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About Elizabeth Hogue

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

Private Duty Home Care in Fraud Enforcers’ Crosshairs

May/June 2024 Issue
SUBSCRIBER CONTENT Personal care private duty agencies, it's crucial to recognize that fraud and abuse enforcement aren't exclusive to services covered by the Medicare Program. In fiscal year 2023 alone, there were 279 criminal convictions associated with private duty home care services. It's vital to understand the implications.

Private Duty Home Care in Fraud Enforcers’ Crosshairs2024-04-29T13:37:52-04:00

Multi-Pronged Efforts to Strengthen Direct Care Workforce: CMS Initiative

May/June 2024 Issue
SUBSCRIBER CONTENT CMS has unveiled the Direct Care Workforce Strategies Center, a pivotal initiative aimed at tackling the pressing shortage of workers providing direct care to elderly and disabled individuals. Worker registries play a crucial role in addressing fundamental questions: Who meets the criteria to deliver Home and Community-Based Services in each state, and how can Medicaid beneficiaries connect with them?

Multi-Pronged Efforts to Strengthen Direct Care Workforce: CMS Initiative2024-04-29T13:38:27-04:00

Enforcers Target Discharge Planners/Case Managers Yet Again

March/April 2024 Issue
SUBSCRIBER CONTENT Case managers or discharge planners found in violation of the anti-kickback statute may face criminal prosecution, potentially leading to prison sentences and other repercussions. If you were aware or should have been aware, you may bear responsibility. Attorney Elizabeth Hogue provides detailed explanations of these implications.

Enforcers Target Discharge Planners/Case Managers Yet Again2024-04-27T15:17:20-04:00

Patients’ Right to Freedom of Choice of Providers

March/April 2024 Issue
SUBSCRIBER CONTENT Patients possess the right to select their care providers, and this choice is reinforced through various avenues embedded in policies and regulations. Attorney Elizabeth Hogue explains the key touchpoints.

Patients’ Right to Freedom of Choice of Providers2024-04-27T15:17:34-04:00

Managed Medicare Plans: Update on Requirements for Prior Authorization

January/February 2024 Issue
SUBSCRIBER CONTENT The issues impacting prior authorizations from managed care organizations have caused some providers to discontinue relationships with plans. Starting January 1, 2024, UnitedHealthcare is changing home health agency processes.

Managed Medicare Plans: Update on Requirements for Prior Authorization2024-03-02T15:59:29-05:00

Preventing Violence in Home Care: Action Items

November/December 2023 Issue
SUBSCRIBER CONTENT According to a recent analysis of Bureau of Labor Statistics data, home healthcare is one of the most dangerous places to work in healthcare. Homecare field staff members who provide services on behalf of private duty agencies, hospices, Medicare-certified home health agencies, and home medical equipment companies are extremely vulnerable.

Preventing Violence in Home Care: Action Items2023-12-31T11:22:50-05:00

Judge Orders State to Provide Private Duty Nursing Care

September/October 2023 Issue
SUBSCRIBER CONTENT A Judge issued an opinion and order, in which he said that the State of Florida must provide services, including private duty nursing care, to medically fragile children who are living in nursing homes or threatened with institutionalization so that they can live at home.

Judge Orders State to Provide Private Duty Nursing Care2023-10-27T16:13:42-04:00

Legal: Recent Study Links Hospital Readmissions to Discharge Planning Process

September/October 2023 Issue
SUBSCRIBER CONTENT The study is based on eight focus groups that included nurses, physicians, discharge planning staff, and patients. It identified areas of possible change to the discharge planning process to reduce instances of unplanned hospital readmissions.

Legal: Recent Study Links Hospital Readmissions to Discharge Planning Process2023-10-27T16:13:55-04:00

Supreme Court Rules on Knowledge Required to Prove False Claims

July/August 2023 Issue
SUBSCRIBER CONTENT A ruling from the Supreme Court may make it more difficult for enforcers to prove liability under the False Claims Act and more manageable for providers to defend themselves against claims of violations.

Supreme Court Rules on Knowledge Required to Prove False Claims2023-08-29T11:24:17-04:00

Legal: Preferred-Provider Arrangements Between Home Health, Hospice and Private Duty Agencies, and Assisted Living Facilities and Retirement Communities

March/April 2023 Issue
SUBSCRIBER CONTENT Preferred-provider agreements are an important strategy for increasing referral relationships. This article provides a greater understanding of the legal aspects.

