This transcript is auto generated
00;00;00;00 - 00;00;28;15
Bryan Nowicki
Hello and welcome to Hospice Insights: The Law and Beyond, where we connect you to what matters in the ever-changing world of hospice and palliative care. Well hello, Joe. Hello, Zaina. Welcome to the podcast. I appreciate you making time. Joe, you're a returning guest, although there's been quite a, a pause between your last appearance on the podcast
00;00;28;15 - 00;00;29;05
Bryan Nowicki
and now. Isn’t that right?
00;00;29;05 - 00;00;38;09
Joe Diedrich
Well, that's right. Thanks for having me here, Bryan. That just goes to show how long you've been doing the podcast and how long it's been a great success.
00;00;38;11 - 00;00;59;21
Bryan Nowicki
Yeah. Well, thanks, Joe. And you're, you're you are, as our audience will get to know, you are the person we turn to when we get into federal court. And it's not a place that you'll want to volunteer to go to, but, if you need to go to federal court, and hospices have had a need to do that increasingly over the years,
00;00;59;27 - 00;01;15;07
Bryan Nowicki
you're the guy and you're the one we turn to. And we've had a lot of success with you. So welcome back. And Zaina, you're more of a regular to the podcast, but you also work on all things hospice, including these federal court cases. So I'm glad you're able to be here.
00;01;15;14 - 00;01;17;04
Zaina Niles
Thank you for having me, Bryan.
00;01;17;07 - 00;01;45;24
Bryan Nowicki
Sure. So what we're going to talk about today is maybe a bright spot in this landscape of CMS trying to crush fraud. We can all agree, I think that crushing fraud sounds like a very noble and worthwhile goal. I think, in my experience, Zaina, you and I representing hospices all over the country on the front lines of enforcement issues, what we've seen is they're certainly crushing fraud.
00;01;45;24 - 00;02;09;06
Bryan Nowicki
But, they also seem to be stepping on some providers that are high quality providers. It's the old casting a wide net. And inevitably some of the good guys get caught up in it. So definitely frost fraudsters are getting caught. But but, Zaina, you and I are helping the good guys continue to be able to serve these vulnerable patients.
00;02;09;09 - 00;02;26;14
Bryan Nowicki
And that's been a real challenge, and I think over the past six months, definitely, Zaina, the kind of increased enforcement of you that you've seen, I know you've been on the hospice team for a number of years, but what's your, perspective on, like, the last six, eight months of hospice enforcement efforts?
00;02;26;21 - 00;02;56;18
Zaina Niles
Well, the the government's really keeping us busy, Bryan. I think we've referred to it as a sledgehammer approach as opposed to the scalpel approach that we think is warranted to, to root out these fraudsters. But we have certainly seen an increase in audit activity, audits of all kinds, and then also an escalation in some of the, the consequences that are being imposed based on quote unquote, poor audit performance.
00;02;56;18 - 00;03;03;22
Zaina Niles
So things like payment suspensions, revocations of billing privileges, huge extrapolated overpayments and the like.
00;03;03;24 - 00;03;34;00
Bryan Nowicki
Yeah, that's that's for sure. And a lot of pressure being put on hospices. And really one of the bread and butter areas of our hospice team is audits, are audits. And so what I mean by that is you have all sorts of CMS contractors auditing hospices, looking at their medical records and determining whether those medical records support a terminal prognosis, whether all the documentation that's required, that's all the I's crosses, all the T's, like election statements.
00;03;34;07 - 00;03;58;13
Bryan Nowicki
And so, Zaina, I don't think a week goes by when somebody on our team isn't doing an ALJ hearing or other kind of administrative appeal, where we have our experts, expert physicians lined up trying to advocate and persuade an administrative law judge that a medical record, in fact, does support a terminal illness, even though CMS contractors would think otherwise.
00;03;58;15 - 00;04;29;00
Bryan Nowicki
And that really brings us to the heart of this episode, where over the past few years, we've seen a number of ALJs get more aggressive in taking on the role of, in our view, we think they may be playing doctor a little bit, where they're reviewing a medical record and coming to their own, layperson conclusion about terminology, even when it is directly contrary to physician testimony.
