Georgia hospices operate under Palmetto GBA JM HHH — the most enforcement-active MAC in the Southeast for post-acute care. PPEO expansion, aggregate cap mechanics, Bene Sharing TPE edits, and the new HOPE tool all hit Georgia operators simultaneously in 2025–2026. We built our practice around exactly this regulatory environment.
Georgia hospices face a layered enforcement environment that other states don't. Palmetto GBA JM HHH is both the MAC and the TPE contractor, meaning the same organization that processes your claims is running the edit programs that target them. Their active TPE edits in 2026 are targeting Bene Sharing, Long-LOS beneficiaries, GIP documentation, and Face-to-Face attestation — simultaneously.
The Northern District of Georgia U.S. Attorney's Office runs the most active hospice and home health Anti-Kickback Statute docket in the Southeast. Recent settlements include Creative Hospice Care ($9.2M), Compassionate Care Atlanta ($2.4M), and Guardian Hospice ($3M) — all within the last 24 months. The enforcement pressure is not theoretical.
On top of the enforcement environment, PPEO expansion effective December 30, 2024 put every newly enrolled, reactivated, or CHOW Georgia hospice into a 100% prepayment review posture. A claim that would have been paid and reviewed post-payment is now sitting in Palmetto's queue until documentation is cleared.
Every engagement below is grounded in 42 CFR Part 418, Palmetto LCD L38655, and the current PPEO and TPE enforcement posture. These are not adapted-from-general templates — they were built for hospice from the ground up.
10-chart CTI and narrative audit, two IDG meeting observations, medical director five-source affiliation check, mock ADR packet, and 9-page findings report. For hospices enrolled, reactivated, or post-CHOW on or after December 30, 2024.
Full Page →12-month aggregate cap projection, 15-chart CTI and eligibility audit, F2F attestation review, GIP length-of-stay analysis, 20% inpatient cap exposure check, and Addendum delivery-timing review. Covers both cap calculations.
Full Page →Document assembly, denial-driver response narrative, submission-ready packet per Palmetto Q&A format, and appeal tracking through redetermination. For hospices and HHAs with active ADRs or under TPE review.
Full Page →Monthly regulatory bulletin covering Palmetto JM HHH updates, OIG Work Plan movement, and Federal Register watch. Quarterly 5-chart desk audit. Annual mock survey. Unlimited email Q&A with 2-business-day SLA.
View on Services Page →Practitioner-level reference guide drawn from verbatim OIG Work Plan language — GIP, cap mechanics, election statement and Addendum compliance, HOPE tool, PPEO posture. Written against 42 CFR Part 418 and Palmetto LCD L38655.
View Resources →Five-layer OIG LEIE screen for IDT members, attending physicians, contracted staff, and volunteers rendering Medicare-billable services. Palmetto PPEO reviews increasingly include LEIE documentation requests. Branded certificate on every engagement.
Full Page →Every hospice deliverable we produce references Palmetto LCD L38655, Palmetto's documented TPE edit patterns, and the Palmetto Hospice Coalition Q&A process. National OIG guidance is the floor; Palmetto's actual denial posture is what we write to.
Every engagement is scoped and priced in writing before work begins. No opaque "custom quote" process — every hospice service has a published list price. The SOW confirms the fee before a single hour is billed.
Our compliance advisory practice was built from operator-level RCM experience — the kind that recognizes documentation failure patterns before they become findings, and delivers conclusions your administrator can act on without translating from consultant-speak.
Every deliverable — PPEO report, cap projection, ADR response packet — is written in institutional voice, cited to specific regulatory authority, and formatted to be placed in a compliance binder, handed to a surveyor, or presented to your ownership group.
Prognosis Consulting sells compliance advisory services. We don't take referral fees, don't resell software, and don't have upstream partnerships that create conflicts with our findings. When we recommend a corrective action, it's because the evidence says it's necessary.
We are based in South Metro Atlanta. Georgia hospice operators are our primary market — not an incidental one. Remote engagements are available for hospices in other PPEO states (TX, FL, NV, CA, IL) where the Palmetto framework doesn't apply but the regulatory pressure does.
We'll confirm whether the engagement fits our practice and give you a fixed-fee quote on the call. If it doesn't fit — if you need a clinically-staffed mock survey team or a full accreditation program — we'll tell you that too and point you toward the right vendor.