Hospice and Palliative Care

Reinhart’s Hospice and Palliative Care attorneys consist of a team of lawyers devoted to issues facing hospice providers in a highly regulated environment.

Forward Page

Since its inception more than 20 years ago, Reinhart Boerner Van Deuren’s Hospice and Palliative Care Practice has evolved into one of the largest and most robust in the United States. At Reinhart, our hospice attorneys have a commitment to hospice goes beyond the practice of law; our mission is to deliver legal solutions that ensure hospice operators across the country can fulfill their mission. As a result, our hospice attorneys are uniquely suited to understand the values, passion and dedication of our clients. Those same principles on which the practice was founded continue to guide and elevate our work in the space today.

Reinhart’s Hospice and Palliative Care team features a specialized group of attorneys completely dedicated to the issues that hospice providers of all sizes are concerned with in today’s highly regulated environment. Providers nationwide place their trust in us due to the collective outcomes we have achieved over decades of work in the industry. We empower our clients by taking control of legal matters and successfully navigating the complex network of rules and regulations. As a result, we deliver confidence and reassurance while restoring a sense of control for hospice operators.

Leveraging the knowledge we have accrued from successfully addressing a high volume of cases over the years, we analyze an obstacle in deep detail and efficiently determine the best course of action in real time. Our hospice attorneys value proactively preventing issues as much as finding solutions to long-term problems.

It is our mission to help hospice and palliative care providers across the full continuum – regardless of size or non-profit/for-profit status – continually adapt and effectively respond to a changing industry. We pride ourselves on seeing the nuance in every case and elevating our response beyond a stock answer by applying our knowledge in new ways. Our client solutions continue to evolve and remain effective due to our deep understanding of the individual business and the hospice industry overall.

In addition to serving individual clients, we contribute our expertise to addressing national hospice policy and regulatory issues. Reinhart attorneys are regular presenters at National Hospice and Palliative Care Organization (NHPCO) conferences and webinars, and are frequently quoted in national hospice publications.


Recognizing that hospice budgets are getting tighter due to rate cuts and increased expenses, we are committed to delivering efficient, scalable models of service that address critical hospice business and legal issues. Our most cost-effective resources include:

Reinhartʼs Hospice and Palliative Care Practice has been a recognized leader and counsel for hospices throughout the United States for more than two decades. Our extensive knowledge and appreciation of hospices, their missions and business needs, and government regulations has allowed us to serve as trusted advisors to many hospices in the industry. Through our daily contact with hospices, we recognize that there is a wide variety of arrangements in which hospices are currently involved, or may be involved in the future. As such, we developed the following toolkits and templates to help hospices cost-effectively customize their approach to important areas of care and contracting:

Toolkits have been sold to hospices in nearly every state. Hospices can count on any of the attorneys in Reinhartʼs Hospice and Palliative Care Practice to help with a broad array of issues facing their organizations today.

Reinhart’s Hospice Law Library provides a comprehensive collection of relevant materials that hospices may need to reference, including federal hospice laws, regulations, CMS commentary, guidance and Office of Inspector General (OIG) reports, gathered and organized for your convenience by Reinhart’s Hospice and Palliative Care Practice Group.

Our depth of experience in the space, combined with a multidisciplinary approach that includes attorneys from related practices, allows us to achieve quality outcomes across the full spectrum of hospice operations – from government audit response, to hospice regulatory and compliance issues to hospice transactions, mergers and acquisitions.

Reinhart’s Hospice and Palliative Care attorneys understand the serious implications that government audits can present to a business. We approach every audit case with an elevated sense of urgency and determination in order to effectively and efficiently resolve the issue. Although audit cases are often complex and daunting, we leverage our experience working with hospices across the country to skillfully reach a favorable outcome.

