Endings, whether a result of a diagnosis, aging, or other life changes, raise big questions related to identity, purpose, and meaning. Mettle Health offers emotional accompaniment for patients and caregivers working through not only the existential but practical questions brought about by illness, disability, and aging. The organization fills an essential gap left in our fragmented healthcare system. 

In this passionate and compassionate conversation, we explore how Mettle Health’s unique model of care works, the advantages and challenges of running a largely “direct to consumer” healthcare business, how generational shifts may impact how we confront the challenges of serious illness in the future, the role and limits of technology in providing meaningful support and much more. 

We’re confident the Hospice Insights podcast will live on in the capable hands of longtime colleague and frequent guest Bryan Nowicki. He will do an outstanding job, and Meg will still be around and looks forward to being a guest a time or two. She started this podcast more than six years ago as a way to connect and provide support to our colleagues and partners. Thanks as always for your loyal support! 

For more information on the innovative work of Mettle Health, check out their website. 

Additional resources:

Medicare Benefit Policy Manual Chapter 9 Excerpt - General Inpatient Care

Additional Resources:

• CMS, Form 855A (Medicare Enrollment Application)
• Five Common Medicare Provider Enrollment Mistakes

In this episode, Husch Blackwell attorneys Meg Pekarske and Andrew Brenton share their thoughts on what the updated F2F attestation rules mean for hospice operators and weigh in on other components of the final rule, including CMS’s attempt at housekeeping by clarifying the types of hospice physicians who can certify patients.

Vitalis was built to solve the challenges hospices face every day — from missed units and clunky schedules to mileage fraud, billing gaps, and compliance headaches. Their tools help hospices predict end-of-life with improved accuracy; generate efficient, patient-centered schedules; track every mile with GPS-backed clarity; and simplify compliance with documentation support. To learn more about Vitalis Care visit their website at https://vitaliscare.ai/.

Additional resources:

05.12.2025 DOJ Memorandum: Focus, Fairness, and Efficiency in the Fight Against White-Collar Crime

In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki, and Emily Solum discuss recent experiences and successes in dealing with statistical extrapolations, as well as what the future of extrapolation looks like.

Additional resources:

Hospice Past v. Present – Considerations

In this episode, host Meg Pekarske is joined by the leaders of Husch Blackwell’s Psychedelics & Emerging Therapies practice group, Kimberly Chew, Karen Luong, and Natasha Sumner, who provide an overview of what psychedelics are, their legal status under federal and state laws, and liability considerations for clinicians. We also discuss the recent amicus brief they filed on behalf of nearly 30 end of life and palliative care providers in a case before the U.S. Court of Appeals for the Ninth Circuit. While there is a lot to digest here, we hope it is a helpful starting point for learning about this complex and evolving area.

Additional Resources:

MM 11808 - Limitation on Recoupment of Medicare Overpayments

CR 11808 - Updating Chapter 3, Sections 200.5 - 200.8, Limitation on Recoupment; Medicare Overpayments Manual

Additional Resources:

Federal Trade Commission (FTC) Non-Compete Clause Rule

Department of Labor (DOL) Rule on Overtime Exemptions

The Impact of the FTC’s Ban on Noncompete Agreements in the Health Care Industry

Additional resource:

• Jury Convicts Hospice Owner for Defrauding Medicare

Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.

Today's Episode | Exploring Upstream Revenue Opportunities for Hospices

In this era of disruption and market consolidation, the talk of the town is how hospices can make strategic pivots to expand their geography, diversify the scope of their services to get further upstream, and otherwise be more attractive to payors, including managed care plans. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton unpack some key upstream care revenue opportunities and release a new tool created for hospices to begin evaluating them.

Subscribe to Husch Blackwell’s Hospice mailing list to receive timely industry content and invitations.

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode | Audit Overlap: Connections and Contradictions Among Audits, Auditors and What to Do About Them

As audit activity escalates, hospices are getting increasingly familiar with the alphabet soup of audits and auditors, including OIG, UPIC, CMS, CPI, SMRC, MAC, TPE and more. Unfortunately, there are times when hospices are dealing with multiple audits at the same time. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the increasing prevalence of simultaneous audits, what it might mean and what to do about it.

Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.

Today's Episode: Insights on Building a Hospice Network From the Ground Up - A Conversation With Mike Milward, CEO of the California Hospice Network

As we explored in our podcast on June 30, 2021, there is no one way for hospices to collaborate and position themselves for value-based care. In today’s episode, Husch Blackwell’s Meg Pekarske has the great pleasure to be joined by Mike Milward, CEO of the California Hospice Network (CHN), who shares his firsthand insights on creating an innovative network model in California. 

