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Fraud and Abuse in Home Care and Hospice: Understanding Risk Areas; Preparing for Review

Wednesday, February 21, 2018
2:00 – 3:30 pm ET

CE/CME Information

Jointly provided by the National Hospice and Palliative Care Organization (NHPCO) and the National Association for Home Care & Hospice (NAHC)

Audits by government auditors (Medicare Administrative Contractors (MACs); Medicaid Integrity Contractors (MICs); Recovery Audit Contractors (RACs) and Zone Program Integrity Contractors (ZPICs), now renamed Unified Program Integrity Contractors (UPICs), are on the increase.  For the homecare industry, these audits have recently focused on physician certification requirement, eligibility for care, and reasonable and necessary services. For the hospice industry, the focus has been on eligibility, physician involvement and live discharges.  As the focus shifts in the early part of 2018, this Webinar will provide you with up to the minute summaries of audit activity and identify new areas for scrutiny.  Though home care and hospice each have distinct areas of concern, both are at high risk for the challenging scrutiny that audits bring.

This Webinar collaboration between the National Hospice and Palliative Care Organization and the National Association for Home Care & Hospice will help providers understand fraud and abuse, the audit process, steps to prevent allegations of fraud and abuse and response to audits if they occur.

Home care and hospice legal experts will identify practices that increase the likelihood that a provider will face allegations of fraud and abuse. Lessons learned from providers that have experienced audits will be shared. Most importantly, guidance on how to prepare for additional scrutiny and audits and what actions responsible leaders should take will be discussed in detail.   

Learning Objectives:

  • Describe and distinguish between the various government audit programs for home care and hospice
  • List audit focus areas for home care and hospice
  • Identify practices that place providers at increased risk for government audits
  • Delineate appropriate actions to take when fraud and abuse allegations occur


Edo Banach, JD

Edo Banach is the president and CEO of National Hospice and Palliative Care Organization. Prior to joining NHPCO, Mr. Banach was a partner in the firm of Gallagher, Evelius & Jones in Baltimore, Maryland. Previously, he served as the Deputy Director of the Medicare-Medicaid Coordination Office at the Centers for Medicare & Medicaid Services. Before his leadership role at CMS, he served as Associate General Counsel at the Visiting Nurse Service of New York. Mr. Banach holds a B.A. from Binghamton University and a J.D. from the University of Pennsylvania Law School. Before attending law school, Banach worked for the New York City Department of Homeless Services and Mayor's Office of Operations. Additional professional experience includes time as General Counsel at the Medicare Rights Center.

Jason Bring, JD

Jason Bring is a Partner at Arnall Golden Gregory, LLC. He co-Chairs the firm's Post-Acute Care Team and is a member of the firm’s Healthcare and Litigation Groups. Mr. Bring also serves as Chair of the Post-Acute and Long-Term Services Practice Group of the American Health Lawyers Association, the nation’s leading largest educational organization devoted to legal issues in the healthcare field. Mr. Bring also serves on the Board of Directors for the Georgia Hospice and Palliative Care Organization. Mr. Bring represents nursing homes, hospitals, hospices, and other institutional providers in litigation, governmental investigations, regulatory compliance, and administrative disputes.

William A. Dombi, Esq.

Bill Dombi is the President of the National Association for Home Care & Hospice. With nearly 40 years of experience in health care law and policy, Mr. Dombi has been involved in virtually all legislative and regulatory efforts affecting home care and hospice since 1975. Mr. Dombi was lead counsel in the landmark lawsuit that reformed the Medicare home health services benefit, challenges to HMO home care cutbacks for high-tech home care patients, lawsuits against Medicaid programs for inadequate payment rates, along with current lawsuits challenging the Medicare home health face-to-face encounter rule and the Department of labor changes to the overtime rules under the Fair labor Standards Act. Mr. Dombi is admitted to practice law in Connecticut and Washington, DC. He is also admitted to numerous federal courts including, the US Supreme Court.

Howard J. Young, JD

Howard Young is a Partner at Morgan Lewis & Bockius and leads the Health Care Practice where he provides counsel to a wide variety of health care providers, including hospices, home health agencies, hospitals, physician groups and pharmacies. He regularly advises on responses to government program integrity contractor inquiries and related appeals.  Additionally, he advises on compliance program matters. From 1997 to 2002, Mr. Young was a Senior Counsel and Deputy Branch Chief with the Office of Counsel to the Inspector General, where he coordinated extensively with CMS and DOJ on the resolution of civil and criminal health care fraud matters and other program integrity matters.  

Compliance Officer: The Compliance Certification Board (CCB)® has approved this event for up to 1.8 CCB CEUs. Continuing Education Units are awarded based on individual attendance records. Granting of prior approval in no way constitutes endorsement by CCB of this event content or of the event sponsor.

Nurse: NHPCO is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

NHPCO designates this live activity for a maximum of 1.5 contact hours.

Physician: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of NHPCO and NAHC. The NHPCO is accredited by the ACCME to provide continuing medical education for physicians.

NHPCO designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Certificate of Participation for Non-physician Healthcare Professionals: For participants* whose disciplines are other than compliance officer, nurse and physician, you may request a Certificate of Participation for Non-physician Healthcare Professionals to submit to your accrediting bodies/licensing boards for continuing education credit. This certificate will indicate the Webinar was certified for AMA PRA Category 1 Credit(s) TM. It is the responsibility of participants to submit the certificates to their accrediting bodies/licensing boards for approval. Unfortunately, NHPCO cannot guarantee its acceptance. To receive this certificate, you must complete all CE/CME requirements and indicate your desire to receive this certificate on the evaluation form.

*including finance professionals, physician assistants, social workers, etc.