00;04;29;06 - 00;04;45;26
Bryan Nowicki
And it's undisputed physician testimony. So that's one area where we're we're going to federal court. We have gotten a number of cases, go to federal court to say they, ALJs are overstepping the boundaries of what they're authorized or competent to do. And another
00;04;45;26 - 00;04;46;10
Bryan Nowicki
area
00;04;46;10 - 00;05;31;20
Bryan Nowicki
is what is called the limitation of liability aspect of the Medicare hospice benefit. And what that means is, in essence, Congress enacted a law that, says that if a hospice had a reasonable belief that it would get paid for a service, it provided, based upon, an interpretation of a medical record that to the hospice, supported a terminal condition that the hospice should get paid for that, even if other even if an ALJ might disagree on whether the record actually supports terminality as long as the hospice was reasonable in its interpretation of the record that's supporting that, then then it ought to get paid.
00;05;31;27 - 00;06;07;17
Bryan Nowicki
And so that's another thing that we appeal to federal courts. And so that's what brings us to a really important decision that came out recently from the Sixth Circuit Court of Appeals. That, in our view, was a very positive development for hospices on that limitation of liability issue. So Joe I want to kind of invite you into this and set the legal stage, if you could like, how the appeal gets to the Court of Appeals and then after that, let's talk a bit about the act, the the issue and the decision from the federal court.
00;06;07;17 - 00;06;09;17
Bryan Nowicki
So set the stage for us, Joe.
00;06;09;22 - 00;06;38;13
Joe Diedrich
Absolutely. So as listeners may know, may have different levels of familiarity with when you're at the ALJ, you've already dealt with a number of levels of contractor review. Then you have a trial like proceeding before an ALJ who may hear some evidence, get some documents, and then make a decision about whether or not the medical evidence supports a terminal prognosis.
00;06;38;21 - 00;07;09;14
Joe Diedrich
And as Bryan mentioned, even if the ALJ says, you know, this doesn't support a terminal prognosis, there's still a question of this limitation of liability or sometimes called safe harbor provision under the Medicare statute. And I'll get back to that. If a hospice or any other health care provider that's going through the Medicare appeals process disagrees with an ALJ decision, they then have two more paths.
00;07;09;14 - 00;07;41;06
Joe Diedrich
Number one, they initially have to go to the Medicare Appeals Council. And if the council either doesn't act or affirms the ALJs decision, then you can go to federal district court. In this particular case, we went to the U.S. District Court for the Northern District of Ohio because that's where our hospice client was located. And then a judge, a federal judge with life tenure, reviews the ALJ’s decision.
00;07;41;08 - 00;08;03;15
Joe Diedrich
But there's not a new trial. It's he's just looking to determine whether the ALJ applied the correct law and had some evidence to support his or her decision. For this case, we lost at the district court. The district court agreed with the ALJ on on all of the relevant decisions that the ALJ made.
00;08;03;15 - 00;08;09;03
Bryan Nowicki
But that's not the end of the story. This has a happy ending. So that is.
00;08;09;06 - 00;08;44;09
Joe Diedrich
Right. That is far from the end of the story. So, federal district courts like that, they make decisions that are that just decide the case. But then there's another level of federal court above that, one level below the US Supreme Court. So the U.S. Court of Appeals for the Sixth Circuit. And these circuits are also geographic, the Sixth Circuit hears appeals from all courts in Michigan or from all federal courts in Michigan, Ohio, Kentucky, and Tennessee.
00;08;44;16 - 00;09;19;18
Joe Diedrich
And so once we go up there, we reargue the case. And again, there's no trial. But there is another round of legal briefing and oral argument. And they're also doing the same kind of review of the ALJ. And this time, well, well, two things. So first of all, when when a federal court of appeals makes a decision, not only does that matter for the particular case, but that also means that any district court in those states has to follow whatever the circuit court says going forward.
00;09;19;18 - 00;09;31;16
Joe Diedrich
So when the when the appeals court says something, it's very important. And we were very fortunate to win on the limitation of liability issue in this case.