When a hospice’s care is challenged, over 20 years of hospice law experience can make the difference. The Reinhart Hospice and Palliative Care team responds to and defends hospices in all types of government audits, including Zone Program Integrity Contractor (ZPICs), Medicare Administrative Contractors (MACs) and Medicaid. In our work, we have saved hospices multiple millions of dollars. Examples of our audit successes include:

  • Achieved a 59% reduction in overpayment amount at rebuttal stage in MIC Audit.
  • Won a $25 million victory in a hospice case. The hospice team successfully argued that the Zone Program Integrity Contractor’s (ZPIC) $25 million extrapolated overpayment was invalid. At the first level of appeal, the hospice was vindicated, leaving a mere $70,000 in dispute.
  • Secured the elimination of a $4.4 million extrapolated overpayment demand by a Zone Program Integrity Contractor (ZPIC). At the reconsideration level of appeal, Reinhart attorneys successfully argued that the statistical extrapolation had fundamental flaws and the Qualified Independent Contractor (QIC) agreed that the methodology was invalid.
  • Secured withdrawal of a $15 million extrapolated overpayment demand by a Zone Program Integrity Contractor (ZPIC).  Prior to filing the first level redetermination appeal, Reinhart attorneys successfully argued that the payment demand had to be rescinded due to fundamental flaws in the statistical extrapolation.  Achieving the withdrawal at this early stage allowed the client to avoid years of costly litigation and, due to the appeal backlog, the threat that the multi-million recoupment would begin before the case was heard by an administrative law judge (ALJ).
  • Secured withdrawal of $12 million extrapolated ZPIC audit finding prior to issuance of the demand letter. Within a few days of getting involved, the hospice team was able to persuade the Medicare Administrative Contractor (MAC) and the Zone Program Integrity Contractor (ZPIC) that fundamental errors had been made in the audit documentation review, rendering the overpayment determinations and statistical extrapolation inaccurate. As a result, the hospice was able to avoid a costly and time-consuming appeal to resolve this threshold matter.
  • At the first level of appeal, successfully overturned 84% of the ZPIC’s claim denials and secured removal of the extrapolation, reducing the $7 million repayment to nearly $96,000
  • Won removal of an extrapolation decision in the initial appeal, resulting in the reduction of the overpayment from about $6 million to nearly $100,000
  • Successfully defended one of the first federal hospice Medicaid Integrity Contractor audits by obtaining the withdrawal of nearly the entire $3 million overpayment after the initial response
  • Received favorable decisions from an administrative law judge on all beneficiary denials appealed in an extrapolated sample, reducing the overpayment from about $4.6 million to just under $40,000
  • Successfully defended a state Medicaid audit that sought to recover more than $6 million in nursing home room and board pass thru payments. After an initial response, the recoupment was reduced to about $82,000.

Our success is driven not only by our in-depth understanding of the unique clinical, legal and operational issues in hospice, but our significant experience in the interrelationship between hospice and nursing home reimbursement. Our extensive experience allows us to handle all types of audits efficiently and cost effectively. Experienced litigators led by Bryan Nowicki frequently partner with our Hospice and Palliative Care regulatory attorneys to assist clients in appealing government audits.

As part of our comprehensive Hospice and Palliative Care Practice, Reinhart attorneys are dedicated to providing counsel on the full spectrum of issues that hospices face. We counsel hospices on nearly every type of regulatory issue, both large and small, including:

  • Vendor, facility, and other contracts
  • Medical director and other physician relationships
  • Licensure, certification, and Medicare enrollment
  • Medicare and Medicaid survey issues
  • Reimbursement, including repayments and disclosures
  • Quality assessment and performance improvement (QAPI)
  • Corporate compliance and compliance program development

Our Hospice and Palliative Care team advises on fraud and abuse matters, including anti-kickback, self-referral, and false claims. We assist clients in identifying ways to grow and improve their organizations. This includes developing various models for non-hospice palliative care, new facility development, structuring direct-shared inpatient units in hospitals and nursing facilities, and new lines of business. We also advise on structuring and performing internal compliance and billing audits.

