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A Growing Practice Area: Home Health Care Law

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By Casey C. Sullivan, Esq. on December 09, 2015 12:10 PM

The home health care industry is thriving. Fueled by an aging Boomer population and the desire of many patients to be treated in their own residences, the at-home provisioning of nursing and therapist care has become a $30 billion industry, with 12,000 Medicare-certified agencies.

That industry growth has lead to an increased need for attorneys experienced in Medicare reimbursement, industry regulations, and old-fashioned litigation. As a practice area, expect to see home health care law grow as quickly as the population grays.

Reimbursement

Home health care will account for about three percent of Medicare spending in 2015. It may not be the largest slice of the Medicare pie, but it is no mere pittance either. Of Medicare's massive budget, that three percent represents about $18 billion in federal assistance.

Professional legal assistance may be necessary during the reimbursement process, both for patients and providers. The home health care industry is facing increased regulation and reduced reimbursement, which is likely to increased mergers in the industry, according to the M&A advising firm Harris Williams & Co. On an individual level, patients may see an increased need to appeal care coverage denial decisions or advocate for an adequate care plan.

Regulation

Regulation of the home health care industry is largely focused on fraud and malpractice, with fraud garnering the lion's share of government attention. Regulatory power is split between federal, state, and local entities. The federal Office of the Inspector General, for example, may audit Medicare payments for home health services, while a state agency could review the quality of care provided to patients. City and county regulators are often the most interested in ensuring positive medical outcomes.

Litigation

Negligence and malpractice litigation tend to be rarer in the home health care industry. The "absence of extensive litigation," may be attributed to the close relationships family members develop with in-house care givers who have become almost a "part of the family," according to veteran health law scholar James T. O'Reilly. But litigation isn't unheard of. It can arise from caregiver malpractice, from government enforcement decisions, or from Medicare denials, for example.

There are many resources available for attorneys interested in the home health care industry. Not least among them is Professor O'Reilly's Home Health Care and Hospice Programs: Regulating, Defending, and Structuring Options, published by Thomson Reuters/Aspatore. (Disclosure: Thomson Reuters is FindLaw's parent company.) That text provides an expansive review of the industry, from its basic structure, to the role of a patient's family in their care, to liability insurance issues.

After all, an industry that's growing this quickly deserves your attention.

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