They explore how this idea became a reality and how that reality has evolved with time. Mike invites us to see how independence and control can work within an integrated model. With so many insights shared in this episode, you must listen. Enjoy!

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: Beyond Part D, OIG Scrutinizes the Hospice Industry to the Tune of $6.6 Billion

In a follow-up to its recent reports on billing outside the hospice benefit for drugs and durable medical equipment (DME), the Office of Inspector General’s (OIG) new data report identifies billions being billed to Medicare Part A and B for hospice patients. What lies behind the headline? 

In this episode, Husch Blackwell’s Meg Pekarske, Andrew Brenton and Erin Burns unpack the OIG’s analysis and its critical shortcomings. They throw in some food for thought on what changes the industry might expect in light of the growing concerns related to the unbundling of care.

Today, Husch Blackwell’s Meg Pekarske has the great pleasure to be joined by two of the founders of the Institute for Story, Jamey Espina and Dr. Berry, who is also a best-selling author and top change management speaker, along with Hospice Savannah CEO, Dr. Kathleen Benton, DrPH, MA, who has found success in using story as a leadership and engagement tool. Their lively discussion explores the role story can play in connecting to ourselves and others, and how it may be a superpower when leading and supporting communities through difficulty. We believe this is a life-affirming and energizing conversation, and we hope you enjoy it!

For more information and to register for the Institute for Story Conference to be held in Savannah, Georgia on April 24–26, please visit their website at instituteforstory.com.

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: The OIG’s Impending Review of Nationwide Hospice Eligibility Demands a Robust Response From Hospices

The Office of Inspector General (OIG) recently announced that its 2022 work plan for hospices will include a nationwide review of hospice beneficiary eligibility. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss what led to this latest effort by the OIG, what hospices can expect and what they should do.

The False Claims Act (FCA) is the government’s most serious weapon to combat fraud in the healthcare community, and hospices are increasingly the target of FCA investigations and lawsuits. The United States Supreme Court is, for the first time, considering FCA cases involving hospices and certifications of terminal illness. Moreover, the relief funds disbursed by the government to hospices as a result of the COVID-19 pandemic add to the existing and substantial number of bases of potential FCA liability for hospices. Aggressive government investigation, enforcement efforts and increased whistleblower activity is coming. Hospices can and should prepare for this new environment. In this series, Meg Pekarske talks with Husch Blackwell attorneys Bryan Nowicki, Jody Rudman and Brian Flood about emerging issues involving hospices and the FCA. Bryan, Jody and Brian will share their experiences as seasoned litigators in FCA cases to help hospices understand the FCA trends affecting hospices, and provide practical guidance to help hospices prepare themselves to preempt, combat and successfully face FCA allegations.

Today's Episode: Proposed Amendment Would Increase Liability Risk

The False Claims Act is a powerful enforcement tool used to go after those who defraud the government. Unfortunately, the wide net cast by the False Claims Act can lead to extremely negative consequences for upstanding hospices. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss a proposed amendment to the False Claims Act that would widen that net even further, and describe the mounting opposition to this legislation.

Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.

Today's Episode: Think Before You Sign - Five Key Insights for VBID and Managed Care Contracts

Private payor contracts will define future revenue for hospices. Whether it be Medicare Advantage Value-Based Insurance Design (VBID) contracts for hospice services or for upstream non-hospice services (palliative and supportive care), the rules of the road will be defined by what you negotiate with payors. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton unpack five takeaways learned in working with hospices on their managed care contracts. We hope you enjoy the conversation and thanks for listening.

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: Hospice Audit Series - Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part II

In Part II of our two-part series on ALJ hearings, Husch Blackwell’s Meg Pekarske unpacks strategies for winning with colleagues Bryan Nowicki, Emily Solum and Erin Burns. They explore what it means to be well-prepared and who should be on your team. They also share tips for overcoming the most common hurdles to winning, and the hidden surprises they have found in ALJ decisions. We hope you enjoy this engaging conversation!

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: Hospice Audit Series - Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part I

In this two-part series, Husch Blackwell’s Meg Pekarske unpacks strategies for winning at ALJ hearings with colleagues Bryan Nowicki, Emily Solum and Erin Burns. They explore what it means to be well-prepared and who should be on your team. They also share tips for overcoming the most common hurdles to winning, and the hidden surprises they have found in ALJ decisions. We hope you enjoy this engaging conversation!

Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.

Today's Episode: Putting a Plan Into Action - A Conversation With Gloria Brooks on Building End-of-Life Partnerships

As many hospices begin the hard work of exploring how collaboration can benefit their organizations, it can be helpful and inspiring to hear how others have walked the same path. In today’s episode, Husch Blackwell’s Meg Pekarske talks with Gloria Brooks, who traveled this road as she led Arbor Hospice and its board through its affiliation with Hospice of Michigan. Gloria provides great insight into what it takes to make transformational change and successfully navigate through the issues that matter. She now helps hospices across the country build end-of-life partnerships through her consulting business called G. Brooks & Associates. Thank you for listening and we hope you enjoy the conversation.

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: A Beginning and an End from CMS - TPE Resumes While QIC Demonstration Ends

In today’s episode, Husch Blackwell’s Meg Pekarske talks with team members Bryan Nowicki and Erin Burns about two recent developments in the hospice audit arena. First, the Centers for Medicare & Medicaid Services (CMS) announced that Targeted Probe and Educate (TPE) audits would resume on September 1. Second, on December 31, 2021, CMS’s popular Qualified Independent Contractor (QIC) Telephone Demonstration is set to end. Meg, Bryan and Erin share insights on TPE and the QIC Demonstration as well as potential actions for hospices to take related to both.

The False Claims Act (FCA) is the government’s most serious weapon to combat fraud in the healthcare community, and hospices are increasingly the target of FCA investigations and lawsuits. The United States Supreme Court is, for the first time, considering FCA cases involving hospices and certifications of terminal illness. Moreover, the relief funds disbursed by the government to hospices as a result of the COVID-19 pandemic add to the existing and substantial number of bases of potential FCA liability for hospices. Aggressive government investigation, enforcement efforts and increased whistleblower activity is coming. Hospices can and should prepare for this new environment. In this 3-part series, Meg Pekarske talks with Husch Blackwell attorneys Bryan Nowicki, Jody Rudman and Brian Flood about emerging issues involving hospices and the FCA. Bryan, Jody and Brian will share their experiences as seasoned litigators in FCA cases to help hospices understand the FCA trends affecting hospices, and provide practical guidance to help hospices prepare themselves to preempt, combat and successfully face FCA allegations.

Today's Episode: Success in False Claims Act Lawsuits

In this third episode of the Husch Blackwell Hospice Team’s “Hospice and the False Claims Act” series, Meg Pekarske, Bryan Nowicki, Jody Rudman and Brian Flood discuss the process and path of a False Claims Act (FCA) lawsuit. FCA cases are a test of endurance as much as they require expert marshalling of facts and law. The Hospice Team gives the insider’s view of an FCA lawsuit, including how hospices and their attorneys work together to identify strengths and weaknesses, manage expectations and develop a winning strategy.

Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.

Today's Episode: Succeeding in Value-Based Care - How Hospices Can Collaborate Through Network Models

Today, Husch Blackwell’s Meg Pekarske is joined by the newest member of our Hospice & Palliative care team, Noreen Vergara, where they discuss different ways hospices can come together to succeed in the value-based care landscape. They explore a continuum of options from messenger-model networks to networks that are clinically and financially integrated all the way to common ownership through merger or acquisition. While there is no one-size-fits-all approach, collaboration can be a fresh way to create operational efficiencies, streamline costs, expand geographic reach and benchmark quality, all of which are critical to enhancing payor relationships. We hope you enjoy this rich conversation. 

In this series, we will explore all things privacy. From HIPAA breaches, to updates on the information blocking rule, to privacy enforcement trends, hospices will learn what they need to know to stay current in this evolving area of law. 

Today's Episode: HIPAA Breaches - When It Is, and When It Is Not a Breach

In today’s episode of our Hospice Privacy Series, Husch Blackwell’s Meg Pekarske is joined by colleagues Wakaba Tessier and Erin Burns, who share insights on the ins and outs of HIPAA breaches. They break down what a HIPAA breach really is, the types of breaches most often experienced by hospices and what to do when you think you have discovered a breach.

Applying a “buy local” philosophy to healthcare, Kathleen sees her future intwined with that of her community in that their needs define her organization’s business plan. Whether it be expanding palliative care opportunities, opening a vaccination center or deepening existing local partnerships, Kathleen brings a passion and purpose to what she does and sees opportunities beyond what has traditionally been in the “hospice lane.” 

