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.

You wear a smartwatch as do so many other Americans. In fact, AI is transforming wearable healthcare devices from simple fitness trackers into powerful tools that collect, analyze, and share health information in real time.

During the next live edition of the long-running Monitor Monday Internet broadcast, special guest Ray Ribble will take a deep dive into AI-powered wearables and explain what you and your team must do to remain compliant.

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

The Department of Justice (DOJ) recently announced “data sharing” agreements with the Centers for Medicare & Medicaid Services (CMS), the Department of Homeland Security (DHS) and the Federal Trade Commission (FTC). Many believe this latest development might be the most consequential enforcement shift in twenty years. DOJ can now run analytics directly against CMS claims data, DHS travel records, and FTC complaint data, all in one shared environment.

During the next live edition of the venerable Monitor Monday Internet broadcast, senior healthcare analyst Frank Cohen, program’s special guest, says it’s the data sharing agreement has changed everything. Register now to listen and learn when Cohen explains why the idea of a defensible pattern just got a lot bigger. It’s important that you need to know what this means for your data.

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 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.

Maybe it’s the summer doldrums that keep otherwise rational people from taking a chance—especially when better alternatives may be available. But according to physician and attorney Dr. John K. Hall, the special guest on the next live edition of Monitor Mondays, some individuals prefer to maintain the status quo rather than pursue a potentially better approach. Case in point: Aetna’s recent discharge policy. Beyond the policy itself, which seems to be causing consternation among some hospitals, are there other examples? Listen to the special broadcast Monday, July 27, at 10:00 a.m. EST.

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 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.

Who would have thought that the otherwise fairly simple Medicare Cost Report could be a serious compliance trap?

Some are calling the new Medicare report worksheet a possible precursor to the most significant reimbursement change in decades.

For 2026, the Centers for Medicare & Medicaid Services (CMS) will require hospitals to report Medicare Advantage (MA)-negotiated reimbursement by Medicare Severity Diagnosis-Related Group (MS-DRG).

The implications extend far beyond compliance, requiring coordination across reimbursement, finance, revenue cycle, managed care, coding, IT, and analytics.

Listen and learn during the next edition of Monitor Mondays when the CEO for Panacea Healthcare, Kevin Chmura, unpacks Worksheet S-12. You’ll quickly discover the finer details of the looming fundamental shift toward market-based reimbursement, and how forward-thinking hospitals can turn this change into a strategic advantage.

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: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.

Payer-driven clinical validation is a common reason given by payers to remove ICD-10-CM/PCS diagnosis and procedure codes affecting reimbursement or quality-based payment models (e.g., the Centers for Medicare & Medicaid Services/CMS Hospital-Acquired Conditions), even though these codes are based on the documentation of licensed providers.

During the next Internet broadcast of the venerable Monitor Monday, Dr. James S. Kennedy of CDIMD will propose a strategy that engages payers in how patient conditions or treatments should be defined, diagnosed, and documented, elevating the practice of medicine and confronting denials that are often based on misinterpretations of current clinical literature.

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

Behavioral health services continue to face heightened payer scrutiny. The result: inaccurate documentation, coding, and compliance issues.

Panacea Healthcare recently hosted a webinar that focused on three high-risk areas: relative to Behavioral Health–telehealth, psychotherapy with evaluation and management (E&M) services, and the Collaborative Care Model (CoCM).

Special guest George Kelly is expected to summarize these issues while outlining the common compliance pitfalls, documentation requirements, coding best practices, and audit risks associated with each service.

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 analyst for Zelis, will report on current healthcare legislation.