Hospice Insights: The Law and Beyond

CMS revised the Medicare 60-Day Repayment Rule, changing how overpayments are identified. In this episode, Husch Blackwell’s Bryan Nowicki and Andrew Brenton analyze this change and how it affects the time frames applicable to internal investigations and repayment obligations. They also introduce a handy one-page summary of key deadlines. Additional resources: 60-Day Repayment Rule

In hospice and home health, certain compliance problems can have a big impact on the organization’s bottom line—and ability to keep operating. Even seemingly minor issues can affect whether the organization will be fully paid for services it provided, subject to financial penalties, or even barred from participating in a payment program. To help home health agencies and hospices spot and prevent t...

Hospice providers remain under heavy scrutiny, with prepayment audit and other audit activity on the rise. Unified Program Integrity Contractors (UPICs) historically conducted post-payment reviews. However, over the last six months, they have joined Medicare Administrative Contractors in reviewing claims on a prepayment basis. In this episode, Husch Blackwell’s Bryan Nowicki and Zaina Niles discus...

Since September 2024, CMS’s Medicare Administrative Contractors have been conducting expanded prepayment reviews (also known as “EPRs” or targeted high-risk reviews) of existing hospice providers in Arizona, California, Nevada, and Texas. As of December 2025, hospices in Georgia and Ohio are also under the microscope. In this episode, Husch Blackwell attorneys Bryan Nowicki and Zaina Niles discuss...

Since July 13, 2023, CMS has applied a Provisional Period of Enhanced Oversight (PPEO) to “new” hospice providers in Arizona, California, Nevada, and Texas. On December 30, 2025, CMS announced it was expanding PPEO to Georgia and Ohio. In this episode, Husch Blackwell attorneys  Bryan Nowicki and  Adam Royal discuss how these changes impact new (and not-so-new) hospice providers.

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 unpack who is subject to PPEO, what it involves, and how to avoid and handle the worst-case consequences of a PPEO gone awry.

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 hospice leaders, current challenges, and why hospices should have hope for the future.

Welcome to a very special podcast! It’s special for many reasons. First, as a longtime admirer of Mettle Health’s visionary work supporting people through change and loss, Meg Pekarske was elated when co-founder Sonya Dolan and counselor Bridget Sumser said yes to being on the podcast. Second, a discussion of how we face endings seems fitting for Meg’s last episode as host of the Hospice Insights...

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 expectation of the patient and the hospital. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki address these questions and provide insights into effectively managing th...

Many hospices established their single entity corporate structure 40+ years ago and have left it largely untouched. But this too is worth a dust off especially as hospices are expanding into new geographies, new service lines, and affiliating with additional organizations. When done thoughtfully, an expanded corporate organizational chart does not need to cause painful complexity and administrativ...

The world of Medicare enrollment and the 855 may seem like a tangle of boring paperwork, but all that i-dotting and t-crossing is critical for avoiding Medicare deactivation and other unpleasant consequences. In this episode, Husch Blackwell attorneys Meg Pekarske and Andrew Brenton discuss the most common mistakes they see providers make related to the 855. You’ll learn which key individuals you...

You know those conversations that leave you feeling excited, hopeful, and ready to change the world? This is one of those conversations. In this episode, Husch Blackwell’s Meg Pekarske is joined by American Academy of Hospice and Palliative Medicine Fellow Dr. Bethany Snider. Dr. Snider shares how she developed a palliative care program that meets the needs of patients, payors, and her organizatio...

CMS’s FY 2026 hospice final rule introduces significant changes to the face-to-face (F2F) attestation requirements starting October 1, 2025. All in all, the news is positive: while there is a new requirement for the F2F attestation to be signed and dated, the signed and dated F2F clinical note on its own can now serve as the F2F attestation.  In this episode, Husch Blackwell attorneys Meg Pekarske...

Substandard quality care is the subject of survey citations and lawsuits, but it has also been used by the Justice Department to support false claim liability. While historically these cases were rare, a recent multi-million dollar settlement puts “worthless services” on the radar. Join Husch Blackwell’s Meg Pekarske and Jonathan Porter as they explore what the “worthless services” theory of liabi...

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, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the circumstances that gave rise to hospices taking their cases to federal court, how those cases are playing out, and...

Husch Blackwell’s Meg Pekarske is joined by Dina Yankelewitz, CEO of Vitalis Care, a technology company that is harnessing AI technology to reduce staff burden and allow more time for patient care. Dina shares her vision and passion for the hospice space, discussing how she applied her background in education and learning methods to inform not only what tools to develop but importantly how they wo...

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 Blackwell’s Meg Pekarske , Bryan Nowicki , and Josi Wergin discuss common reasons auditors give for denying claims based on election statement deficiencies, and how hospices can...

On May 12, 2025, the Head of the Criminal Division for the Department of Justice (DOJ) issued a memorandum outlining its enforcement priorities. In this episode, Husch Blackwell’s Meg Pekarske and Jonathan Porter break down what is new and not so new in DOJ’s announcement. They explore the memorandum’s revisions to the Voluntary Self-Disclosure Policy, its treatment on individual liability, and ho...

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 the OIG, and can apply to Medicare and Medicaid.  In this episode, Husch Blackwell’s Meg Pekarske , Bryan Nowicki , and Emily Solum discuss recent experiences and successes in...

Husch Blackwell’s Meg Pekarske is joined by colleague Kathleen Snyder , who has extensive experience in digital health and has been busy advising health care providers on how to safely implement artificial intelligence (AI) tools in their organizations. With AI holding so much promise for helping hospices gain efficiencies, reduce staff burdens, and improve the patient experience, we all need to j...

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 neighbor’s. Instead of following the herd, Husch Blackwell’s Meg Pekarske and Bryan Nowicki explore how to begin thinking about what should be on your strategic plan and the importanc...

There has been a lot of buzz around psychedelics and particularly their potential usefulness in treating existential suffering at the end of life. Husch Blackwell was the first law firm in the country to establish a Psychedelics & Emerging Therapies practice group devoted to helping clinicians, researchers, and investors navigate the complex and difficult legal and regulatory issues involved in de...

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 narrative. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss a new twist on these kinds of denials, and how hospices can strengthen their documentation to try...

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 Pekarske and Bryan Nowicki discuss these enhanced oversight efforts and ways, both structurally and operationally, for hospices to mitigate these risks.

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 their wish list for 2025. We hope you enjoy this episode and let us know what is on your wish list of podcast topics for 2025. Wishing you a happy new year!