Kathleen’s wit and good humor are contagious, and so are her enthusiasm for her work and her trust in the questions that lead us forward. We hope you enjoy the conversation.

The False Claims Act (FCA) is the government’s most serious weapon to combat fraud in the healthcare community, and hospices are increasingly the target of FCA investigations and lawsuits. The United States Supreme Court is, for the first time, considering FCA cases involving hospices and certifications of terminal illness. Moreover, the relief funds disbursed by the government to hospices as a result of the COVID-19 pandemic add to the existing and substantial number of bases of potential FCA liability for hospices. Aggressive government investigation, enforcement efforts and increased whistleblower activity is coming. Hospices can and should prepare for this new environment. In this 3-part series, Meg Pekarske talks with Husch Blackwell attorneys Bryan Nowicki, Jody Rudman and Brian Flood about emerging issues involving hospices and the FCA. Bryan, Jody and Brian will share their experiences as seasoned litigators in FCA cases to help hospices understand the FCA trends affecting hospices, and provide practical guidance to help hospices prepare themselves to preempt, combat and successfully face FCA allegations.

Today's Episode: Successful Approaches to Government Investigations

In this second episode of the Husch Blackwell Hospice Team’s three-part “Hospice and the False Claims Act” series, Meg Pekarske, Bryan Nowicki, Jody Rudman and Brian Flood discuss the precursor to almost every False Claims Act (FCA) lawsuit—the government investigation. Before an FCA case proceeds in court, the government typically conducts a thorough investigation. FCA cases can be won or lost at this stage, and how hospices respond to such investigations can set the stage for future success (if done properly) or future problems and liability (if mishandled). 

The Hospice Team discusses the ways in which the government investigates hospices in the FCA context and provides tips for a successful response to an investigation.

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: How are Hospices Faring at ALJ Hearings?

After waiting years, hospices are getting their “day in court.” How are hospices faring? In this episode, Husch Blackwell’s Meg Pekarske is joined by colleagues Bryan Nowicki and Emily Park, who share insights on what it takes to be successful before an Administrative Law Judge (ALJ). They discuss what is important to spend time on and what can be a distraction, as well as tips for how to stay focused on what matters. We hope this conversation provides you with new ideas on how to approach your next hearing.

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: CMS Program Integrity Audits Are Back!

In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the new wave of CMS Center for Program Integrity (CPI) audits that have been issued during the past couple weeks. These CPI audits remain focused on long length of stay patients and typically involve hundreds of claims valued at over $1 million. As Meg and Bryan explain, these audits may signal a new approach to auditing by CMS, and it is important for hospices to refine their response and appeal strategy accordingly.

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: The Second Guessing of Billed Hospice Physician Visits

Today, Husch Blackwell’s Meg Pekarske is joined by colleagues Bryan Nowicki and Erin Burns to discuss the recent denial of physician visits. Over the last several months, a number of auditors have begun questioning the medical necessity of billed physician visits, claiming the physician services were solely administrative in nature. They break down the criteria auditors appear to be using, what this means for hospices and how hospices can avoid such denials. We hope you enjoy the conversation.

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: Spring Audit Bloom—Medicaid UPICs and MAC ADRs

Today, Husch Blackwell's Meg Pekarske is joined by colleagues Bryan Nowicki
and Erin Burns to discuss the recent flurry of audit activity, specifically the
re-emergence of UPIC Medicaid audits and MAC post-pay ADRs. We will talk about what these requests look like, what we think it means and strategies for how hospices should respond.

The False Claims Act (FCA) is the government’s most serious weapon to combat fraud in the healthcare community, and hospices are increasingly the target of FCA investigations and lawsuits. The United States Supreme Court is, for the first time, considering FCA cases involving hospices and certifications of terminal illness. Moreover, the relief funds disbursed by the government to hospices as a result of the COVID-19 pandemic add to the existing and substantial number of bases of potential FCA liability for hospices. Aggressive government investigation, enforcement efforts and increased whistleblower activity is coming. Hospices can and should prepare for this new environment. In this 3-part series, Meg Pekarske talks with Husch Blackwell attorneys Bryan Nowicki, Jody Rudman and Brian Flood about emerging issues involving hospices and the FCA. Bryan, Jody and Brian will share their experiences as seasoned litigators in FCA cases to help hospices understand the FCA trends affecting hospices, and provide practical guidance to help hospices prepare themselves to preempt, combat and successfully face FCA allegations.

