This episode was mind boggling to yours truly! Just when you think you understand a Medicare process you realize you really need brilliant health care attorneys like Ashley Morgan and Robert Liles to help you make sense of things! Don't miss this one

Sean was joined by Hassan Abdallah of ATLAH to take on a wide-range of topics directly impacting healthcare compliance, audits, private equity, and so much more!

About Hassan F. Abdallah

Hassan F. Abdallah is a proven and recognized professional in the field of organizational

compliance with extensive experience in designing and managing compliance based solution

systems. Throughout his career he has worked and consulted exclusively with some of the top

healthcare institutions in the country, assisting them in navigating and understanding regulatory

requirements through a strategic and analytical view. 

Mr. Abdallah is a co-founder and former Board Member of the SAFE Substance Abuse

Coalition. SAFE is a grassroots organization that aims to lead and support local communities in

dispelling myths and stigmas about substance abuse and drug addiction. In his two years as

Executive Director, SAFE had become a leader in substance abuse prevention and education in

the Dearborn and Dearborn Heights communities. 

As he progressed throughout his professional career, Mr. Abdallah climbed the corporate ranks

throughout two different organizations achieving great success in the field of regulatory

compliance. In previous positions, Hassan F. Abdallah served as the Chief Compliance Officer

of Health Alliance Plan (HAP) becoming the youngest C-suite executive in the company’s

history. In that capacity, he managed compliance activities in the broad range of U.S. regulatory

obligations including Consumer Privacy, Consumer Protection, CMS, and HIPAA; as well as

global regulatory obligations such as EU General Data Protection Regulation, and Consumer

Data Protection.

Prior to joining HAP, Hassan

Terry is back in the hot seat to discuss facility vs pro-fee coding... lots to unpack in the episode!

The entire gang is back for this one... Terry, Christine, Stephanie, Scott and Paul teamed up with Sean to discuss:

1. AI and the impact on healthcare...

2. Q3014 Site of Service Fee Differential...

3. Patient Centered Care...

4. Statistically Valid Random Sample (SVRS) when and how can it be used...

Sean takes on the question "should we fear the “Bots” or should we openly embrace them"? You be the judge. What risk(s) do we face during an audit if it’s determined the documentation is cloned. What potential med-mal issues could be hiding around the corner?

Sean was joined by Ashley Morgan and Robert Liles of Liles/Parker to discuss Medicare Part C Appeals and how different the process is from traditional Medicare Part A and B Appeals...

Once again, this was such an incredible episode with two of the best attorneys in the administrative process!

About Ashley Morgan:

Ashley Morgan is a Partner at Liles Parker. She focuses her practice on regulatory health care compliance matters, fraud and abuse, and reimbursement issues. Ms. Morgan represents health care providers across the country in connection with a wide variety of health law issues including coverage disputes, documentation concerns, compliance, medical board complaints, and exclusion / termination issues. She has worked with an assortment of providers including dentists, home health companies, hospice agencies, pain management practices, primary care and specialty physicians, mental health professionals, physical therapists, and licensed acupuncturists. Ms. Morgan is one of only a small percentage of health lawyers who has also trained and passed the certification examination requirements to become designated as a "Certified Professional Coder." 

About Robert Liles:

Mr. Liles first began working in hospital management after receiving both an M.B.A. and an M.S. in Health Care Administration. After graduating from law school, he was hired as an Assistant United States Attorney (AUSA) in the Southern District of Texas (SDTX) where he primarily handled False Claims Act cases. He was later promoted to Chief, Financial Litigation Unit.

Shortly after the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Mr. Liles was asked to serve as our country's first National Health Care Fraud Coordinator.He was detailed to Washington, DC and was later promoted to the position of Deputy Director, Legal Programs, for the Executive Office for U.S. Attorneys (EOUSA), a component of the United States Department of Justice (DOJ). While at EOUSA, he advised Federal prosecutors around the country on civil and criminal fraud statutes, schemes, investigative tools, privacy concerns, and compliance issues. 

Sean was joined by Elliot Golding of McDermott Will & Emery to discuss all things HIPAA Privacy and Security, Information Blocking, and a few more critical aspects of cybersecurity! This episode is a must for all medical practices, hospitals and health systems to ensure your compliance with the ever-changing landscape!

Elliot is Sean's go-to when it comes to Data Privacy and Cybersecurity!

About Elliot Golding:

Terry and Sean take on the question of why... why are auditors, billers, coders, and providers still doing things that expired with the end of the PHE!

Jerrod Bailey is the CEO of Medplace, Joined me to discuss technology in healthcare, advancements in #artificialintelligence and how he and his company are filling a vital gap in the #litigation, #peerreview and #clinicalreview spaces.

Bio:

Jerrod is the CEO of Medplace, an app built for healthcare, legal, and insurance industries to streamline their case and peer review processes. He holds over 20 years of experience in venture-backed technology companies and specializes in healthcare technology development and human-centered user experience design. Jerrod has helped launch over 100 technology start-ups, including corporate new ventures with American Express, Intel, and other notable names. 

Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/

Around 6000 children are diagnosed with serious brain injury in the UK every year which result in devastating effects on the child and their family. Children rarely receive the rehabilitation they require, predominantly due to the lack of available support. There is a limited number of specialist rehabilitation beds for children and young people in the UK. Acceptance to relevant services come with strict pre-requisites and waiting times can be lengthy. Private treatment is very expensive. All in all, many children have little access to rehabilitation and do not reach their full potential. Delivering support for these children and their families is the sole aim of the foundation.

Terry and Sean take on the new "Graduate Physician Program" and what this means... This is a very interesting topic that we got to explore. The discussion then shifts to DME Audit Targets...

Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/

Around 6000 children are diagnosed with serious brain injury in the UK every year which result in devastating effects on the child and their family. Children rarely receive the rehabilitation they require, predominantly due to the lack of available support. There is a limited number of specialist rehabilitation beds for children and young people in the UK. Acceptance to relevant services come with strict pre-requisites and waiting times can be lengthy. Private treatment is very expensive. All in all, many children have little access to rehabilitation and do not reach their full potential. Delivering support for these children and their families is the sole aim of the foundation.