases | February 22, 2021
Husch Blackwell's Hospice Team Opens 2021 with Significant Audit Victory

The victory was the most significant victory to date for the Madison, WI-based team, which arrived at Husch Blackwell in January 2020.

"I love the Hospice Insights podcast by Husch Blackwell and Meg Pekarske! It is on my favorite list."

Toni Modak, Vice President, Valley Home Care & Valley Hospice