Off the Chart: A Business of Medicine Podcast

Denied claims are cutting deeper into practice revenue — and the numbers are getting worse.

In this episode, Medical Economics Managing Editor Todd Shryock talks with Clarissa Riggins, chief product officer at Experian Health, about the company’s 2025 State of Claims Report.

Riggins explains why claim denials are rising, how inaccurate patient data and staffing shortages are fueling the problem, and where artificial intelligence (AI) can make a measurable difference. She also discusses how practices can use automation and predictive analytics to prevent denials before they happen, and why getting ahead of payer complexity is now essential to financial survival.

Music Credits:
Ambient Jazz by AurbanniAudio - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – Cold open
“If you can address the issues from the outset of the revenue cycle, it makes everything so much easier — and helps prevent denials before they happen.”

0:20 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation between Todd Shryock and Clarissa Riggins, Chief Product Officer at Experian Health.

1:22 – Setting the stage
Todd introduces the 2025 State of Claims Report and asks what’s driving the sharp rise in claim denials.

1:59 – The top cause: bad data
Riggins explains how missing or inaccurate patient data has become the leading driver of denials — and why AI could help fix it.

2:32 – Why clean claims are harder to submit
Riggins discusses new regulatory pressures, workflow friction, and the challenges of preparing for complex documentation requirements.

4:01 – Staffing shortages and technology gaps
How workforce turnover and fragmented tech stacks compound denial problems and strain practice operations.

5:34 – The biggest problem areas
Why fixing inaccurate data and registration errors at intake remains the most urgent step for revenue recovery.

6:32 – The AI awareness gap
Although 62% of providers say they understand AI, only 14% use it. Riggins explains the hesitation — and how to start small.

7:59 – Lessons from early adopters
Practices seeing ROI from AI share common traits: they start small, track measurable outcomes, and scale success.

9:01 – Building trust in AI
Riggins discusses HIPAA, payer rules, and why transparency is key to physician confidence in AI-driven claims tools.

12:01 – Falling confidence in tech
Todd asks why fewer providers feel their claims systems are effective — and what’s behind the frustration.

12:56 – Fixing payer–provider collaboration
Why better technology and open communication are both needed to reduce denials for good.

13:59 – Where providers should start with AI
Practical first steps for adopting automation — from identifying pain points to choosing the right technology partners.

16:36 – Training and workflow integration
How to implement new AI tools with minimal disruption and staff retraining.

18:28 – What surprised Experian most
Riggins shares the biggest takeaways from the State of Claims data — and why adoption still lags optimism.

19:30 – Final takeaways
Why AI works best when it starts small, delivers measurable ROI, and helps staff focus on higher-value work.

22:12 – Closing
Todd thanks Clarissa for joining, followed by Austin’s closing credits and subscription reminder.

In the 100th episode of Off the Chart: A Business of Medicine Podcast, host Austin Littrell is joined by Todd Shryock, Richard Payerchin, and Keith Reynolds — the editors from Medical Economics and Physicians Practice who helped build Off the Chart into what it is today. Together, they look back on favorite conversations, memorable guests and defining trends from the show’s first 100 episodes.

From the rise of artificial intelligence and new liability concerns to the return of independent practice, rising costs and shifting patient trust, the team discusses how medicine’s business landscape continues to evolve — and what stories they plan to chase next.

Music Credits:
Cup of Coffee by Ionics - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – Opening thanks
Richard opens with gratitude to guests and listeners who helped shape 100 episodes of Off the Chart.

0:20 – Introduction
Austin welcomes listeners to the 100th episode and introduces Todd Shryock, Richard Payerchin and Keith Reynolds.

1:17 – Looking back on the journey
Austin recalls joining the show at episode 48 and asks what the 100-episode milestone means to the team.

1:42 – Milestone reflections
Austin shares appreciation for the show’s growth and its role as a forum for fresh ideas in medicine.

2:17 – Podcast evolution
Todd Shryock on how Off the Chart grew from a side project into a polished, professional production.