Today's Episode: What Will Hospices Face and What Can They Do About It

In this first episode of the Husch Blackwell Hospice Team’s 3-part “Hospice and the False Claims Act” series, Husch Blackwell’s Meg Pekarske, Bryan Nowicki, Jody Rudman and Brian Flood discuss how the False Claims Act (FCA) has historically affected hospices and the emerging areas of potential FCA exposure for hospices. These include two hospice FCA cases being considered by the U.S. Supreme Court relating to physician certifications of terminal illness and the FCA implications relating to the receipt and use of COVID-19 relief funds. The Hospice Team provides their insights and tips about how to proactively approach FCA allegations.

Information related to this episode:

• HomeCare: Husch Blackwell Secures Hospice Overpayment Reduction
• News release: Husch Blackwell's Hospice Team Opens 2021 with Significant Audit Victory
• Husch Blackwell's Hospice Medicare & Medicaid Audits Team
• Hospice Medicare Audits: Strategies for success
• Hospice Medicaid Audits: Vigorous advocacy

Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this new series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.

Today's Episode: The State of the Hospice Market

Join Husch Blackwell's Meg Pekarske as she talks with Mark Kulik, Managing Director at the Braff Group, who shares his insights on growth and change in the hospice industry and the forces at work. They explore who the “disruptors” are, who is leaving the market and what matters to those who continue onward. Drawing parallels to change in other healthcare sectors, Mark opines on what the hospice market may look like in 5 and 10 years. We hope you enjoy the conversation and it leaves you with a new insight or perspective on where hospice is going.

While nothing is easy these days, we are hopeful this discussion will leave you with some clarity that can ease the burden as you juggle the challenges of the day.

Join Meg Pekarske in this deep and meaningful conversation with Dr. Janet Bull as we explore how best to relieve suffering at the end of life and her reflections on what death has to teach us about living. Janet’s perspective is profoundly unique and is informed by being a witness to both the beginning of life – as an obstetrician-gynecologist – and toward the end of life as a hospice physician and Chief Medical Officer of Four Seasons, a nationally recognized leader in caring for those with serious illness. Janet has devoted the second half of her medical career to end-of-life care. She is a long-time leader in Hospice & Palliative Care, serving as past President of the American Academy of Hospice and Palliative Medicine and conducting significant research on the role and impact of palliative care in our healthcare system. In this episode, Janet shares what her life’s work has taught her on how we care for the dying, how it has evolved over time and what remain our greatest hurdles to ensuring good deaths. We explore what influence the growth and acceptance of hospice care has had on our societal relationship to mortality and where we have yet to go to ensure quality end-of-life care. We hope you enjoy this expansive conversation and that it enriches your thinking about how we can better serve those experiencing death and loss.

In this session, Meg Pekarske is joined by her colleagues Jon Anderson and Tom O’Day, who offer their insights on what makes unions attractive to employees and what you can do about it. The session addresses how a well-trained management staff can identify union activity at the outset and can use proven human resource best practices to effectively prevent a union effort and, if one arises, to help your employees make good choices. The time to prepare for a union campaign comes well before the union knocks at the door. What you do now will improve your chances in this high-stakes game.

Additional resources:

• FY 2021 Hospice Wage Index Final Rule
• FY 2021 Hospice Wage Index Rule:  What We Wanted vs. What We Got 
• CMS Model Election Statement Example
• CMS Model Election Addendum Example
• Medicare Hospice Regulatory Conditions of Payment 

For resources related to this episode, please see the following:

• Aseracare and Care Alternatives

For resources related to this episode, please see the following:

• CMS, FY 2021 Hospice Wage Index Proposed Rule
• CMS, Proposed Modifications to Model Election Statement and New Model Addendum
• CMS, FY 2020 Hospice Wage Index Final Rule

This episode commonly asked questions from hospices across the country. The group shares legal and accounting perspectives as well as practical considerations to help hospices as they operationalize their use of relief payments.

Presenters:

Husch Blackwell’s Hospice & Palliative Care attorneys Meg Pekarske, Bryan Nowicki and Andrew Brenton, and Crowe’s accounting professionals Bucky High, Dan Yunker and Stephanie Cerney/professionals/meg-pekarske

Resources:

• Presentation Slides: COVID-19 Town Hall for Hospices
• CARES Act Provider Relief Fund Webpage
• HHS Provider Relief Fund Frequently Asked Questions (May 18, 2020)
• Husch Blackwell: Risks of Spending Public Health and Social Services Emergency Fund Payments
• Husch Blackwell Coronavirus Toolkit
• Husch Blackwell CARES Act Updates