00;09;31;18 - 00;09;32;05
Bryan Nowicki
I felt.
00;09;32;05 - 00;09;33;03
Joe Diedrich
Quite
00;09;33;06 - 00;09;35;19
Bryan Nowicki
Yeah. Well, and Joe, just go ahead.
00;09;35;19 - 00;09;36;07
Joe Diedrich
Right. Yeah.
00;09;36;07 - 00;09;59;12
Bryan Nowicki
No, just, yeah. You mentioned the federal courts in those four states. They're bound by this. What about federal district courts in other states? How would they view a decision from the Sixth Circuit Court of Appeals, like a, a case in Texas or California or Maine or something? What would they how would they perceive that kind of decision?
00;09;59;15 - 00;10;45;24
Joe Diedrich
So that's that actually a super important question for this case in particular, because when you have a federal court in a different state, they're not bound to follow what the Sixth Circuit does. They have their own circuits that they have to follow. But if their circuit has not decided the relevant issue, then they often look to a different circuit court of appeals has done as highly persuasive and informative and on the question of limitation of liability under Medicare for us, is this Sixth Circuit case that we're talking about today is the first court anywhere in the country at that court of appeals level to make this determination?
00;10;45;24 - 00;10;58;29
Joe Diedrich
So we think in our industry it's going to be hugely persuasive for all other pending federal district court cases and even ALJ cases, that are, that are currently pending.
00;10;59;05 - 00;11;07;04
Bryan Nowicki
Yeah. And so ALJ is are bound I guess ALJ is hearing cases relating to the four states. They're they're bound by this.
00;11;07;06 - 00;11;10;05
Joe Diedrich
Yes. They have to follow circuit precedent as well.
00;11;10;13 - 00;11;17;10
Bryan Nowicki
All right. Well great. Let's take us to the the issues then. Kind of give us the rundown on what the court decided.
00;11;17;12 - 00;11;42;18
Joe Diedrich
Yeah, absolutely. If you want to read more of the case that the name of the case is In Home Health v. Kennedy. It's number 253542. The key issue here is that limitation of liability or safe harbor provision of the Medicare Act. So what happens when you get all the way to the ALJ and the ALJ says, actually, I don't think there was coverage here.
00;11;42;18 - 00;12;16;21
Joe Diedrich
I don't think this patient was terminally ill. Even when that's the case, Medicare still sometimes has to pay for those services. And regardless, and that happens when a provider acts in good faith and reasonably, even if wrongly, in concluding that a patient is terminally ill. So the Sixth Circuit went through the statutory language, which, Bryan you did a beautiful job of making it sound clear, but when you actually read it on the page, it's anything but.
00;12;16;21 - 00;12;31;01
Joe Diedrich
And that's what's tripped up some ALJs in the past, it's tripped up some federal district courts in the past. But I think the Sixth Circuit does a great job, of really making it clear what an ALJ has to do going forward.
00;12;31;09 - 00;12;39;28
Bryan Nowicki
It goes to the language. It's like double negatives. And it's it is a, a twist and turn that, that you have to navigate.
00;12;40;00 - 00;13;13;08
Joe Diedrich
Exactly. So the key phrases here from the Sixth Circuit, it says an ALJ must consider whether a provider could reasonably have interpreted the relevant notices or local standards of practice as covering each denied claim. And if the provider reasonably, albeit incorrectly, interpreted Medicare's notices and standards as covering a patient's claim of terminal illness, then the safe harbor saves them from liability, meaning they get reimbursed for that patient's care.
00;13;13;15 - 00;13;48;18
Joe Diedrich
Now, what that means for hospice is incredibly important. There might be other circumstances where there's not really daylight between actual coverage and reasonably interpreting the standards for coverage. For example, if Medicare has made it clear and is a guidance document that you can't prescribe a certain medication for a certain condition, or you can't use a particular type of medical device to treat some ailment, then that makes it pretty clear.
