Hospice Insights: The Law and Beyond

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 podcast. Endings, whether a result of a diagnosis, aging, or other life changes, raise big questions related to identity, purpose, and meaning. Mettle Health offers emotional accompaniment for patients and caregivers working through not only the existential but practical questions brought about by illness, disability, and aging. The organization fills an essential gap left in our fragmented healthcare system. In this passionate and compassionate conversation, we explore how Mettle Health’s unique model of care works, the advantages and challenges of running a largely “direct to consumer” healthcare business, how generational shifts may impact how we confront the challenges of serious illness in the future, the role and limits of technology in providing meaningful support and much more. We’re confident the Hospice Insights podcast will live on in the capable hands of longtime colleague and frequent guest Bryan Nowicki. He will do an outstanding job, and Meg will still be around and looks forward to being a guest a time or two. She started this podcast more than six years ago as a way to connect and provide support to our colleagues and partners. Thanks as always for your loyal support! For more information on the innovative work of Mettle Health, check out their website. 

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 this situation.Additional resources:Medicare Benefit Policy Manual Chapter 9 Excerpt - General Inpatient Care

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 administrative burdens. In fact, it may allow you to streamline governance, better protect your assets, and create operational efficiencies. Husch Blackwell’s Meg Pekarske and Adam Royal discuss what they are seeing across the country and key considerations when contemplating organizational changes.

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 should be sure to include on your 855 and why it is important not to wait for revalidation to make enrollment updates. Listen in for these and other practical tips on how to sidestep your next provider enrollment headache.Additional Resources:CMS, Form 855A (Medicare Enrollment Application)Five Common Medicare Provider Enrollment Mistakes

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 organization at-large. Their wide-ranging conversation covers alternative payment models, the importance of scale, the role of data analytics, and how to stay motivated in today’s regulatory environment.

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 and Andrew Brenton share their thoughts on what the updated F2F attestation rules mean for hospice operators and weigh in on other components of the final rule, including CMS’s attempt at housekeeping by clarifying the types of hospice physicians who can certify patients.

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 liability is, when it has been used, and whether the recent settlement could signal a resurgence of these types of cases.

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 what the future looks like.

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 work for the end user. Dina and Meg explore what AI is good at as well as its limits and why scheduling optimization, compliance, and reimbursement were the first areas Vitalis tackled. Dina shares her thoughts on what may be next for AI in the home care space, the hurdles she sees to adoption and change, and the opportunities for technology to enhance care, boost staff engagement, and give us all more time to do the work that is most meaningful.Vitalis was built to solve the challenges hospices face every day — from missed units and clunky schedules to mileage fraud, billing gaps, and compliance headaches. Their tools help hospices predict end-of-life with improved accuracy; generate efficient, patient-centered schedules; track every mile with GPS-backed clarity; and simplify compliance with documentation support. To learn more about Vitalis Care visit their website at https://vitaliscare.ai/.

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 improve their election statements to try to avoid them.

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 how whistleblowers may be impacted. Importantly, Jonathan shares takeaways on what hospices and their boards should do to stay vigilant.Additional resources:05.12.2025 DOJ Memorandum: Focus, Fairness, and Efficiency in the Fight Against White-Collar Crime

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 dealing with statistical extrapolations, as well as what the future of extrapolation looks like.

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 jump into the future—but do so thoughtfully. This episode will help you with just that. We explore critical do’s and don’ts for AI and key infrastructure hospices should have in place when implementing any type of AI solution. Happy listening!

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 importance of bringing your board along with you.Additional resources:Hospice Past v. Present – Considerations

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 developing new therapies in this space.In this episode, host Meg Pekarske is joined by the leaders of Husch Blackwell’s Psychedelics & Emerging Therapies practice group, Kimberly Chew, Karen Luong, and Natasha Sumner, who provide an overview of what psychedelics are, their legal status under federal and state laws, and liability considerations for clinicians. We also discuss the recent amicus brief they filed on behalf of nearly 30 end of life and palliative care providers in a case before the U.S. Court of Appeals for the Ninth Circuit. While there is a lot to digest here, we hope it is a helpful starting point for learning about this complex and evolving area.

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 to avoid them.

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!

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 regulated industry, including healthcare and hospice in particular. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the implications of this decision in the hospice space.

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 identified updates to the Medicare Financial Management Manual relating to these options. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss those updates which, practically speaking, do not significantly change the existing options.Additional Resources:MM 11808 - Limitation on Recoupment of Medicare OverpaymentsCR 11808 - Updating Chapter 3, Sections 200.5 - 200.8, Limitation on Recoupment; Medicare Overpayments Manual