An ever-increasing number of adults and minors with post-acute care needs or chronic conditions are choosing home health, hospice, and community-based services rather than residing in institutional settings. These services typically include, among other things, nursing care under supervision of a registered nurse, physical or occupational therapy or speech-language pathology services, medical social services under the direction of a physician, and home health aide services.
The U.S. Department of Health and Human Services’ Office of Inspector General has identified home health, hospice, and community-based providers as program areas vulnerable to fraud, waste, and abuse, including questionable billing patterns, compliance problems, and improper payments. As a result, home health, hospice, and community-based providers around the country are under the microscope.
Epstein Becker Green attorneys have assisted home care, hospice, and community-based providers in not only surviving, but prospering, during an era of unprecedented scrutiny in the way that their services are provided and reimbursed. Our attorneys understand the complex and rapidly changing legal and regulatory framework relating to home health, hospice and community-based services. We serve as trusted advisors to our private equity and investment bank clients active in the home health, hospice, and community-based provider market. We provide these clients with transaction, legal, and health regulatory advice regarding acquisitions and divestitures.
Furthermore, we add value by providing clear, concise legal reasoning and effective, practical solutions to address the myriad of legal and regulatory issues that arise in this segment of the health care industry.
Services/Scope of Practice
Epstein Becker Green’s full array of legal services to home health and community-based providers includes:
- Representation before state and federal regulatory agencies with respect to investigations, surveys and certification, reimbursement, licensure, and certificates of need
- Representation in civil and criminal litigation
- Regulatory analysis and audits for compliance with federal and state laws and regulations
- Development and review of compliance plans
- Guidance regarding Medicare, Medicaid, and private third-party reimbursement issues
- Representation in mergers, acquisitions, joint ventures, and other business transactions
- Strategic analysis of affiliations and acquisitions
- Representation with respect to labor, employment, and OSHA matters
- Counsel and assistance regarding health care decision-making issues, ethics committees, and guardianship proceedings
- Represented a home medical equipment supplier in the $26 million acquisition of the assets of a home medical equipment supplier and medical/industrial gas company
- Advised a middle-market private equity firm on the health regulatory aspects of its acquisition of entities—which included a home care provider, a home health agency, a medical supply company, and a child care agency—and orchestrated the regulatory filings throughout all stages of the transaction
- Served as general outside regulatory counsel to a multistate home health company; conducted internal investigations as to potential wrongdoing by home health aides and supervising nurses; negotiated multiple settlements with the Medicaid Fraud Division in payment disputes; defended several Medical Fraud Control Unit investigations, which resulted in no action against the client; and defended the client in a U.S. Attorney’s Office investigation
- Served as general outside regulatory counsel to a New Jersey home health company, negotiated Medicaid Fraud Division settlements, resolved Attorney General matters with no action against the client, and conducted internal investigations of potential misconduct by home health aides and supervising nurses
- Negotiated the retention of a home health client’s operating certificate with the Department of Health, while arranging a smooth transition to the purchaser, and negotiated and implemented a compliant preferred provider program and arrangement as part of the transaction
- Defended a home health client in a Medicaid overpayment audit based upon the untimely submission of claims, and convinced the Office of the Medicaid Inspector General that the vast majority of the claims were caused by the transition to the state’s eMevs (electronic filing) system, leading to the complete withdrawal of any alleged overpayment
- Prepared policies and procedures for a hospital and home health agency ownership relationship to ensure that the discharge process did not violate fraud and abuse laws
- Assisted a home health, hospice, and care management client in due diligence activities and a merger
- Conducted due diligence of a provider of home health, hospice, and community services
- Assisted a large home health provider with a variety of research as to regulatory and managed care requirements, and reviewed and edited a variety of provider and other agreements
- Defended home health companies and adult day care centers in multiple state and federal investigations