00;13;48;18 - 00;14;14;18
Joe Diedrich
And it would be totally unreasonable to say that I just made a mistake. But when you're dealing with local coverage determinations that are that are often the case in hospice and there are no black and white, answers in that. Sometimes it's multi-factor tests or things that are open for interpretation, that nurses and doctors might reasonably disagree on. That reasonableness
00;14;14;21 - 00;14;40;11
Joe Diedrich
part of this matters a lot, because our physician or our client's physicians might reasonably at the time, think that this patient is, in fact, terminally ill. And then an ALJ might disagree with that and also be reasonable in disagreeing with that several years later. But the at the end of the day, the safe harbor provisions says as long as both sides were reasonable, the provider still gets paid.
00;14;40;13 - 00;14;56;04
Joe Diedrich
And that's what this decision makes crystal clear. And hopefully this decision will not only apply in those four states where the Sixth Circuit is, but also, across many other states as in the entire country.
00;14;56;06 - 00;15;16;10
Bryan Nowicki
Yeah. And Joe, I think good to to kind of dig into your description of no cases where there may be some daylight between, whether there's coverage and whether it should be paid. An example I think of and I'm, I'm, I'm making this up. I'm not a doctor. But I think it's a good way to illustrate it.
00;15;16;10 - 00;15;41;29
Bryan Nowicki
Let's say there's a local coverage determination that one of the max has put out that says you, we will only cover, this surgery or this medication for your heart if you have an ejection fraction of less than 20%. Well, okay, you measure the ejection fraction, you either do or you don't. And therefore either the medication or surgery is covered or it is not.
00;15;41;29 - 00;16;20;10
Bryan Nowicki
It can be somewhat black and white in the hospice space, there are local coverage determinations, but they're far from black and white. And I think they're intentionally open ended to provide that. It's a recognition of the inexact nature of prognostication. And I think what was helpful in this case is the court recognized the open ended nature or the non mandatory, the gray area of prognostication, which is something that I don't think ALJs or other contractor decision makers have recognized to this point.
00;16;20;12 - 00;16;48;24
Bryan Nowicki
So so I think, along those lines, what we've seen in a lot of these decisions is an ALJ. The quick the Mac, they will say, well, you don't get the limitation of liability because there's an LCD that's published and you should have known from looking at the LCD. Joe, does the Sixth circuit, allow that kind of reasoning to, to be made anymore, or does it shut the door on that?
00;16;48;26 - 00;17;21;20
Joe Diedrich
The sixth circuit shuts the door on that. So that is exactly the reasoning that the ALJ in this sixth Circuit case had used. And the Sixth Circuit said, that's not enough. You have to submit. The Sixth Circuit actually actually sent this case back to the ALJ to try again on the question of limitation liability. And it said you have to analyze not only whether the provider like literally had notice of the LCD, because of course they did.
00;17;21;23 - 00;17;34;08
Joe Diedrich
You have to analyze whether what they said, applying that to the particular patients in the case was a reasonable thing for a doctor to do at the time they did it.
00;17;34;10 - 00;18;09;04
Bryan Nowicki
All right. Well, great. And, Zaina, let me involve you because, Joe, Joe is our federal court, go to person. But, Zaina, you you lead our efforts on all of the audit activity that leads up to federal court. You're also involved in federal court on the briefing side. But regarding this denial reason that you're not entitled to the limitation of liability because, the regulations and the local coverage determinations, put the hospital on notice that these claims wouldn't be covered.
00;18;09;04 - 00;18;18;01
Bryan Nowicki
Is that how prevalent is that as a reason not to allow a limitation of liability for a particular hospice?
00;18;18;08 - 00;19;14;23
Zaina Niles
Bryan, all of the underlying decisions that we get from these CMS contractors usually include a sentence or two that just wholesale dismisses the application of section 1879, the limitation of liability section. And they do typically only give the rationale that the provider had notice because these guidelines are published. And so since I very first joined the team back in 2020, we have always argued in our appeal documents up through the ALJ phase that it would be impossible to determine, based on these generic guidelines and rules and regulations, including the LCDs, whether each individual patient with unique clinical state, clinical circumstances would not have their care covered and paid by Medicare.
