Welcome to NACDL's podcast series, "The Criminal Docket," hosted by Ivan J. Dominguez, NACDL's senior director of public affairs & communications. NACDL is the National Association of Criminal Defense Lawyers and is well-known to many as "Liberty's Last Champion." Each episode of "The Criminal Docket" explores important items on the criminal justice agenda, in-depth, with top leaders in the legal practice, public policy, journalism, academia, and others whose lives intersect with the crimina ...
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Sean is the host of “The Compliance Guy” a live production dedicated to the intersection of regulatory compliance and the business of medicine. The show provides timely, accurate, and easy to digest information to healthcare professionals. The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape. Sean M. Weiss (AKA – The Compliance Guy) has been an industry respected name for more than 25-years. A physician and health system ...
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National Advocacy Calls on Developing Legislation
National Association of Criminal Defense Lawyers
NACDL’s State Criminal Justice Network (SCJN), has initiated a conference call series entitled National Advocacy Calls on Developing Legislation (NACDL). The teleconferences generally feature an expert on an issue area and are designed to inform criminal defense lawyers and advocates across the country on a variety of criminal justice issues. Key to the calls is informing participants of any legislation or litigation pending that seeks progressive reform on the issue, and serves as a call to ...
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Episode 350 - The Ethics of Compliance in Healthcare
59:49
59:49
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59:49Summary In this conversation, the panel discusses the complexities and challenges faced by external auditors in the healthcare industry. They explore the importance of maintaining integrity and ethical standards while navigating client relationships, compliance issues, and the business side of medicine. The discussion highlights the need for clear …
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Episode 349 - #TerryTuesday - Decoding Imaging Services
23:22
23:22
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23:22Summary In this episode, Sean and Terry discuss the complexities of billing for imaging services, focusing on the distinctions between professional and technical components. They explore compliance issues, the importance of proper documentation, and the challenges faced by healthcare providers in navigating billing practices. The conversation also …
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Episode 348 - #TerryTuesday - E&M Challenges and Solutions
30:52
30:52
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30:52Summary In this episode, Sean and Terry discuss various aspects of E&M audits, focusing on compliance, documentation, and the importance of accurate patient records. They share personal anecdotes and insights into the challenges faced by healthcare providers in maintaining proper documentation and the implications of upcoding. The conversation emph…
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Episode 347 - Monday Auditing, Coding and Compliance Roundtable
1:00:31
1:00:31
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1:00:31Summary This round table discussion focuses on critical aspects of healthcare compliance, particularly around deductibles, copays, telehealth, and billing practices. The panelists emphasize the importance of understanding patient financial responsibilities, the need for modernized billing processes, and the legal implications of waiving deductibles…
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Episode 346 - Vaccine Mandates and How To Handle Vaccine Injuries
42:42
42:42
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42:42Summary In this episode, Sean discusses the complexities of vaccine injury law with attorneys Jon Groth and Jubaile Abila. They explore the differences between various compensation programs, particularly focusing on the COVID-19 vaccine and the challenges faced by individuals seeking compensation for vaccine-related injuries. The conversation delve…
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Episode 345 - Navigating Compliance in Healthcare: Insights from Kenneth Polite
44:29
44:29
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44:29Summary In this conversation, Sean and Kenneth Polite discuss Kenneth's transition from the head of the criminal division at the DOJ to a partner at Sidley, a global law firm. They explore the importance of compliance in healthcare, the role of data in investigations, and the implications of AI in the industry. Kenneth shares insights on the focus …
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Episode 344 - #TerryTuesday - Navigating The New Political Landscape
25:38
25:38
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25:38Summary In this episode, Sean and Terry discuss the recent withdrawal of the United States from the World Health Organization, the implications of this decision on healthcare policy, and the political landscape surrounding healthcare administration. They explore the effectiveness of global health organizations, critique the previous administration'…