3:01 – Early days and transition
Keith Reynolds describes taking over around episode 35 and credits Austin for elevating production and consistency.

4:15 – Memorable episodes
Austin asks which episodes have stuck with the editors over the years.

4:24 – Running for office
Richard Payerchin highlights Episode 43: The Physician’s Guide to Running for Office and lessons from doctors-turned-policymakers.

5:06 – What’s broken in healthcare
Todd Shryock revisits his interview with Michigan Medicine’s Marschall Runge, M.D., Ph.D., and how academic leaders see systemic challenges.

6:18 – Behind the mic
Keith recalls producing the “Running for Office” episode, his conversations with MGMA’s Anders Gilberg, and his latest chat with attorney Katie Russell, J.D.

8:03 – AI and malpractice
Austin reflects on Episode 97: AI, malpractice and the future of physician liability, and the October cover story on artificial-intelligence liability in medicine.

8:28 – Team reflections
Keith shares why editor roundtables and behind-the-scenes episodes remain his favorite part of the job.

9:04 – How medicine has changed
Austin asks how the health care landscape has shifted since the podcast began.

9:30 – AI everywhere
Todd explains how artificial intelligence went from novelty to necessity — and raises the looming question: who pays for it?

12:05 – The changing public mood
Keith discusses how public perception of physicians has evolved since the pandemic and why trust feels more fragile today.

13:41 – Independence and private practice
Richard points to episodes 70 and 95 on physician autonomy and the growing nuance around private-equity partnerships.

15:25 – Lightning round: trends for 2026
Austin asks each editor for one trend to watch in the year ahead.

15:35 – Price transparency
Richard predicts renewed momentum for transparency policy under the current administration.

15:53 – Trust in AI
Todd warns that adoption will hinge on physicians’ confidence in AI accuracy.

16:29 – Return to independence
Keith expects a migration back to physician-owned practices as consolidation stalls.

17:14 – P2 Management Minute
Keith delivers a quick interlude of practice-management advice and listener call-to-action.

18:04 – Looking ahead: the next 100
Austin asks what stories or themes should shape Off the Chart going forward.

18:16 – Keith: More creative episodes
Keith lobbies (again) for holiday specials and continued AI coverage.

19:06 – Richard: Rural healthcare and affordability
 Richard calls for deeper dives into rural access, insurance costs and medical debt.

20:08 – Todd: Front-line voices
Todd wants more firsthand perspectives from practicing physicians on fixing medicine.

20:47 – Austin: Financial literacy
Austin advocates expanding coverage of physician wealth-building, taxes, and loan repayment.

21:08 – Lightning round: advice for 2026
One-sentence takeaways from each editor for practice leaders.

21:08 – Richard's advice
“Tune in twice a week to Off the Chart.”

21:15 – Todd’s advice
“You can’t save the world — start with the patient in front of you.”

21:25 – Keith’s advice
“Take care of your coders; they make everything work.”

21:33 – Closing and gratitude
Austin thanks the editorial team and listeners for helping reach the 100-episode milestone.

21:57 – Outro
Final wrap-up, subscription reminder and acknowledgments to the Medical Economics and Physicians Practice teams.

Jennifer Trilk, Ph.D., FACSM, DipACLM, professor of biomedical sciences and director of lifestyle medicine programs at the University of South Carolina School of Medicine Greenville, joins the show to discuss how her program is reshaping physician education through lifestyle medicine.

Trilk explains how training future doctors in nutrition, physical activity, behavior change and self-care is key to preventing chronic disease — and why prevention needs to be valued as highly as treatment. She also shares how the school’s hands-on approach, including culinary and teaching kitchens, helps students translate science into real-world patient care.

The discussion covers the evolution of nutrition education in medical schools, national policy efforts to prioritize “food as medicine,” and what it will take for lifestyle medicine to become a standard part of every physician’s toolkit.