00;19;14;25 - 00;19;48;13
Zaina Niles
So that's a routine argument that we raise. And up to this point, it really didn't have any teeth. It was just dismissed. And now the favorable decisions that we've gotten in federal district courts and also at the Sixth Circuit, like Joe just discussed, really take the wind out of the contractors sales because they say that it's not enough to just give a blanket statement that the provider had constructive notice.
00;19;48;15 - 00;20;00;01
Zaina Niles
There has to be a case by case determination of whether the provider was reasonable in providing that care and billing for those claims.
00;20;00;03 - 00;20;37;05
Bryan Nowicki
Yeah, I think the practical effect of this for for those hospices that have gone through the appeal process and you're sitting with an ALJ decision. ALJ is they always address this limitation of liability. It's sometimes known as the 1879 argument or consideration, because that's the section of the Social Security Act. But if you take a look at your ALJ decision, and if the ALJ said, the hospice was on notice that these claims would not get paid because LCDs are published and the regulations are published.
00;20;37;07 - 00;20;52;02
Bryan Nowicki
Now, Joe, that's what you have, have kind of interpreted in the Sixth Circuit decision as saying that is insufficient. That is something that can be reversed. And the ALJ needs to try again on that, that what I'm hearing.
00;20;52;09 - 00;20;53;02
Joe Diedrich
That's right.
00;20;53;05 - 00;21;20;28
Bryan Nowicki
Great. So so, you know, I think, Zaina, what you said about this is a standard decision in every ALJ decision we have received, it can really open up opportunities to try to get another, go at some of those decisions. Now, it remains to be seen, in this case, Joe, it was remanded. So the ALJ is going to get another attempt at this to and in applying the correct interpretation that right.
00;21;21;00 - 00;21;22;00
Joe Diedrich
Yep. That's right.
00;21;22;02 - 00;21;41;25
Bryan Nowicki
That's so. So it remains to be seen whether the ALJ is going to be able to come up with another decision that results in denial. But but at least there's this opportunity to take the case to an appeal and try to get another stab at a victory in some of these cases. And now this is not the only case we've worked on.
00;21;41;28 - 00;21;56;09
Bryan Nowicki
Zaina, you and I have been involved in cases that the district court level. So a level short of the Court of Appeals, we recently had a case out of the Northern District of Indiana. Why don't you describe the central holdings of that case and how it relates to hospices?
00;21;56;16 - 00;22;26;16
Zaina Niles
Sure. So just taking a step back for a second, Bryan, and providing the context again here in order for a decision in ALJ decision to withstand scrutiny upon judicial review, the decision has to be supported by substantial evidence, and it also has to apply the correct law. We've already talked a little bit about the holding with regard to the limitation of liability provision there.
00;22;26;18 - 00;22;58;28
Zaina Niles
But just to put a finer point on it, the court in Indiana agreed with our long standing argument that simply stating a provider had notice based on the publication of rules and regulations is not enough to establish that that provider is not entitled to payment for the care that it provided. And so the ALJ or the judge in that case, rather said the ALJ’s blanket inference of constructive notice was really an error of law.
00;22;58;28 - 00;23;06;07
Zaina Niles
And that's something that on remand, the ALJ is going to have to cure in their decision.
00;23;06;09 - 00;23;27;10
Bryan Nowicki
And so they kind of anticipated the six circuit decision. But the Sixth Circuit being a higher court, you know, that has a lot more persuasive power to it. But it's not just the sixth Circuit. We have a case out of Indiana now, which is outside the Sixth Circuit, but at a lower court level that essentially shares the Sixth Circuit's view.
00;23;27;16 - 00;23;28;14
Zaina Niles
Absolutely.
00;23;28;16 - 00;23;33;21
Bryan Nowicki
And what what else? What else about that case? Was there any other aspect of that case that was noteworthy?
00;23;33;26 - 00;24;17;14
Zaina Niles
Yes. We won on another very important issue regarding the substantial evidence piece. So in that case, the court also found that the decision was flawed because the ALJ did not show that there were substantial evidence supporting his conclusion. And they cited to two examples of how the decision wasn't supported by substantial evidence. The first was that the ALJ conclusively, conclusively dismissed, certain symptoms as insignificant to support a terminal prognosis without providing a sufficient basis for that conclusion.