Legal: Preferred-Provider Arrangements Between Home Health, Hospice and Private Duty Agencies, and Assisted Living Facilities and Retirement Communities2023-06-19T08:34:57-04:00

HIPAA Violations to Avoid

March/April 2023 Issue
SUBSCRIBER CONTENT Compliance with HIPAA can be complex. Examples of violations, or “HIPAA stories,” may make requirements more understandable. We share some of those stories.

HIPAA Violations to Avoid2023-05-21T12:08:49-04:00

Legal: HIPAA Violations To Avoid

Compliance with HIPAA can be complex. Examples of violations, or “HIPAA stories,” may make requirements more understandable. Here are some of those stories.

Legal: HIPAA Violations To Avoid2023-04-12T16:03:47-04:00

Legal: Non-Compete Agreement Trends

Although the trend is certainly against non-compete agreements or restrictive covenants in the health care industry, some state courts have affirmed their use.

Legal: Non-Compete Agreement Trends2023-04-12T16:04:03-04:00

Complaints About Referrals Must Be Based on Facts

The owner of a supplier of home medical equipment (HME) complained that her company did not receive referrals from TidalHealth Nanticoke Hospital. The Court dismissed the owner’s lawsuit because she could not prove her claims. This case illustrates why providers who complain about practices of referral sources must have facts to support their claims. 

Complaints About Referrals Must Be Based on Facts2023-04-12T16:04:08-04:00

The Latest on Recoupment of Overpayments

In a November 2021 decision, the U,S, Court of Appeals said that CMS can recoup overpayments from providers even though its appeals are still pending before Administrative Law Judges.

The Latest on Recoupment of Overpayments2023-04-12T16:04:08-04:00

Legal: What Can Providers Give to Patients?

Providers, including marketers, are tempted to give patients free items and services. But be careful! These activities may violate laws prohibiting providers that participate in state and federal health programs from giving free items and services to patients.

Legal: What Can Providers Give to Patients?2023-04-12T16:04:09-04:00

Can Hospitals Require Physicians to Direct Referrals?

November-December 2021 Issue
FREE CONTENT Effective on January 19, 2021, new regulations related to the Stark laws expanded and underscored the ability of hospitals to require physicians to send referrals to particular providers. These new regulations also make it clear that providers can monitor and enforce requirements to direct referrals to designated providers.

Can Hospitals Require Physicians to Direct Referrals?2023-04-12T16:04:11-04:00

What Legal Parameters Establish Patient Choice?

May/June 2021 Issue
The right of patients to choose providers has generated considerable conflict within the provider community. In this article, learn the four key legal sources supporting patient choice and actions your organizations and patients can take to have them enforced.

What Legal Parameters Establish Patient Choice?2023-04-12T16:04:18-04:00

OIG Says Providers Can Offer Services to Caregivers

November-December 2020 Issue
In Advisory Opinion No. 18-05; issued on June 18, 2018; the OIG addressed the circumstances under which providers can establish “caregiver centers” that provide or arrange for free or reduced-cost support services to caregivers in local communities.

OIG Says Providers Can Offer Services to Caregivers2023-04-12T16:04:26-04:00

Marketing Hospice Service to ALF: Preferred-Provider Agreements

September/October 2020 Issue
How do anti-kickback statutes apply if providers or Assisted Living Facilities (ALFs) are involved in referral arrangements and receive any type of federal or state funds? Attorney Elizabeth Hogue breaks it all down.

Marketing Hospice Service to ALF: Preferred-Provider Agreements2023-04-12T16:04:28-04:00

Legal: Managing the Risks of Wound Care

Wound care is a risky business these days. Providers who render wound care services are at risk for many things, including liability for negligent wound care, violation of fraud and abuse prohibitions based on substandard wound care, and liability for abandonment when wound care services are discontinued.

Legal: Managing the Risks of Wound Care2023-04-12T16:04:28-04:00

COVID 19: Key Legal Issues

May/June 2020 Issue
It’s an important time to review legal questions and issues related to COVID-19. There is a lot of mis-information flying around and it’s easy for providers to get tripped up. But providers must ensure that they are doing it right in order to avoid a day of legal reckoning that could threaten their businesses in the future.

COVID 19: Key Legal Issues2023-04-12T16:04:34-04:00
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