Music Credits:
Paper Cranes by Buurd - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – Cold open
Hippocrates said, “Let food be thy medicine, and medicine be thy food.” If that was said so long ago — how did we miss that in treating our patients?

0:20 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation between Richard Payerchin and Dr. Jennifer Trilk, professor and director of lifestyle medicine programs at the University of South Carolina School of Medicine Greenville.

1:30 – Why nutrition belongs in medical education
Dr. Trilk explains why future physicians need formal training in nutrition, exercise, and behavior change to help patients prevent and reverse chronic disease.

2:23 – Lifestyle medicine vs. conventional medicine
She describes how lifestyle medicine focuses on root causes of illness, shared decision-making, and long-term patient partnerships — not just symptom management.

7:13 – Why doctors weren’t taught nutrition
Dr. Trilk traces the history of medical education, from the Nutrition Academic Award in the 1990s to why most schools still lack meaningful nutrition training.

11:55 – Sorting fact from fad
How physicians can navigate conflicting diet advice, dispel misinformation, and focus on evidence-based nutrition — starting with the Mediterranean diet.

17:14 – Reimbursement for prevention
Dr. Trilk calls for Medicare, Medicaid, and private payers to reimburse physicians for lifestyle and nutrition counseling to make prevention financially sustainable.

20:12 – Inside the teaching kitchen
She describes Greenville’s hands-on culinary medicine program — where medical students and patients cook together — and how it’s changing health outcomes.

25:06 – Cooking as CME
How practicing physicians and fellows are returning to the kitchen to earn CME credit and rediscover the joy of learning through food and connection.

26:22 – Creating national nutrition competencies
Dr. Trilk explains how the new consensus statement, “Proposed Nutrition Competencies for Medical Students and Physician Trainees,” is shaping the future of medical education.

30:09 – The ‘Make America Healthy Again’ initiative
A look at current federal efforts to promote prevention, lifestyle medicine, and nutrition under HHS and CMS.

32:34 – A message to primary care physicians
Dr. Trilk thanks primary care clinicians for their foundational role in patient wellness and encourages them to explore lifestyle medicine in their own practices.

34:29 – Closing
Austin Littrell wraps up the episode with production credits and links to subscribe and learn more at MedicalEconomics.com and PhysiciansPractice.com.

Stefanie Simmons, M.D., FACEP, chief medical officer of the Dr. Lorna Breen Heroes’ Foundation, joins the show to talk about the state of burnout in health care and what’s being done to fix it.

She explains how the foundation is working to remove stigmatizing mental health questions from licensing and credentialing forms, and why addressing burnout requires systemic change — not just resilience training. Simmons also shares what’s giving her hope, how organizations can better support their teams and what a healthier culture in medicine could look like.

Music Credits:
Paper Notes by Eden Keyes - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – Cold open
Stefanie Simmons, M.D., FACEP, on how changing licensing language is helping health care workers seek mental health care without fear of losing their ability to practice.

0:29 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation with Stefanie Simmons of the Dr. Lorna Breen Heroes’ Foundation.

1:34 – About the Foundation
Simmons explains the mission of the Dr. Lorna Breen Heroes’ Foundation and its national coalition, “All In: WellBeing First for Healthcare.”

3:02 – The state of burnout
How burnout has changed since the pandemic, and why administrative burden continues to strain the workforce.

4:41 – Which specialties are most affected
Emergency medicine and mid-career physicians continue to report the highest burnout rates.

6:15 – Signs of progress
A look at licensing and credentialing reforms across the country — and why they matter for clinician mental health.

8:07 – The importance of peer support
Simmons explains why peer support is one of the most powerful tools for health care workers in crisis.

10:17 – Generational perspectives
How younger clinicians are changing attitudes about work-life balance and mental health in medicine.

15:00 – Human performance and system design
Why medicine should take lessons from athletic performance — and how rest, coaching, and system design improve care.

16:50 – The Impact Wellbeing Guide
How the foundation’s guide and the Caring for Caregivers program are helping hospitals and states build sustainable well-being initiatives.