00;24;17;16 - 00;25;01;04
Zaina Niles
And then the decision was also flawed because the ALJ did not explain why he ignored or disregarded the hospice physician's, expert testimony provided during the hearing. And so the court went on to say that while an ALJ is allowed to dismiss and expert's opinion, they have to give legitimate reasons for doing so. And simply paraphrasing portions of the expert's testimony without really engaging with it or providing any reasoning or rationale of why those conclusions are insufficient, renders the decision unsupported by substantial evidence.
00;25;01;07 - 00;25;26;04
Bryan Nowicki
And this is essentially the argument we've been making about ALJ improperly playing doctor, that I think, Zaina, you and I see this in ALJ decision after decision after decision, they'll list a number of clinical data points. They might summarize the testimony of the hospices expert. But then in a very short fashion they'll say, I don't think that information was sufficient.
00;25;26;06 - 00;25;51;04
Bryan Nowicki
And or if essentially the patient wasn't sick enough to be terminal without explaining why they think that or based on what, it's very frustrating to have an administrative law judge who is an attorney, former attorney, to just disagree with the physician, often board certified physician, board certified in hospice without explaining where did that hospice physician go wrong?
00;25;51;04 - 00;26;14;10
Bryan Nowicki
So we're kind of left scratching our heads a lot. So I remember when this decision came down, it was refreshing to see a court really put it to the ALJ. You can't just say you disagree. You got to say why you disagree so that the court can tell if you disagreed on appropriate grounds. If you disagree with the physician because you know you don't like the way they parted their hair, well, that's a problem.
00;26;14;12 - 00;26;28;03
Bryan Nowicki
But and if you don't agree because you don't think it was sufficient, well, why wasn't it sufficient? There's so many variables in, in, prognostication that it's hard to hard to just say it's not sufficient without that explanation, so.
00;26;28;10 - 00;27;07;02
Zaina Niles
Right. And, and one of the ways that they a lot of the underlying case law characterizes, the substantial evidence piece is they refer to a logical bridge. An ALJ isn't allowed to just list out clinical data points and then conclude that the patient wasn't terminally ill. They have to provide a logical bridge to show how they got from the information that they're citing, including any evidence from expert testimony to their ultimate conclusion that the services were not reasonable and necessary, or that the patient did not have a terminal prognosis.
00;27;07;04 - 00;27;20;12
Zaina Niles
And where that logical bridge is missing, that, renders the decision flawed and in this case at least warranted a remand back to the ALJ for further consideration. Explanation.
00;27;20;14 - 00;27;48;12
Bryan Nowicki
Yeah. So it kind of the practical takeaway from this is, again, if you've been before the ALJ, you have a decision and you don't see the kinds of explanations. Bill is supporting the ALJ rationale, you may have a potential appealable issue, to go to federal court and have that administrative law judge take a new crack at it, or what you're able to do is just ask the federal court to reverse the ALJ.
00;27;48;15 - 00;28;07;06
Bryan Nowicki
We've been able to obtain that in some cases, but but at least you get another kick at it, with some of these flaws in ALJ decision. And I just want to wrap up this or this, call this podcast with a couple of other decisions that kind of echo the same themes. One of them echoes the same themes here.
00;28;07;06 - 00;28;30;12
Bryan Nowicki
One is out of Florida, where hospice is is big business down there. And we, in the past couple of months, we got a decision from a Florida district court. So not a court of appeals. It's the trial level court that looked at the Medicare regulations themselves. So not the limitation of liability, which is part of the Social Security Act.
00;28;30;12 - 00;29;11;29
Bryan Nowicki
But it looked at the Medicare hospice regulation. And Joe described kind of how the limitation of liability standard identified by the Sixth Circuit is a no. You need to have a reasonable interpretation of the medical record, not the definitive interpretation. Well, this court in Florida, agreed with our argument that even outside the limitation of liability statute, a similar standard applies just under the regular Medicare hospice regulation that that also requires a reasonableness test as opposed to a definitive test that requires proof of a terminal illness.
