Home Health & Hospice

Changing demographics, shifting healthcare policies, and growing competition calls for an experienced team that has the depth of experience our clients have come to rely on and trust.

Overview

The growing fields of end-of-life and home healthcare presents business and regulatory challenges that require thoughtful legal approaches and experienced counsel. AGG represents publicly traded, privately held, and tax-exempt home health and hospice companies throughout the U.S. We also provide advice to lenders and investors in the home health and hospice sectors. Our clients span the broad range of home and community based services providers, for whom we provide counsel in corporate and transactional, compliance, enrollment, survey and enforcement, reimbursement, fraud and abuse, privacy, litigation, real estate, and labor and employment matters. 

Our team includes recognized leaders in the home health and hospice sector who are invited to present regularly at industry events including Home Care 100, National Association of Home Care & Hospice (NAHC) and at the American Health Lawyers Association (AHLA) Long Term Care and the Law conferences. Our attorneys include a former general counsel to a national home health provider and former member of the Board of Directors of CHAP, one of the deemed status accrediting organizations for home health and hospice, as well as a former Assistant Regional Counsel at U.S. Health and Human Services (HHS), Office of General Counsel (OGC).

Experience

  • Advised a leading owner-operator of integrated senior healthcare campuses in multiple facility refinancings (including with HUD) in a number of states, including Indiana, Kentucky, Michigan, and Ohio. AGG assisted with determining any filing requirements for the refinancings, the compilation of filings, and the opinion-writing process for the many facilities, including nursing facilities, assisted living facilities, residential care facilities, and homes for the aged.
  • Advised private home care and assisted living company in sale to private equity backed strategic buyers.
  • Assisted a national REIT in its minority investment in a portfolio of a variety of healthcare providers, including assisted living, memory care, hospice, and private-pay in-home care. The providers were located in multiple states, including Arizona, California, Illinois, Texas, Utah, Washington, and Wisconsin. AGG’s involvement included in-depth diligence, including a review of the providers’ licenses, permits, certifications, and accreditations, PEPPER reports, government investigations and surveys, hospice cap calculations, compliance program, background screening, HIPAA, medical directorships, admission agreements, commercial payor audits, and corporate practice of medicine. AGG also assisted with preparing the underlying investment agreement and related disclosure schedules.
  • Obtained precedential temporary restraining order and settlement preventing the government from recouping against a hospice provider during its ZPIC appeal.
  • Represented three private home care businesses in a simultaneous sale to a national private home care business.
  • Following the filing of federal lawsuit and motion for injunctive relief, obtained successful settlement for home medical service provider on its claims for federal trademark infringement and various state law violations (including deceptive trade practices, dilution and unfair competition) against a competitor who had misappropriated client’s trademark.
  • Serving as health regulatory counsel to private equity group in the acquisition of home health provider, including transfer of all necessary operational licenses. Purchase price was in excess of $5 million.
  • Successfully represented the entire spectrum of healthcare providers – including hospitals, nursing homes, home health agencies, hospices and physicians – in numerous Medicare and Medicaid reimbursement disputes with, in the aggregate, several hundreds of millions of dollars at issue.
  • Successfully obtained reversal by CMS of revocation of home health agency’s Medicare provider number based upon an allegation that the provider parent location was not operational, resulting in CMS overturning the fiscal intermediary’s decision to revoke, and reopening the enrollment to be processed.
  • Successfully represented a Georgia home health provider in a request for reconsideration of a CMS contractor’s decision to terminate the provider’s Medicare enrollment.
  • Counseled home health provider in structuring “house call” service model for Stark/Anti-kickback compliance and satisfying Medicare reimbursement rules.
  • Regulatory due diligence for a private equity investor supporting the acquisition of a three-state home health
    provider;
  • Defending and negotiating settlements for home health agencies in complaint survey enforcement actions by state survey agencies;
  • Working with a national home health clients in defending against state attorney general and AUSA False Claims investigations
  • Successful reversal via a request for reconsideration to CMS, of a home health agency termination from Medicare for not being operational;
  • Challenge to Medicaid program redesigns contrary to CMS waiver approvals;
  • Successfully litigating and resolving certificate of need competitive batch appeals relating to expansion of home health agency services;
  • Advising home health clients on implementation of CMS’ face-to-face and thirty-day functional assessment rules;
  • Defending a class action suit against a hospice provider alleging violations of HIPAA;
  • Development of compliance program policies and HIPAA/HITECH Act policies for providers;
  • Successfully litigating to obtain a statewide increase in hospice rates;
  • Conducting regulatory due diligence and counsel to lenders in connection with a loan to a home health provider acquiring agencies in Texas, Tennessee and Michigan;
  • Handling an administrative appeal of a seven-figure Medicaid recoupment for a hospice;
  • Handling a “without fault” determination request with a fiscal intermediary regarding a potential over-payment for a hospice provider;
  • Advising a home health client on its successful application for participation in PPACA’s Independence at Home demonstration;
  • Handling numerous hospice cap appeals, both through courts and before the Provider Reimbursement Review Board;
  • Handling an investigation by the Office of Inspector General regarding the billing practices of a South Carolina hospice;
  • Representing a publicly traded home health technology and support services provider as outside general counsel from 1999 to 2011; taking the company private, representing the company in corporate governance matters, in defense of a government investigation and handling a number of acquisitions, divestitures and financings;
  • Asset acquisition of a non-profit Texas hospice and associate change of ownership requirements;
  • Represented a hospice provider in the acquisition of a hospice company with more than 60 locations in 14 states.

    News & Insights

    Healthcare Authority Newsletter

    The Healthcare practice at AGG produces a weekly newsletter which includes current news briefs relevant to the healthcare industry as well as articles and announcements, all for the benefit and interest of our clients and other industry members.