Our Hospice and Palliative Care team frequently helps hospice programs develop their business through acquisitions and divestiture. We have:

  • Represented a national hospice provider in its acquisition of hospice programs
  • Successfully negotiated and closed the divestiture of a large hospice program
  • Negotiated the transition of a hospice program on behalf of our client
  • Represented a client who sought to achieve a benefit for transferring its hospice program

We also have represented hospices in exploring joint ventures and affiliations, including:

  • Representing a joint venture in the exploration of a management service organization for hospice and long-term care businesses
  • Working closely with exempt clients to create legal structures and relationships with affiliates to achieve desired economic benefits

Our multidisciplinary team of attorneys leverages expertise from other practices within the firm to achieve successful outcomes for our hospice clients. Attorneys Larri Broomfield and Adam Konrad handle corporate issues for our hospice clients and serve as lead transaction counsel for all of the firm’s hospice transactions. Attorney Lucien Beaudry also lends his significant knowledge in advising tax-exempt health care entities on exemption and other tax-related issues.

  • Achieved a 59% reduction in overpayment amount at rebuttal stage in MIC Audit.
  • Won a $25 million victory in a hospice case. The hospice team successfully argued that the Zone Program Integrity Contractor’s (ZPIC) $25 million extrapolated overpayment was invalid. At the first level of appeal, the hospice was vindicated, leaving a mere $70,000 in dispute.
  • Secured the elimination of a $4.4 million extrapolated overpayment demand by a Zone Program Integrity Contractor (ZPIC). At the reconsideration level of appeal, Reinhart attorneys successfully argued that the statistical extrapolation had fundamental flaws and the Qualified Independent Contractor (QIC) agreed that the methodology was invalid.
  • Secured withdrawal of a $15 million extrapolated overpayment demand by a Zone Program Integrity Contractor (ZPIC). Prior to filing the first level redetermination appeal, Reinhart attorneys successfully argued that the payment demand had to be rescinded due to fundamental flaws in the statistical extrapolation. Achieving the withdrawal at this early stage allowed the client to avoid years of costly litigation and, due to the appeal backlog, the threat that the multi-million recoupment would begin before the case was heard by an administrative law judge (ALJ).
  • Secured withdrawal of $12 million extrapolated ZPIC audit finding prior to issuance of the demand letter. Within a few days of getting involved, the hospice team was able to persuade the Medicare Administrative Contractor (MAC) and the Zone Program Integrity Contractor (ZPIC) that fundamental errors had been made in the audit documentation review, rendering the overpayment determinations and statistical extrapolation inaccurate. As a result, the hospice was able to avoid a costly and time-consuming appeal to resolve this threshold matter.
  • At the first level of appeal, successfully overturned 84% of the ZPIC’s claim denials and secured removal of the extrapolation, reducing the $7 million repayment to nearly $96,000
  • Won removal of an extrapolation decision in the initial appeal, resulting in the reduction of the overpayment from about $6 million to nearly $100,000
  • Successfully defended one of the first federal hospice Medicaid Integrity Contractor audits by obtaining the withdrawal of nearly the entire $3 million overpayment after the initial response
  • Received favorable decisions from an administrative law judge on all beneficiary denials appealed in an extrapolated sample, reducing the overpayment from about $4.6 million to just under $40,000
  • Successfully defended a state Medicaid audit that sought to recover more than $6 million in nursing home room and board pass thru payments. After an initial response, the recoupment was reduced to about $82,000.
  • Represented a national hospice provider in its acquisition of hospice programs
  • Successfully negotiated and closed the divestiture of a large hospice program
  • Negotiated the transition of a hospice program on behalf of our client
  • Represented a client who sought to achieve a benefit for transferring its hospice program
  • Represented a joint venture in the exploration of a management service organization for hospice and long-term care businesses
  • Worked closely with exempt clients to create legal structures and relationships with affiliates to achieve desired economic benefits

News


Tracey L. Klein and Meg S.L. Pekarske were chosen as two “Women in the Law” by the Wisconsin Law Journal, paving the way for other women in the legal profession.
Continue

View All News

Knowledge

Prepare For Actual On-Site Auditor Questions and Requests

The following questions and requests were posed by actual government auditors – Zone Program Integrity Contractors (ZPICs) and Medicaid Integrity Contractors (MICs) – during on-site audits. Consider integrating this tool into your leadership and employee training, and use these questions and requests to test your audit preparedness.

View All Knowledge