19:54 – The Lorna Breen Act reauthorization
Updates on federal legislation to reduce administrative burden and support clinician mental health.

21:02 – Technology and AI
The promise and limits of artificial intelligence in reducing administrative work for clinicians.

23:45 – Hope and the path forward
Simmons shares why she’s optimistic about the growing attention to workforce well-being.

25:49 – A message to primary care physicians
Encouragement and gratitude for primary care clinicians — and a reminder that improving care starts with supporting the whole team.

28:16 – Closing
Austin Littrell closes the episode with show credits and information on where to find Off the Chart and related Medical Economics content.

Artificial intelligence (AI) is entering everyday care, so of course it’s raising questions about malpractice. In this episode, we sat down with three national experts shaping how AI liability will evolve: Sara Gerke, associate professor of law at the University of Illinois Urbana-Champaign; David A. Simon, J.D., LL.M., Ph.D., associate professor of law at Northeastern University; and Deepika Srivastava, chief operating officer at The Doctors Company.

They explain how AI could redefine the standard of care, what happens when an algorithm contributes to patient harm, and practical steps physicians can take now to protect themselves — including documentation, communication and clear internal policies.

Check out our October cover story for a deeper look at how AI is reshaping medical malpractice: "The new malpractice frontier: Who’s liable when AI gets it wrong?" available online at: www.medicaleconomics.com/view/the-new-malpractice-frontier-who-s-liable-when-ai-gets-it-wrong-

Music Credits:
Groovy 90s Hip-Hop Acid Jazz by Musinova - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – Opening: The AI malpractice paradox
Why using too little or too much AI can both create legal risk.

0:13 – Episode setup
Austin introduces the guests and frames the core question: How does AI shift malpractice liability?

1:14 – AI and the standard of care
Gerke explains how jurors already view AI-guided decisions as potentially “reasonable.”

2:07 – Adoption drives legal expectations
Simon outlines how widespread use — not hype — determines when AI becomes mandatory practice.

4:03 – When AI harms a patient
Gerke on physician and hospital exposure today — and surgeons’ skepticism of manufacturer liability.

5:51 – Regulated devices enter the chat
Why manufacturers get pulled in when AI tools behave like medical devices.

6:04 – Device pathways and lawsuits
Simon details 510(k) vs. De Novo vs. PMA — and how each influences manufacturer accountability.

8:27 – Policy levers
How FDA and state decisions could shift responsibility upstream.

9:25 – Insurance reality check
Srivastava: Physicians still bear primary legal risk since they make the clinical call and sign the chart.

10:29 – Transition: From risk to action
Before pulling the plug on AI tools — what physicians should actually do.

10:43 – Practical protections
Srivastava’s immediate steps: informed consent, chart review, governance, and patient disclosure.

12:01 – Transparency as defense
How clear communication about AI use strengthens trust and reduces exposure.

13:20 – Training + governance gaps
Keeping workflows tight matters just as much as clinical judgment.

14:02 – Vetting tools and contracts
Simon: If AI claims accuracy, ask for validation — and liability protections.

15:30 – Labeling matters
Gerke calls for food-style transparency labels for AI devices.

16:27 – The “learned intermediary” burden
Even with better labels, liability flows back to the physician.

17:01 – P2 Management Minute
Quick interlude from Keith Reynolds.

17:54 – Rapid compliance playbook
Five habits that will hold up in court — whether you follow or override AI suggestions.

18:40 – Closing
Why AI is here to stay — and why documentation discipline must evolve with it.

19:10 – Outro
Credits, subscription reminder and link to October cover story.

David Ford, CEO of MedWay, joins the show to discuss how the California Medical Association’s (CMA's) new business support program is helping independent physicians take control of their practices without taking on more administrative work.

Launched in 2025, MedWay is a subscription-based management service designed to handle HR, payroll, benefits, insurance and other day-to-day business operations for smaller, physician-owned practices. Ford explains how the program was built, what kinds of support it offers and how it aims to give doctors more time to focus on patients instead of paperwork.

