Monitor Mondays

The Associated Press (AP) reported this week that President Donald Trump and Vice President JD Vance announced a $25 million program to encourage the public to blow the whistle on suspected fraud in the federal government.
In making the announcement, Trump said the federal government will pay whistleblowers who help identify fraud 1 percent of the total amount uncovered.

Enter famed whistleblower attorney Mary Inman, from Whistleblower Partners, who will provide context and perspective to the announcement during the next edition of Monitor Mondays, the exclusive Internet broadcast produced by RACmonitor.
The broadcast will also include these instantly recognizable segments:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Poyner and Spruill, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Folana Houston, a legislative affairs liaison for Zelis, will report on current healthcare legislation.

The San Diego chapter of the Association of Clinical Documentation Integrity Specialists (ACDIS) is meeting this week in San Diego, attracting a host of well-known CDI subject-matter experts, including James S. Kennedy, MD. and our very own Penny Jefferson, cohost of Talk Ten Tuesdays.

Kennedy, a frequent panelist on both Monitor Monday and Talk Ten Tuesday, has agreed to be the latest special guest on the venerated Monitor Mondays Internet broadcast, even after the San Diego ACDIS chapter has gaveled down.

Kennedy, purported to be as conversant on ICD-10 coding as most professional coders, will report on the recent U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) audit of Medicare Advantage (MA) diagnosis codes from UnitedHealthcare that were submitted to the Centers for Medicare & Medicaid Services (CMS).

The long-running Internet broadcast will also include these instantly recognizable segments:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Poyner and Spruill, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

You’re invited to take a journey with us as we spend time walking in the shoes of professional case managers, during National Case Management Week.

Join us during the next live edition of the venerated Monitor Monday weekly Internet broadcast. You’ll feel the sense of excitement. The energy is palatable as these care professionals work to improve patient care outcomes and reduce readmissions while helping patients navigate America’s complex healthcare system – thus helping them receive the right care at the right time.

The long-running Internet broadcast will also include these instantly recognizable segments:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Poyner and Spruill, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Federal officials announced that a Fortune 500 healthcare devices and medical supplies company has agreed to pay just shy of $385 million to resolve allegations involving issues with its production of baby formula.

During the next live edition of the venerable Monitor Mondays weekly broadcast, famed whistleblower attorney Mary Inman, reports on this major false claim act settlement.

The long-running Internet broadcast will also include these instantly recognizable segments:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Adam Brenman, senior affairs liaison for Zelis, will report on current healthcare legislation.

Government agencies routinely publicize allegations and settlements. But convictions are different – and far more consequential. When a court reaches such a judgment, the warning is no longer theoretical.

Understanding how and why entities or individuals are refunding money or serving prison time as result of valid evidence and the judgment of a court helps give a clearer awareness of regulatory and statutory guardrails.

During the next live edition of the venerable Monitor Mondays weekly broadcast, physician and attorney Dr. John K. Hall will examine some recent convictions and help tease out guidance for all of us.

The long-running Internet broadcast will also include these instantly recognizable segments: 

·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. 

·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. 

·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

·      Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

As expected, Monitor Monday continues to focus squarely on healthcare auditing and compliance.

During the next live edition of the venerable Internet broadcast, Monitor Monday will examine a range of compliance and auditing concerns associated with skin lacerations. Led by esteemed physician and popular program special guest Dr. James S. Kennedy, the program will take listeners on a fascinating deep dive beneath the skin to explore documentation and reporting issues related to skin laceration repairs.

Skin laceration repairs can significantly influence inpatient facility MS-DRG and APR-DRG assignments, depending on the documented depth of the repair: skin only for medical DRGs, or subcutaneous tissue or deeper for surgical DRGs.

Dr. Kennedy will discuss differing CPT® and ICD-10-PCS documentation requirements, along with recent CPT Assistant and Coding Clinic guidance affecting skin repair—issues that warrant the attention of facility compliance officers.

Broadcast segments will also include these familiar features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will make his Monday Rounds.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Poyner Spruill, will report the latest auditing news.
  
  
• Risky Business: Nicole Moan, Esq., an associate with the law firm of Fredrikson & Byron, will substitute for healthcare attorney David Glaser.
  
  
• Legislative Update: Cate Brantley, JD,senior healthcare legislative affairs analyst for Zelis, will report on current healthcare legislation.

Artificial intelligence (AI) is dramatically reshaping healthcare by accelerating data analysis, auditing, and documentation. But while it appears to reduce provider burden, AI also strengthens medical necessity support.

What about compliance – and the role of human oversight?

The producers of Monitor Mondays have invited senior compliance consultant Veronica Richardson with First Class Solution to report on current healthcare issues related to these compliance risks, plus essential tips for ensuring that your organization can respond effectively.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• False Claims Act Update: Famed whistleblower attorney Mary Inman will report on a recent $541.5 million False Claims Act settlement with The Villages Health System LLC, a Florida provider group, over allegations that it submitted invalid diagnosis codes that increased Medicare Advantage payments – a practice known as risk-adjustment fraud.

There has been a noticeable recent surge of activity among data-mining companies or individuals who analyze publicly available government data for potential signals of fraud, rather than the insiders who have traditionally served as relators under the federal False Claims Act (FCA).

As such, the venerable U.S. Department of Justice (DOJ) has a new process in place to mitigate the trend. It’s called Fraud Oversight through Careful Use of Statistics, (FOCUS), which will be the topic of a new report from Mary Inman, who is scheduled to be the special guest on the next edition of Monitor Mondays.
Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.

Program Update: CMS-2451-F has been published in the Federal Register. The proposed rule is effective Oct. 13, 2026. The recently posted rule prohibits federal and state Medicaid and CHIP program dollars from being spent on gender-affirming care for persons under 19 years of age.

Earlier this year, CMS-3481-P —a related proposed rule— was reported by Drew Updike, MD, a senior healthcare consultant. That rule was published in mid-December 2025.

During the next live edition of the venerable Monitor Monday Internet broadcast, Dr. Updike will share the potential impacts if this proposed rule and CMS 3481-P are both finalized.

The broadcast will also include these instantly recognizable segments:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Poyner Spruill, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Cate Brantley, legislative affairs liaison for Zelis, will report on current healthcare legislation.

Much like the iconic TV commercials in which the late newscaster John Cameron Swayze would demonstrate on live television how the venerable Timex wristwatch could withstand relentless beatings and “could keep on ticking,” the venerable federal drug program, 340B, continues in its role to provide expensive drugs at discounted prices to the nation’s safety-net hospitals.

Due to recent legislation introduced in Congress to make comprehensive changes to the federal 340B drug pricing program, the producers of RACmonitor have invited attorney Jeff Davis with the law firm of Bass, Berry & Sim, to summarize key provisions, the potential impact of the legislation on 340B providers and the likelihood of enactment.

The broadcast will also include these instantly recognizable segments:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Poyner Spruill, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Cate Brantley, legislative affairs liaison for Zelis, will report on current healthcare legislation.