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Season 8 - Episode -25 - #TerryTuesday - Audio Only Clarification and Guidance for Mitigating Risk
31:18
31:18
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31:18Summary In this episode, Sean and Terry discuss the complexities surrounding audio-only telehealth services, particularly in the context of evolving regulations and compliance challenges. They emphasize the importance of understanding the regulatory landscape, the need for proactive measures in healthcare practices, and the potential risks associat…
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Season 8 - Episode -24 - #TerryTuesday - Metadata "The What, When and Who"
29:04
29:04
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29:04Summary In this episode of the Compliance Guy program, Sean and Terry discuss the importance of understanding compliance and auditing in the healthcare industry as they enter 2025. They emphasize the significance of metadata and audit trails in electronic medical records, the need for documentation integrity, and the challenges that healthcare prov…
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Season 8 - Episode 23 - Monday Roundtable - Payor Policies for Telehealth and The OIG's Year-Long Audit of Incident-To Servics
1:06:09
1:06:09
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1:06:09Summary In this episode, the panel discusses the complexities and challenges surrounding telehealth services, particularly focusing on the regulations, compliance issues, and the evolving landscape of audio-only services. They explore the implications of recent legislative changes, the importance of understanding payer policies, and the need for ca…
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Season 8 - Episode 22 - From Military to Medicine - Jose Vela, Jr., ESQ
1:23:58
1:23:58
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1:23:58Summary In this episode, Sean welcomes back Jose Vela Jr., a retired military officer and former federal prosecutor, to discuss his transition into healthcare law. They explore Jose's military career, his experiences as a prosecutor, and the complexities of healthcare fraud cases. The conversation delves into the impact of indictments on healthcare…
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Season 8 - Episode 21 - #TerryTuesday - Navigating CMS' Final Rule "Key Points"
30:58
30:58
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30:58Summary In this episode, Sean and Terry discuss the recent CMS final rule and its implications for healthcare practices, focusing on telehealth regulations, direct supervision requirements, and updates in behavioral health services. They also delve into the G2211 add-on complexity code, emphasizing the importance of understanding the nuances of the…
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Season 8 - Episode 20 - Navigating the Future of Healthcare: Challenges and Opportunities
1:02:21
1:02:21
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1:02:21Summary The conversation delves into significant healthcare issues, including the targeted assassination of a healthcare CEO, the ongoing challenges and expansion of telehealth services, and the implications of new Medicare regulations. The panel discusses the importance of compliance, the impact of the new administration on healthcare policies, an…
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Season 8 - Episode 19 - #Terry Tuesday - HIPAA Audits and OIG Identification of Significant Failures by OCR
28:29
28:29
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28:29Summary In this episode, Sean and Terry discuss the current state of healthcare regulations, focusing on HIPAA compliance and government oversight. They provide a critical analysis of the effectiveness of HIPAA audits and the contradictions within healthcare regulations. The conversation emphasizes the need for accountability in government and heal…
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Season 8 - Episode 18 - Daily Dose - The Role of DOJ and OIG in Healthcare Compliance
35:08
35:08
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35:08Summary In this conversation, Sean discusses the critical issue of healthcare fraud, emphasizing the roles of the Department of Justice and the Office of the Inspector General. He outlines various laws and regulations, shares alarming statistics about fraud losses, and highlights emerging challenges in the healthcare landscape. Sean also explores t…
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Season 8 - Episode - 17 - #TerryTuesday - The Role of AI in Provider Documentation
24:02
24:02
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24:02Summary In this conversation, Sean and Terry discuss the implications of artificial intelligence (AI) in healthcare, emphasizing its role as a tool rather than a replacement for human oversight. They explore the potential benefits and risks associated with AI in clinical documentation, the importance of maintaining patient privacy, and the legal ra…
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Season 8 - Episode 16 - Monday Auditing, Coding and Compliance Roundtable
42:02
42:02
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42:02Summary The conversation delves into the complexities and changes surrounding telehealth services, particularly in light of the 2025 Medicare physician fee schedule final rule. Key topics include the confusion regarding telehealth reimbursement post-public health emergency, the implications of new regulations, compliance challenges, malpractice con…
