In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss recent OIG guidance on hospice and skilled nursing facility relationships, focusing on anti-kickback risks and fraud concerns. They cover key issues such as the importance of documenting fair market value for any services or space provided, being cautious of payments exceeding Medicaid room and board rates, and avoiding arrangements that appear to be made solely to secure referrals. Bill and Jason also touch on increased oversight and enforcement in the healthcare sector under a new presidential administration.

In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss the role of managed care, artificial intelligence, and prior authorizations in home health and hospice. Bill and Jason examine a recent lawsuit filed against a major Medicare Advantage plan in the United States District Court for the District of Minnesota challenging the use of AI-driven claims reviews in Medicare Advantage coverage decisions. They also address concerns around prior authorization denials, their high reversal rates, and potential consequences for providers and patient care.

In this episode, AGG Healthcare attorneys Bill Dombi and Jason Bring discuss the hospice special focus program and CMS’ announcement that it will cease implementing the program in the face of litigation filed by providers and state associations.