Nelson Hardiman represents California home health agencies in their business, regulatory, and strategic challenges, including:
- Business Transactions
- Formation of entities and business structure
- Negotiation of payor contracts
- Purchase and sale agreements
- Service agreements and vendor contracts
- Employment and independent contractor agreements
- Regulatory Defense
- Department of Public Health (“DPH”) licensure investigations and appeals
- Reimbursement audits by private and governmental payors and their contractors
- CMS
- Medicare
- Medi-Cal
- National Government Services
- Fraud and abuse investigations by government payors and their contractors
- Safeguard Services
- Office of Inspector General
- Federal Bureau of Investigations
- Department of Justice
- Department of Health Care Services
- Bureau of Medi-Cal Fraud and Elder Abuse
- Audit defense
- Zone Program Integrity Contractor (“ZPIC”)
- Recovery Audit Contractor (“RAC”)
- Program Integrity Safeguard (“PSC”)
- Compliance
- Licensing, operational, and reimbursement compliance
- Medicare and Medi-Cal enrollment and changes of ownership
- Corrective action plans and other compliance strategies
- Prepayment review
- Licensure citations and deficiencies
- Medicare and Medi-Cal enrollment errors
- Local Coverage Determination compliance and documenting medical necessity
- Skilled nursing services
- Rehabilitation services
- Physician certifications
- Physician face-to-face encounters
- HIPAA and state patient data privacy and security requirements
- False Claims Act compliance for marketing and business development activities
- Litigation
- Licensure defense and appeals
- Medicare and Medi-Cal provider enrollment appeals
- Payor and reimbursement disputes
- Overpayment appeals
- False Claims Act/qui tam whistle-blower litigation defense
- Business litigation
- Medicare and Medi-Cal exclusions and suspensions by government entities
- CMS
- Office of the Inspector General
- California Department of Health Care Services