The Compliance Guy

Matt Lawhon and Eric Rubenstein sit down with Sean to discuss their former agencies inner workings and clear up the misperceptions on how an investigation at each of these entities is initiated and the actual steps taken during one!

Thank you for making us number 6 on the Top 25 Regualtory Compliance Podcasts: 25 Best Regulatory Compliance Podcasts You Must Follow in 2022 (feedspot.com)

Sean sits down with Frank Cohen, Director of Analytics and Business Intelligence for DoctorsManagement, LLC

Such an outstanding discussion on statistical sampling and post audit extrapolation! Spend some time with us to learn and better understand how to create a process from the start to avoid fatal flaws resulting in bigger problems and how to effectively challenge payers when they fail to follow statistical standards!Frank Cohen's areas of expertise include data mining, applied statistics, and predictive analytics. In addition, he provides compliance risk analysis and meaningful assistance to healthcare organizations in the areas of process improvement, compliance, quality and profitability.Frank works with a wide range of clients including solo-physician offices to practices with over 1,000 physicians, academic medical centers, cancer clinics, legal and accounting professionals, government agencies, and national associations such as MGMA and AMA. He and his team have worked with physicians and practices in nearly 60 different specialties and within every state in the U.S.The author of several books, including his newest, “Don't Do Something, Just Stand There: A Primer for Evidence-Based Practice,” Frank is a sought-after speaker. He has participated in and published numerous articles and studies and trained thousands of physicians, administrators, CPAs and other healthcare professionals in all areas of healthcare analytics.His experience also includes eight years as a physician assistant in both the Navy and as a civilian, clinic administrator and hospital CEO. Frank's clients appreciate his depth of knowledge and especially his ability to deliver complex analytical findings

CERT is a program that gets very little attention but still packs a significant punch with their ability to demand overpayment refunds and/or escalate potential fraud, waste, and abuse to law enforcement... Don't sleep on this one! In less than 15 minutes I break down all of the critical aspects of this program!

Terry and Sean take on Evaluation and Management Services (pre-2021) as it relates to audits and investigations like you have never heard it explained before. The fact that these services are low-hanging fruit and highly subjective make them the easiest of targets to go after!

What elements are really required for an established patient (2 of 3) and how does "Medical Necessity" really impact the overall level of service!

So much to unpack in this episode!

“The Godfather” of corporate governance and compliance joined Sean to discuss the False Claims Act, Regulatory Compliance Matters and what healthcare professionals should be aware of to avoid unwanted legal entanglements. As the Deputy Chief Counsel, Office of the General Counsel, United States Department of Health and Human Services, Dallas, Texas, Gabriel advised and represented various agencies of the Department of Health and Human Services, including the Center for Medicare and Medicaid Services, the Public Health Service, the Social Security Administration, and the Office of the Inspector General.

Gabriel's personal practice includes representing individuals and organizations accused of healthcare fraud and assisting and advising healthcare organizations on corporate governance and compliance matters. Gabriel is board certified as a specialist in Health Law by the Florida Bar.

Gabriel is a graduate of DePaul University College of Law and the University of Massachusetts. He is also certified in Health Care Compliance (CHC) by the Society of Corporate Compliance and Ethics and the Health Care Compliance Association (SCCE/HCCA). This national accreditation reflects a professional level of competence and experience in compliance processes sufficient to assist healthcare business organizations to understand and address legal obligations and to promote organizational governance and integrity through the operation of effective compliance programs.

Gabriel's specific practice areas include Federal Government Strategies, Healthcare Compliance & Operations, Healthcare Government Investigations & Litigation, Healthcare Qui Tam Investigations & Litigation, State & Local Government Relations, and HIPAA & Health Information Privacy & Security.

In this episode the panel takes on HCC Audits, Behavioral Health Issues in coding / documentation and the mass confusion that exists in Split/Shared Services and what you need to know to ensure you get it right in light of the final rule taking effect January 1 2023!

Yes, I know, Incident-To... but here's the thing, everyone is getting it wrong and that's a fact! Guess who makes the most mistakes with these types of services; Yep, you guessed it, the government! Give me 17 minutes and I will clear it up for you in easy to follow plain speak!

Is it or is it not a HIPAA violation??? Terry and Sean take on a topic that few enjoy but all must comply with!

This Daily Dose Episode focuses on when a payer can use statistical sampling and extrapolation... You may think you know the answer but take a listen and you might just be surprised.

"I'm the best. The Sharpshooter. The caviar. The Rolls Royce of Rheumatology" This is Stephen Soloway... and no one can dispute who he is or why he is the best! Sean spent more than an hour discussing a vast number of topics with Dr. Soloway regarding his book "Bad Medicine", the struggles he's had and continues to go through, battling the government and commercial insurance companies, beating Pancreatic Cancer, being elected into the Professional Sports Authenticators (PSA) Hall of Fame, and so much more!

Dr. Soloway has dedicated his life to helping patients and colleagues. Patients come from around the world as well as from around the country to seek his help. Dr. Soloway's devotion to patient's needs have earned him Top Doctor Awards every year since 2003 and he is regarded as one of the leaders in the Philadelphia, New Jersey, and Delaware area for Rheumatologic care. He's recently written a book titled Bad Medicine: The Horrors of American Healthcare.

His credentials are as follows:

Nominated Chairman Department of Rheumatology Division of Internal Medicine Inspira Health Network

Clinical Associate Professor Rowan University School of Osteopathic Medicine

Adjunct Clinical Associate Professor Drexel University College of Medicine

Castle Connolly America's Top Doctor

Philadelphia Magazine and Inside New Jersey Magazine Top Doctor

As an industry leader he sits on numerous boards and panels within the pharmacology industry along with national advisory panels for all major companies involved in arthritis or osteoporosis research. He is known within the medical community as a medical detective and will proudly announce "If I can't fix you, I will get someone that can."Dr. Soloway is involved not only in arthritis and osteoporosis treatment, but sports and occupational medicine as well. He runs osteoporosis, knee, and back pain clinics. Dr. Soloway enjoys giving back to the community thru charity and by teaching doctors from several medical institutions in New Jersey and Pennsylvania. He has been board certified in Internal Medicine since 1991 and Rheumatology since 1993 with specialized certificates in Osteoporosis