He also talks big picture — why independent practice remains vital to the health care system, how administrative complexity drives burnout and what MedWay’s success could mean for the future of independent medicine in California.

Music Credits:
Sleepy Sunday by Buurd - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 — Why Medway?
Independent physicians didn’t spend 20 years training to run payroll. Ford explains the need for a business-support solution.

0:22 — Welcome to Off the Chart
Austin introduces the episode and outlines what Medway offers for practices.

1:14 — Who is David Ford?
Ford shares his background in practice transformation and supporting physician practices.

2:30 — The Birth of Medway
How CMA identified the universal administrative struggles facing independent practices.

4:29 — A Platform Built for Doctors
HR, payroll, benefits, compliance — and real human support when physicians need it.

5:32 — Early Success & Expansion Plans
Medway launches in California and gains national interest quickly.

7:08 — The Business Burden Behind Burnout
Why administrative stress is driving physicians out of independent practice.

8:58 — Burnout in the Post-Pandemic Era
Workload, staffing strain, and the need for relief.

10:00 — California Challenges
The state’s strong but complex regulatory environment for independent practices.

11:47 — Why Independent Physicians Matter
Better access for underserved patients and stronger provider-patient relationships.

14:05 — Supporting the Support Staff
Freeing clinical teams for patient care — and allowing everyone to go home on time.

15:14 — How Practices Enroll
Fast onboarding, one login, and training for staff.

17:33 — Cybersecurity Boundaries
Medway stays away from EMRs and patient data to simplify compliance.

18:44 — Transparent Pricing
A flat $89 per employee per month — and no co-employment arrangement.

22:00 — Billing & Reimbursement?
Not yet — but potentially on the roadmap.

23:10 — Conservative Growth Strategy
Ensuring excellent service for every early adopter.

26:01 — A First-of-Its-Kind Model
Medical societies in other states want to replicate Medway’s approach.

28:47 — Expansion Beyond Medicine
Dental practices begin adopting the service as well.

29:50 — For Any Specialty
Applicable whether pediatrics, ENT, surgery, or anything in between.

30:52 — Final Thoughts
Where to find Medway and who it’s designed to help.

32:19 — Helping New Practices Get Started
Supporting physicians launching their own groups from the ground up.

33:40 — Closing & What’s Ahead
Austin wraps the episode and encourages listeners to subscribe.

Paul Merrick, M.D., and Dan Greenleaf of Duly Health and Care join the show to discuss why independent medical practices deliver high-quality care at lower costs — and why that matters for the future of U.S. health care.

They share insights from a Duly study on health care spending, the importance of physician autonomy and how independent groups can stay competitive amid industry consolidation.

Learn more about their report, “Chicago provider market trends: Key considerations for employers,” here: https://www.medicaleconomics.com/view/independent-physicians-are-a-viable-alternative-to-hospitals-for-patient-outcomes-lower-costs-study-says

Music Credits:
Light Jazz Piano Trio by Summer Nights - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:20 – Introduction
Austin Littrell introduces the guests and outlines the episode’s focus on independent medicine.

1:35 – Defining independence
How Duly differs from large hospital systems despite its size and reach.

2:10 – Governance and ownership
Merrick explains Duly’s physician-led board and private equity partnership structure.

5:00 – Cost and quality advantage
Greenleaf compares Duly’s lower prices and stronger outcomes against Chicago hospital systems.

8:20 – The Avalere Health study
How Duly’s collaboration quantified the value of independent practice in the Chicago market.

11:00 – Breaking nonprofit myths
Merrick argues that outcomes — not ownership status — define real community value.

14:10 – Study findings
Duly patients experience lower costs, fewer hospital stays and faster follow-up care.

19:20 – Primary care and coordination
Why integrated teams and close specialist ties improve patient outcomes.

21:10 – Using AI to cut friction
How Duly applies artificial intelligence to streamline documentation, scheduling and coding.