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Season 8 - Episode 15 - #TerryTuesday The Unsung Heroes of Healthcare
25:34
25:34
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25:34Summary In this episode, Sean and Terry discuss the critical role of support staff in healthcare, and the necessity of listening to compliance experts to avoid legal pitfalls. They emphasize the need for collaboration and communication within healthcare practices to ensure compliance and effective billing practices. Takeaways Support staff play a c…
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season 8 - Episode 14 - #TerryTuesday - The Final Rule is A Critical Mistake
34:36
34:36
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34:36Summary In this episode, Sean and Terry discuss the implications of the recent Medicare final rule, particularly focusing on the challenges facing telehealth services. They explore the political dynamics surrounding healthcare access, the importance of equitable access to telehealth, and the need for legislative action to address these issues. The …
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Season 8 - Episode 13 - Navigating Post-Pandemic Audits in Healthcare
45:00
45:00
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45:00Summary In this episode of the Compliance Guy Podcast, Sean engages with Dean Viskovich, a healthcare attorney with extensive experience in lab-related compliance and reimbursement. They discuss the challenges faced by healthcare providers in the wake of post-pandemic audits, the importance of documentation, and proactive measures that can be taken…
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Season 8 - Episode 12 - #TerryTuesday - Navigating The World of Consultants in Healthcare
35:03
35:03
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35:03Summary In this episode, Sean and Terry discuss the challenges faced by consultants in the healthcare industry, particularly regarding collaboration requests and the importance of maintaining credibility. They share personal experiences with scams and the necessity of due diligence when engaging with potential partners. The conversation also touche…
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Season 8 - Episode 11 - Dr. Muhamad Aly Rifai - Lessons Learned from a High-Stakes Trial
1:25:20
1:25:20
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1:25:20SummaryIn this episode, Sean discusses the complexities of compliance in healthcare with Dr. Muhammad Ali Rafai, who faced a criminal indictment for healthcare fraud. The conversation covers the emotional toll of the indictment, the audit process, trial preparation, expert testimonies, and the eventual acquittal. Dr. Rifai shares insights on the ch…
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Season 8 - Episode 10 - #TerryTuesday - Demystifying Compliance
22:39
22:39
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22:39Summary In this episode, Sean and Terry discuss the critical importance of compliance in healthcare, focusing on the need for consequences for non-compliance, the implementation of financial penalties, and the role of documentation in ensuring patient safety. They emphasize the necessity of creating a culture of compliance within medical practices …
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Season 8 - Episode 9 - Monday Auditing, Coding and Compliance Roundtable
1:03:28
1:03:28
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1:03:28Summary The conversation delves into the complexities of Medicare Advantage plans, highlighting concerns about their effectiveness and the implications of recent changes in coding. The panel discusses the challenges faced by patients under these plans, the deceptive marketing tactics used, and the potential shift towards remote patient monitoring a…
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Season 8 - Episode 8 - The Complex World of Qui Tam Cases - Dismissal Dynamics: With and Without Prejudice
35:00
35:00
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35:00Summary Eric Rubenstein and Ron Chapman join The Compliance Guy to discuss the implications of a recent dismissal of a False Claims Act case based on the appointment clause. The guys explore the historical context of key tam cases, the role of relators, and the complexities surrounding the appointment clause. The conversation delves into the differ…
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Season 8 - Episode 7 - #TerryTuesday - Evaluation Medical Necessity
29:05
29:05
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29:05Summary In this episode, Sean and Terry discuss the intersection of sports and healthcare, particularly focusing on the implications of sports injuries on mental health. They delve into the nuances of preventative medicine visits, the complexities of evaluation and management services, and the importance of medical necessity in billing practices. T…
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Season 8 - Episode 6 - Monday Auditing, Coding and Compliance Roundtable -
1:01:25
1:01:25
