Tag Archives: acute integration

Notes On Increasing Acute and Post-Acute Integration

By Brian Daucher on March 5, 2014 Posted in Hospice Law

The focus of the AHLA Long Term Care Conference was on convergence of acute (hospital) and post-acute (SNF, home health, hospice) service delivery mechanisms. A number of forces promote this convergence including: Accountable care organizations forming integrated delivery systems including doctors, hospitals, and post-acute services; Growth of exchange based insurance alliances that limit post-acute choices … Continue Reading

The Hospice Law Blog is designed to provide timely news, insights, legal analysis and resources on Hospice reimbursement issues. The blog’s primary editor, Brian Daucher, has counseled clients on all aspects of hospice law, including hospice cap appeals, selection of cap calculation method, pre-payment edits, and post payment ZPIC audit appeals.

In 2007, Mr. Daucher filed the first challenge to the streamlined hospice cap regulation on behalf of a single hospice in Oklahoma. From 2008 to 2011, more than 15 other courts (from California to the District of Columbia), including the 5th and 9th Circuit Courts of Appeal issued rulings for Sheppard Mullin clients finding the streamlined method unlawful; no court upheld the regulation.

During this time, Sheppard Mullin won suspension and set aside more than $50 million in cap repayment demands for more than 100 hospices. Sheppard Mullin has secured settlements for these providers that required credit of interest paid on such demands, recalculation of demands under the new pro-rated method, forgiveness of interest through the date of the recalculated demand, partial reimbursement of attorneys’ fees, and return of overpayments by hospices with interest.

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