23:50 – Battling burnout
Inside Duly’s “Joy in Medicine” program and how it helps physicians rediscover purpose.

27:35 – Prevention and wellness
Duly’s “Make America Healthy Again” initiative, culinary medicine and supplement education.

32:15 – Message to independents
Advice for smaller practices on collaboration, technology and sustaining autonomy.

36:40 – Closing thoughts
Greenleaf and Merrick on the future of physician-led medicine.

37:10 – Outro
Host wrap-up, credits and subscription reminder.

Katie P. Russell, J.D., partner at Brown Immigration Law in Cleveland, Ohio, joins the show to explain what physicians and practice managers should do if Immigration and Customs Enforcement (ICE) comes knocking at their practice door.

She discusses how to identify valid warrants, protect patient information under HIPAA, and prepare staff with clear response plans. Russell also shares how practices that employ international medical graduates can stay compliant and avoid costly mistakes.

Music Credits:
Lo-Fi Mood by Mit-Rich - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction and Episode Overview (00:00:00) Katie Russell discusses the importance of not over-cooperating with ICE and introduces the episode’s focus.

Podcast Welcome and Guest Introduction (00:00:29) Austin Littrell introduces the podcast, the topic and guest Katie Russell.

Preparing for an ICE Visit: First Steps (00:01:29) Katie Russell explains the need for a plan, designating a point of contact and having written protocols.

Responding to ICE: Initial Actions (00:03:29) Guidance on being calm, respectful and directing ICE to the designated compliance officer.

Understanding Warrants: Administrative vs. Judicial (00:03:54) Explanation of the differences between administrative and judicial warrants and their implications.

Safeguarding Patient Information and HIPAA (00:06:28) Discussion on HIPAA protections and when ICE can access patient records or treatment areas.

Employer Responsibilities and Employee Rights (00:07:23) Advice on I-9 audits, handling ICE requests for employee information and avoiding over-cooperation.

When to Call an Attorney and Their Role (00:10:28) Guidance on involving legal counsel, attorney roles during/after ICE visits and staff training.

P2 Management Minute Segment (00:13:28) Keith Reynolds shares quick management tips and invites listener contributions.

Post-ICE Visit: Documentation and Managing Anxiety (00:14:20) Steps for documenting ICE visits, protecting reputation and supporting staff and patients.

Best Practices for Employing International Medical Graduates (00:15:35) Measures and audits to reduce ICE visits and manage visa compliance for international staff.

Final Thoughts and Additional Advice (00:17:40) Katie Russell emphasizes preparation, dispelling misinformation and the value of legal counsel.

Episode Closing and Credits (00:18:19) Hosts thank Katie Russell, recap the episode and provide subscription information.

David Tawes, regional inspector general in the Office of Evaluation and Inspections at HHS’ Office of Inspector General, joins the show to discuss the agency’s new report on the massive rise in Medicare spending for skin substitutes.

He explains what’s driving the surge — from changing billing practices to outright fraud — and how policymakers can balance patient access with stronger oversight. Tawes also shares what physicians should know about potential red flags and how to report suspicious activity.

Music Credits:
Cool Chill Summer Lo Fi Hip-Hop by Musinova - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction and Overview (00:00:00) Explosive growth in Medicare Part B spending on skin substitutes; vulnerability to fraud, waste and abuse.

Podcast Introduction and Guest Background (00:00:33) Host introduces the episode, guests and outlines the focus on Medicare Part B skin substitute spending.

David Tawes’ Background and OIG Mission (00:01:50) David Tawes introduces himself and explains the Office of Inspector General’s mission and scope.

OIG’s Oversight and Specialization (00:02:28) Discussion of OIG’s focus areas, including prescription drugs, Medicare, Medicaid and other HHS programs.

How the Skin Substitutes Report Originated (00:04:20) Explanation of why OIG began investigating skin substitute payments and compliance with new reporting laws.

Findings on Increased Billing (00:05:56) Analysis of factors driving increased skin substitute billing: more enrollees, higher units per patient, rising costs.

