In this episode Jordan Johnson sits down with Sean to discuss operational concerns in physician practices driving them to abandon their practice and join large groups, hospital networks, and integrated delivery health systems. The discussion the transitions to the impact of nurse strikes and what it will take to get them aligned with their employers. This episode is a bit charged but hey, someone has to stand-up for America's Elite! 

Terry joins Sean for a discussion on what it means to stay in your lane and not create liability situation for your clients or yourself. This episode gets a bit salty so buckle up and enjoy the ride! 

This was one of the best episodes of our Monday Roundtable! Sean was joined by Stephanie Allard, Terry Fletcher, Scott Kraft, and Paul Spencer. Topics included: 

1. Dealing with Commercial Payor Demand for Refund of Overpayments, when they say they did a statistically valid random sampling that led to an extrapolated overpayment. 

2. The No Surprises Act and the change to how the process works based on CMS sneaking in a change prior to Christmas after making promises they would not change. 

3. How to deal with "clinical plagiarism" in 2023 with the changes to EM Guidelines. 

4. The impact of terms like Fraud, Waste, Abuse when speaking to providers. 

You Do Not Want To Miss This One! 

Salvador Hernandez, Senior Compliance and Ethics Advisor at Husch Blackwell joins Sean to discuss the state of compliance... Topics of discussion include: 

As a former senior executive with the Federal Bureau of Investigation (FBI)

Sal began his career inside government with 25 years at the FBI, where he rose through the ranks, via numerous assignments, from Special Agent to executive-level positions at FBI Headquarters in Washington, DC, the U.S. Embassy in Mexico City, and the FBI’s Los Angeles Field Office. At FBI Headquarters, as Deputy Assistant Director in the Criminal Investigative Division, he had oversight responsibility for the FBI’s Financial Crimes and Public Corruption Programs. In Los Angeles, he held the title of Assistant Director and served as the office’s chief executive, with responsibility for the work of more than 1,300 FBI employees charged with carrying out the FBI’s criminal, counterterrorism and national foreign-intelligence responsibilities in Southern California. Sal followed his FBI career with a career in the private sector where, first as Security Director, and then as Vice President of Compliance and Ethics, he expanded the security and investigations programs and established and led the legal and regulatory compliance efforts at Enterprise Holdings, Inc., the world’s largest vehicle rental, leasing and sales company.

Sal is uniquely suited to collaborate closely with attorney teams and clients to strategize at all stages of investigative and compliance-program work. He has experience building compliance structures for clients and is equally adept at program review, risk assessment, crisis response and mitigation.

phone: 314.345.6193

email: [email protected]

 Ronald Chapman II, Esq. LLM of Chapman Law Group | Health Care Attorneys sits down with Sean to discuss his full trial acquittal in United States vs. Lesley Pompy, MD.

You do not want to miss this one because what happened to Dr. Pompy can happen to you!

This is the very first episode of the newest segment on The Compliance Guy... It is not J2, it's J-Squared with Jordan Johnson, Healthcare Data Analytics Expert! Such a great first episode and the topics will not disappoint: 

Omnibus bill includes relief from Medicare cuts, extensions of rural and telehealth programs

1.7 trillion dollar package and what it means for healthcare

· Telehealth provisions

· Medicaid coverage

· No mention of prior auth

Prior auth bill

· Go live January 2026

· API utilization

Access to care and what will need to be tackled

· Fewer physicians in specialties

· Fellows and residency going to urban areas

Hospital closures

631 rural hospitals at risk of closure by state (beckershospitalreview.com)

More rural hospitals will close in 2023 - Poynter

Rural hospital closures affect operations of surrounding hospitals (medicalxpress.com) 

Terry Fletcher joins Sean for the very first #TerryTuesday episode of 2023 to discuss the Medicare Fee Schedule Change and What it Really Means! As they say... watch out for the ole bait and switch! While Congress indicates a slight bump was given to the conversion factor the reality is, it was still an overall decrease. Terry and Sean explain it all in this episode.

The All Star Panel was back together for an outstanding first roundtable of the year! Sean was Joined by Terry, Christine, Scott, and Paul to discuss 2023 EM Services for the Inpatient setting, Split/Shared Services, Corporate Compliance Programs, HIPAA, and much more! 

In this episode Sean takes on H.R. 8800 (The Supporting Medicare providers Act of 2022)... Medicare Providers are facing a potential cut in reimbursement of up to 8.4%. However, if your contracts are paid at a % of Medicare your commercial contracts may be taking up to the same 8.4% cut.

H.R. 8800 was referred to the Subcommittee on Health back on September 14, 2022, but there’s been crickets ever since… the question is why and whether Congress (who by the way does not have to worry about healthcare in the same way civilians do) realizes that if these cuts hold up, there will be a mass exodus from the Medicare System. Providers will either retire early or shut their doors to Medicare and any insurance company that follows suit with reducing provider fees. The industry is already facing a crisis with respect to a shortage in physicians, couple that with what COVID-19 did to the industry with mandatory shutdowns and closures of surgery rooms and ASCs for elective surgeries and now a looming cut based on a reduction to the conversion factor and a PAYGO Sequestration cut, and you have a situation that the industry and patients may never recover from.

H.R. 8800 introduced by Congressmen Bera and Bucshon looks to amend title XVIII of the Social Security Act to extend certain increases in payments for physicians’ services under the Medicare program through 2023. “It is the sense of Congress that the Secretary of Health and Human Services, the House of Representatives, and the Senate should commit to take administrative and legislative actions to—

(1) ensure financial stability and predictability in the Medicare physician payment system;

(2) promote and reward value-based care innovation; and

(3) safeguard timely access to high-quality care by advancing health equity and reducing disparities”.

In this final #TerryTuesday episode, Sean and Terry tackle the OIG Report on improper payments for Co-Surgeons and assistants at surgery! Such an important topic to round out the year!