00;29;12;02 - 00;29;43;06
Bryan Nowicki
And that court criticized the ALJ for her repeated use or phrasing of, well, the hospice didn't establish terminality or didn't kind of demonstrate or prove it. And the judge says that's too high a standard. The standard is was the hospice reasonable? So kind of taking it from another angle, we have a court in Florida now, in another area of the law, tilting the scales a little bit more in the favor of the hospices than they were before that decision.
00;29;43;12 - 00;30;00;26
Bryan Nowicki
And that just applies to that particular case. But we have a few other cases that have reached similar results. And so we hope to keep the momentum up with some other cases. We have pending one final case that's completely unrelated to any of these issues, but it was a win for a hospice, so I want to talk about it.
00;30;00;28 - 00;30;22;21
Bryan Nowicki
We represented a hospice that, according to the administrative law judge, it failed to file an appeal on time. You usually have 60 days to file an appeal. Well, this administrative law judge said the hospice was too late. Now, the problem with that decision was that the hospice never got the decisions that it was supposed to have appealed.
00;30;22;26 - 00;30;48;04
Bryan Nowicki
Well, how can it appeal a decision it's never received? And the ALJ said, well, you should have gone out and gotten the decisions or made some effort to obtain them. We appealed that to federal court. This is back in Ohio. And the judge agreed with us that the the deadline is triggered. The appeal deadline is triggered not by when you could have received a decision, but when you actually received them.
00;30;48;09 - 00;31;11;02
Bryan Nowicki
And so, after several weeks of effort, we ultimately got the quick to fax us the decisions it issued. But I think these were decisions dated October 3rd. They didn't fax them to us until January. So quite a time lag. But the federal court nonetheless said, your deadline started in January, not in October. So that was another success.
00;31;11;02 - 00;31;32;05
Bryan Nowicki
You know, several hundreds of thousands of dollars are now back in play for this hospice to go through the appeal and try to win them. So so overall, we're seeing some good say good news on the federal court level, which is very welcome. And in light of all the crushing fraud efforts that are out there. So, Joe and Zaina, any kind of parting words based upon this?
00;31;32;07 - 00;31;40;07
Bryan Nowicki
I think this is a, a happier podcast than some of the ones that are more issuing warnings and, and lookouts for things.
00;31;40;11 - 00;31;43;25
Joe Diedrich
Nothing further for me. Bryan, thanks for having me on.
00;31;43;28 - 00;31;47;06
Bryan Nowicki
Yeah, happy to do it. Zaina, what's your words of wisdom.
00;31;47;09 - 00;31;47;13
Bryan Nowicki
For
00;31;47;13 - 00;31;48;15
Bryan Nowicki
Our client?
00;31;48;17 - 00;32;20;28
Zaina Niles
My words of wisdom. Well, just a parting thought is it has been so vindicating to see these judges. At all levels, really agree with what we've been saying all along. And that is ALJ is you're not allowed to just deny claims for no reason. You have to provide an explanation. You can't just ignore, the Social Security Act because of a rule being published.
00;32;21;00 - 00;32;44;11
Zaina Niles
You can't just ignore expert physician testimony, because you are putting yourself up against a physician with absolutely no basis. And so it's been really vindicating. And I'm I'm happy to see, that these hospices are getting the results that they deserve. And hopefully they will be helpful for our other clients who are similarly situated.
00;32;44;13 - 00;33;02;15
Bryan Nowicki
Great. Well, Joe, thanks so much for for being a part of this. We got we're not going to wait five years before you're on the next time. So we'll get you on here and and Zaina, thank you. And thank you both for fighting these battles on behalf of hospices. You know, now more than ever, they need help wherever they can get it.
00;33;02;15 - 00;33;14;00
Bryan Nowicki
And I think these cases really are gonna prove to be a difference maker in a lot of these. Thank you so much. And thank you, everybody for listening. Take care.
00;33;14;03 - 00;33;34;02
Bryan Nowicki
That's it for today's episode of Hospice Insights: The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com or sign up wherever you get your podcasts. Until next time, take care.