In this episode, Husch Blackwell’s Claire Postman joins host Bryan Nowicki to discuss CMS’s provisional period of enhanced oversight (PPEO) program that has now expanded to six states. From the basics to the fallout, they...more
Meg Pekarske has dedicated her professional life to the hospice community. In this episode, Bryan Nowicki interviews her about her years as a hospice attorney. Meg reflects on the characteristics of successful hospices and...more
CMS has extended its Provisional Period of Enhanced Oversight (PPEO) and its Expanded Prepayment Review (EPR) enforcement efforts to Georgia and Ohio. The enhanced enforcement efforts can lead to the revocation of a hospice’s...more
1/8/2026
/ Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Enforcement Actions ,
Georgia ,
Health Care Providers ,
Healthcare ,
Healthcare Facilities ,
Hospice ,
Medicaid ,
Medicare ,
Mergers ,
Regulatory Oversight ,
Regulatory Requirements ,
Reimbursements ,
Risk Management
A common referral scenario involves hospital clinicians referring a dying patient to hospice. This circumstance gives rise to questions relating to hospice eligibility, the appropriate level of hospice care, and the...more
Increasing audit activity combined with certain decreasingly favorable audit appeal outcomes has resulted in hospices appealing audit results beyond the administrative law judge phase and into federal court. In this episode,...more
In an audit, election statement deficiencies can be costly. Auditors deny all claims covered by the problematic election statement, and those costs can multiply if more than one patient was affected. In this episode, Husch...more
Host Jonathan Porter welcomes to the show Husch Blackwell partner Bryan Nowicki, a Madison-based member of the firm’s Healthcare group, to discuss payment suspensions involving the Centers for Medicare & Medicaid Services...more
Hospice audits can have profound financial implications, particularly when the auditors use statistical extrapolation to identify an overpayment amount. The use of extrapolation runs across auditor types, including UPICs and...more
For hospices, unprecedented competition, enhanced oversight, and looming payment reform create business obstacles or growth opportunities, depending on your outlook. Your growth strategy shouldn’t be the same as your...more
Hospices that have gone through audits are familiar with certain recurring reasons why auditors deny claims. Two common reasons are the lack of support for a six-month prognosis and the insufficiency of the physician...more
CMS recently expanded its Provisional Period of Enhanced Oversight, or PPEO, in Arizona, California, Nevada, and Texas, and its enforcement activities nationwide appear more aggressive. In this episode, Husch Blackwell’s Meg...more
It’s our first podcast of 2025 and we wanted to start the year out with some reflections. Join Husch Blackwell’s Meg Pekarske and Bryan Nowicki as they each share their biggest surprises and victories of 2024 and what is on...more
The United States Supreme Court recently overruled decades-old precedent that favored an administrative agency’s interpretation of ambiguous statutes. This seismic shift in the role of the judiciary will affect every...more
Hospices that have been audited have to decide how to address any alleged overpayment identified by the auditor, whether through a voluntary repayment, recoupment, or applying for an extended repayment schedule. CMS recently...more
UPIC activity is picking up, and the UPICs are reviving some old tactics. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki continue the discussion on these trends which include extrapolation, Medicaid nursing...more
UPIC activity is picking up, and the UPICs are reviving some old tactics. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss these trends which include extrapolation, Medicaid nursing home room and...more
Recovery Audit Contractors (RACs) have played a relatively limited role in the hospice space, often overshadowed by UPICs, SMRCs, and Center for Program Integrity audits. In this episode, Husch Blackwell’s Meg Pekarske and...more
Hospice Targeted Probe and Educate reviews (TPEs) continue to be initiated all over the country. That means it’s time to check in with Husch Blackwell’s Hospice team on the latest developments. In this episode, Meg Pekarske...more
Five years ago, the U.S. Department of Health and Human Services Office of Inspector General (OIG) initiated audits of 13 hospices and published its findings in 13 separate reports. It appears that the OIG is at it again, as...more
Centers for Medicare & Medicaid Services (CMS) devised a “Special Focus Program” to identify poor performing hospices and help them improve through more frequent surveys and technical assistance. CMS would also impose...more
CMS has criticized hospices for underutilizing general inpatient care (GIP) but has also specifically targeted GIP claims for audit and medical review. In addition to CMS’s standard tools for reviewing GIP claims, such as...more
While not new, the number and scope of Targeted Probe and Educate (TPE) reviews have soared to new heights. At the same time, more hospices are facing the uncomfortable position of moving to a second and sometimes third round...more
A study published by NORC at the University of Chicago, a nonpartisan research organization, concluded that the Hospice Benefit saved Medicare $3.5 billion in 2019. The data behind that figure, and the study’s related...more
In the five-step audit appeals process, hospices often stop their appeal efforts after finding success at the third step, a hearing before an administrative law judge (ALJ). However, if an ALJ issues an unfavorable decision,...more
Hospice professionals are often left wondering how the Centers for Medicare and Medicaid Services (CMS) and other government entities identify enforcement priorities. They also seek understanding about the subsequent steps...more