Admissibility of statistical sampling to prove liability in FCA suit is fact dependent. In a February 14, 2017 decision, the Fourth Circuit declined to rule on the question of whether statistical sampling can be used to prove liability and damages in False Claims Act (FCA) lawsuits, concluding that it should not have agreed to [...]
The DOJ’s theory of falsity based on clinical disagreement alone fails as a matter of law. In a closely watched False Claims Act (FCA) proceeding by the healthcare industry and FCA practitioners, the US District Court for the Northern District of Alabama ruled in favor of a national hospice provider and dismissed the action, rejecting [...]
The evaluation and policy division of the HHS Office of Inspector General (OIG) issued a study dated January 13, 2015 after evaluating all Medicare hospice claims from 2007 through 2012. If history is a guide, critical OIG studies such as this one trigger additional targeted scrutiny, and so hospices, particularly for-profit hospices, should expect increased hospice audits related to their services to ALF residents.
Years of experience and research have demonstrated that “…people learn, and organizations change most readily when they focus on, study, and engage in dialogue about strengths, patterns of success and who they are at their best."
Through collaborative thinking, the team chooses innovative processes that are in alignment with both the strengths identified in Discovery and the imagined hopes of the future (Dream).
What does hospice have in common with political campaigns besides elections? Unfortunately, more than you'd think. It's not to late to reverse course and return to the days when journalists, patients/families, and referring physicians were promoting the benefits of hospice. Our colleague Kathy Brandt explores these similarities and ways each hospice can work to repair the reputation of hospice.
The Medicare Hospice Benefit has always defined the terminal illness, not as a single diagnosis, but as the interplay of conditions that together cause an individual to have a prognosis of 6 months or less. At this point, the proposed definition is open for comments. However, my guess is that in the final determination there may well be a clear differentiation between the definition of ‘terminal illness’ and that of the ‘principle/hospice-qualifying diagnosis’ to better underscore the prognostic implication and comprehensive nature of the former.
Proactively preparing for medical review positions your hospice for the best possible outcome in the event you receive IMPACT-related scrutiny, Additional Development Requests (ADRs) or become the target of any audits or investigations related to patient eligibility.
The passage of the 2014 IMPACT Act will bring more survey's to hospices. In this first of two blog posts, Joy Barry details what hospices need to do now to prepare for more frequent surveys of a hospice’s compliance with the Medicare Conditions of Participation (CoPs).
Am I a party pooper? A Debbie Downer? You can decide, but I don't think the hospice provisions in the Impact Act of 2014 are going to do much to increase transparency, sort out the "good" hospices from the "bad," or, sadly, improve the quality of care provided by hospices. Let me explain...