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1:01:25Summary In this conversation, Sean and his guests discuss various pressing issues in healthcare, focusing on the implications of HIPAA violations, the challenges of patient privacy, and the recent controversies surrounding the Epic EMR system. They delve into the complexities of unauthorized access to patient information, the role of AI in healthca…
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Season 8 - Episode 5 - Nicole Thorne - Understanding the Surge in Healthcare Audits and the Role of AI in Shaping Healthcare Compliance
45:46
45:46
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45:46Summary In this conversation, Sean and Nicole Thorn discuss the increasing challenges healthcare providers face regarding compliance, particularly in light of rising audit risks and overpayment demands. They explore the complexities of healthcare law, the role of attorneys in navigating disputes, and the importance of proactive compliance strategie…
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Summary In this episode, Sean and Terry discuss the current state of the healthcare industry, focusing on the business of medicine, the impact of external factors on healthcare operations, and the alarming rise in healthcare bankruptcies. They delve into the role of private equity in healthcare, the importance of compliance, and the need for health…
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Season 8 - Episode 3 - David Womack of Practice Management Institute
41:40
41:40
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41:40Summary In this episode, Sean and David discuss the importance of compliance education in healthcare, highlighting the diverse educational sources available, particularly through the Practice Management Institute (PMI). They explore the various certifications offered by PMI, the significance of personalized education, and the impact of recent chang…
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Summary In this episode, Sean and Terry Fletcher discuss the complexities of prior authorization in healthcare, emphasizing its critical role in the reimbursement process. They explore the misconceptions surrounding prior authorization, the disconnect between healthcare providers and payers, and the challenges posed by Medicare Advantage plans. The…
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Season 8 - Episode 1 - Monday Auditing, Coding and Compliance Roundtable
59:39
59:39
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59:39Summary In this episode, the panel discusses the critical importance of honesty in healthcare compliance, the challenges posed by audits, and the responsibilities of providers in navigating vendor relationships. They explore the implications of using AI in clinical documentation, the escalation of compliance issues to law enforcement, and the risks…
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Season 7 - Episode 50 - #TerryTuesday - Independence and Objectivity in Auditing!
30:05
30:05
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30:05Summary In this conversation, Sean and Terry discuss the critical importance of conducting audits in healthcare practices, emphasizing the need for both internal and external reviews to ensure compliance and accuracy in coding and billing. They highlight real-world examples of practices that have suffered due to a lack of audits and the biases that…
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Season 7 - Episode 49 - #TerryTuesday - When It's Clear As Mud!
36:09
36:09
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36:09Summary In this episode, Sean and Terry discuss various topics related to healthcare compliance. They start by sharing their recent experiences, including Sean's trip to Alaska. Then, they dive into the theme of the episode, which is when things are as clear as mud in the healthcare community. They discuss the challenges of finding clear guidelines…
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Season 7 - Episode 48 - Monday Auditing, Coding and Compliance Roundtable
1:01:15
1:01:15
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1:01:15Summary The conversation revolves around the topic of padding medical bills and the importance of clear communication with patients regarding their financial responsibilities. The speakers discuss instances where unnecessary charges are added to the bill, such as billing for lifestyle medicine codes during a visit for a finger fracture or adding ch…
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Season 7 - Episode 47 - #TerryTuesday - Navigating the Challenges of Telehealth Services and Billing
42:49
42:49
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42:49In this episode, Sean and Terry discuss the recent incident where Sean accidentally went live with colorful language during a recording. They also dive into the proposed changes to the telehealth services and fee structure for 2025. Terry explains the challenges and limitations of telehealth services, especially when it comes to billing and coding.…
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Season 7 - Episode 46 - #TerryTuesday - Privilege or No Privilege "That is the Question"
29:50
29:50
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29:50This is a controversial topic depending on which side of the yellow line you stand on... The question is does all work with a consultant require attorney client privilege... This is a great discussion for those of you looking to engage in coding and billing audits.
