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Hospice

Fenton Law Group represents California hospices to respond to their business, regulatory, and strategic challenges, including:

Business Transactions

  • Formation of entities and business structure
  • Physician and Medical Director contracts
  • Purchase and sale agreements
  • Negotiation of payor contracts
  • Service agreements and vendor contracts
  • Employment and independent contractor agreements

Regulatory Defense

  • Department of Public Health (“DPH”) licensure investigations and appeals
  • Reimbursement audits by private and governmental payors and their contractors
    • CMS
    • Medicare
    • Medi-Cal
    • National Government Services
  • Fraud and abuse investigations by government payors and their contractors
    • 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
  • Audit defense
    • Zone Program Integrity Contractor (“ZPIC”)
    • Recovery Audit Contractor (“RAC”)
    • Program Integrity Safeguard (“PSC”)

Compliance

  • Licensing, operational, and reimbursement compliance
  • Medicare and Medi-Cal enrollment and changes of ownership
  • Corrective action plans and other compliance strategies
    • Prepayment review
    • Licensure citations and deficiencies
    • Medicare and Medi-Cal enrollment errors
  • Audit risk assessment
    • Medical necessity of hospice claims
    • Length of stays and number of nursing home patients
    • Physician certifications and re-certifications
  • Local Coverage Determination compliance and documenting medical necessity
    • Terminal status in routine hospice claims
    • Special physician service claims
    • Inpatient hospice claims
  • Compliance with hospice cap
  • HIPAA and state patient data privacy and security requirements
  • False Claims Act compliance for marketing and business development activities

Litigation

  • Licensure defense and appeals
  • Medicare and Medi-Cal provider enrollment appeals
  • Payor and reimbursement disputes
  • Overpayment appeals
  • False Claims Act/qui tam whistle-blower litigation defense
  • Business and employment litigation
  • Medicare and Medi-Cal exclusions and suspensions by government entities
    • CMS
    • Office of the Inspector General
    • California Department of Health Care Services