Home Health Agencies: Regulatory and Enforcement Trends
Identifying Compliance Pitfalls and Minimizing Risk of Fraud and Abuse Investigations

Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
- work Practice Area
Health
- event Date
Tuesday, February 25, 2020
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE course will provide guidance to healthcare counsel for withstanding heightened regulatory scrutiny and increased enforcement activity targeting home health operations. The panel will discuss steps home health agencies can take to minimize the risk of fraud and abuse investigations.
Faculty

Ms. Erdfarb advises a wide range of healthcare organizations such as hospitals, long-term-care providers, dental practices, behavioral health clinics, individual practitioners, and information technology companies. She advises on a broad range of issues, including compliance, fraud and abuse, False Claims Act, HIPAA, patient care, regulatory, and corporate matters. Ms. Erdfarb’s experience includes assisting providers with state and federal survey issues, including handling compliance and informal dispute resolution meetings and appealing deficiencies with the Centers for Medicare and Medicaid Services; managing Medicaid audits; and responding to governmental subpoenas. She assists clients in developing and evaluating corporate compliance programs, HIPAA policies, and managing compliance issues, including conducting internal investigations, submitting self-disclosures, and negotiating with government authorities. Ms. Erdfarb is the AHLA Vice Chair for the Health Information Technology Practice Group's Digital Health Records Affinity Group and is on the editorial board of the AHLA's Federal Healthcare Laws & Regulations. She formerly served on the ABA Health Law Section's taskforce on HITECH and in the AHLA's Leadership Development Program and is an adjunct professor at Quinnipiac University School of Law.

Mr. Markette focuses his practice on representing home health, hospice and private duty providers in all aspects of their operations. With more than 10 years of experience in working with these industries, he has developed a reputation for understanding the issues facing home care providers and has assisted clients in a number of areas related to the operation of their businesses. Mr. Markette works with clients on issues related to Medicare and Medicaid compliance, including surveys, responding to surveys and state and federal appeals of survey findings; payer issues; HIPAA compliance; and Medicare and Medicaid fraud and abuse. He also assists clients with purchasing and selling home health, hospice and private duty agencies. Mr. Markette is certified in healthcare compliance by the Health Care Compliance Board. He is also a frequent speaker on home health, hospice and private duty matters across the country.
Description
In recent years, there has been a substantial increase in the availability and severity of sanctions, including civil monetary penalties, that may be imposed by CMS on home health agencies with survey deficiencies. The Office of Inspector General (OIG) has also identified particular areas within the home health industry that are vulnerable to fraud and abuse. Moreover, the roll out of the new Patient-Driven Groupings Model (PGDM) payment system for home health agencies will present new liabilities for home health agencies, as there are sure to be audits verifying compliance.
Healthcare counsel should monitor the areas of home health operations that are currently targeted for enforcement, evaluate their clients' potential risks, and assist with developing effective compliance measures.
Listen as our authoritative panel examines these changes in the home health industry and discusses best practices to ensure compliance with federal fraud and abuse laws and minimize the likelihood of government investigations.
Outline
- Survey readiness and process
- OIG work plan focus
- PDGM compliance
- Recent cases and lessons learned
Benefits
The panel will review these and other key questions:
- What does CMS survey data show about surveyor focus areas?
- How did the revisions to State Operations Manual, Appendix Q alter the immediate jeopardy process?
- What areas of home health operations are more susceptible to potential fraud and abuse violations?
- What are the risks to agencies whose utilization patterns change under PDGM?
- What lessons can be learned from recent actions and settlements for mitigating risk?
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