Summary

In this episode of The Compliance Guy podcast, Sean M Weiss engages in a detailed conversation with attorney Summer McKeivier about the complexities of healthcare law, particularly focusing on incident two billing, healthcare fraud prosecutions, and the challenges faced by providers in navigating compliance issues. They discuss the current trends in healthcare fraud, the role of medical directors and Medicare Administrative Contractors (MACs), and the implications of inexperienced prosecutors in healthcare cases. The conversation also highlights the impact of accusations on healthcare professionals and the importance of understanding medical necessity in the context of local coverage determinations. Throughout the discussion, both Sean and Summer share insights from their experiences in the field, emphasizing the need for knowledgeable representation in healthcare law.

Takeaways

• Summer McKeivier is a leading attorney in healthcare law.
• Incident two billing is a significant issue in healthcare compliance.
• Wound care is currently a major focus for healthcare fraud investigations.
• CMS's definition of medical necessity often differs from providers' perspectives.
• Local Coverage Determinations (LCDs) do not have the effect of law.
• Medical directors may lack the necessary expertise in specific healthcare areas.
• Healthcare providers face challenges due to poorly written LCDs.
• Overpayment disputes can escalate if not addressed properly.
• Inexperienced prosecutors can lead to unjust accusations in healthcare cases.
• Accusations can severely impact healthcare professionals' ability to practice.