Total Dollar Amounts and Growth (00:08:11) Details on the magnitude of spending: over $10 billion in 2024, projected $15 billion in 2025.

Fraud Indicators and Investigations (00:08:49) Discussion of fraud’s role in increased spending and the vulnerability of skin substitutes to abuse.

Major Fraud Case Example (00:09:28) Description of a $1.2 billion fraud case involving non-medical professionals and fraudulent billing schemes.

Medicare Part B vs. Medicare Advantage Trends (00:12:11) Comparison of skin substitute spending and utilization between Medicare Part B and Medicare Advantage.

Role of Prior Authorization in Medicare Advantage (00:13:49) How prior authorization in Medicare Advantage helps limit fraud compared to traditional Medicare.

Care Settings and Utilization Patterns (00:14:45) Trends in where skin substitutes are used most — physician offices, home care, and expenditure differences.

Enforcement and Compliance Process (00:16:32) How OIG detects trends, enforces compliance, and the lag between data anomalies and enforcement action.

Policy Recommendations to Curb Spending (00:18:47) OIG’s recommendations for policymakers: reconsider payment classification, explore alternative payment methods and learn from Medicare Advantage.

Ongoing OIG and CMS Actions (00:20:31) CMS’s proposed changes, use of AI, and OIG’s continued monitoring of skin substitute billing and fraud.

Prior Authorization as a Safeguard (00:21:28) Discussion of prior authorization’s role in preventing inappropriate or fraudulent skin substitute claims.

Advice for Physicians (00:22:22) Warning to physicians about aggressive marketing and fraudulent schemes involving skin substitutes.

Emphasis on Payment Incentives (00:23:08) Highlighting how reimbursement differences drive provider behavior and the need for payment reform.

Closing Remarks and Podcast Outro (00:24:21) Thanking the guest, summarizing the conversation, and providing subscription information for listeners.

Bryan Jepson, M.D., CFP, joins the show to explain what “true wealth” really means for physicians, and why retirement planning goes far beyond money.

He explains how to balance financial goals with personal fulfillment, tackle student debt and make smart decisions about saving, investing and enjoying life along the way.

Music Credits:
Distant Memories by Buurd - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction and Episode Overview (00:00:19) Host introduces the podcast, Dr. Jepson, and outlines topics: true wealth, financial planning, overcoming hurdles and work-life balance.

Defining True Wealth (00:01:33) Dr. Jepson distinguishes between being rich and being truly wealthy, emphasizing freedom, fulfillment and relationships.

Mindset Shifts for Early Financial Planning (00:03:41) Discussion on the importance of intentionality, compounding interest and starting early to build assets for true wealth.

Carving Out Time and Building Habits (00:05:42) Strategies for physicians to create financial plans, develop good habits and work with planners to enjoy life before retirement.

Clinical Resource Promotion (00:07:46) Brief segment promoting Patient Care Online as a clinical resource for physicians.

Balancing Retirement Accounts and Flexible Investments (00:08:04) Advice on prioritizing tax-advantaged retirement accounts before exploring alternative investments like real estate or crypto.

Incorporating Philanthropy and Service (00:10:16) Ways to include giving — both money and time — into financial plans without risking personal security.

True Wealth and Career Fulfillment (00:11:56) How financial independence empowers physicians to avoid burnout, pivot careers or retire early while staying fulfilled.

P2 Management Minute Segment (00:14:32) Short segment offering practical management tips and inviting listener contributions.

First Steps Toward True Wealth (00:15:23) Dr. Jepson’s advice for residents: live below your means, pay off high-interest debt and build an emergency fund.

Emergency Fund Guidelines (00:18:15) Recommendations for emergency savings: 3–6 months of expenses, adjusted for single or dual income households.

Final Advice and Resources (00:19:25) Emphasis on intentionality, understanding basics, and choosing the right financial planner; resources and website shared.

Episode Closing and Credits (00:22:44) Host wraps up, thanks listeners, and provides subscription and newsletter information.