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Season 7 - Episode 45 - Monday Auditing, Coding, and Compliance Roundtable
58:35
58:35
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58:35This was a great live show! Sean was joined by Terry, Christine, and Paul to discuss Medical Decision-Making for levels of EM service when Rx Management is involved. There was a lot to unpack in this episode so don't miss this one!
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Season 7 - Episode 44 - #TerryTuesday - Words Matter
22:43
22:43
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22:43Terry and Sean take on the importance of words in the medical record. There is no slowing of the audit trend so providers better buckle up!
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Season 7 - Episode 43 - #TerryTuesday - Flat-lining!
29:09
29:09
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29:09In this episode Terry and Sean take on what it means to flat-line with your coding and how to avoid unnecessary scrutiny!
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Season 7 - Episode 42 - Defending Your Claims Action
29:21
29:21
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29:21This one is a head-scratcher for The Compliance Guy for so many reasons... Not going to give it away but this is a really good episode you are gonna want to catch!
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Season 7 - Episode 41 - Monday Auditing, Coding and Compliance Roundtable
52:50
52:50
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52:50We had a great program on Monday with Terry Fletcher CPC CEMC CCC CCS CCS-P CMC ACS-CA SCP-CA PACS QMPM Christine Hall Stephanie Allard, CPC, CEMA, RHIT Scott Kraft and John Paul Spencer and their take on some hard-hitting issues: 1. Practices wanting to use RNs or MAs to do post of visits after 90-global surgery 2. Medical necessity for E/M servic…
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Season 7 - Episode 40 - #TerryTuesday - G2211 and Some Payors Refusal to Pay
27:49
27:49
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27:49Terry Fletcher CPC CEMC CCC CCS CCS-P CMC ACS-CA SCP-CA PACS QMPM and #TheComplianceGuy, addressed critical issues in the latest #TerryTuesday episode. In this episode, we delved into current events affecting our country, marking a significant departure from our usual content. Listeners can fast forward to the 15-minute mark for an insightful discu…
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Season 7 - Episode 39 - Dana McMahon Chief Compliance Officer / Stryker
34:39
34:39
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34:39Sean sat down with Dana McMahon, Chief Compliance Officer for Stryker to discuss all the great things she and her team are doing to ensure a culture of compliance and to lead Stryker into the future. Beyond that Dana is the Global President for Stryker Women's Network (see bio below)! This is one great discussion you do not want to miss! Bio Dana s…
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Terry and Sean sat down to discuss credentialing vs contracting. What are the main differences, how do you handle various aspects of each and the pitfalls to avoid.
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Season 7 - Episode 37 - Monday Auditing, Coding and Compliance Roundtable
1:02:12
1:02:12
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1:02:12The full panel was back this week taking on an array of topics impacting healthcare organizations across the country! Join Stephanie, Paul, Scott, Christine and Terry as they discuss and debate HCC Coding Issues, No Charging Physicians and others who refer to the practice and so much more...
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This episode Terry and Sean take on adding services to your revenue mix and the costs for doing so if "Medical Necessity" is not met. There is a ton to unpack in the episode. Sean also blogged about this topic on LinkedIn Monday, July 1, 2024... take a look at that blog!
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Terry and Sean are back at it once again taking on the big issues impacting healthcare providers! It's all about risk mitigation and creating a culture of compliance!
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Season 7 - Episode 34 - Monday Auditing, Coding and Compliance Roundtable
1:02:47
1:02:47
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1:02:47The Monday Roundtable is back with all new segments and compliance centered topics. Join Sean, Terry, Christine, Scott, Paul and Stephanie as they tackle the biggest issues in healthcare.
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Season 7 - Episode 33 - #TerryTuesday - Employment Requirement of Incident-To
24:31
24:31
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24:31Don't let the title fool you... this is not just another incident-to podcast. This episode focuses on the employee/employment requirement(s) and how organizations continue to make significant mistakes.
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