Stark Integrity

Send us Fan Mail AI in healthcare is moving at a pace we’ve never seen. In this episode, Captain Integrity Bob Wade explores the fascinating future of AI (Artificial Intelligence) in healthcare with David Norris, Co-Founder & CEO of Affineon Health. Hear why you should embrace AI as a healthcare provider, why this is the most transformative time for healthcare providers, how AI will significan...

Send us Fan Mail Compliance programs matter. In this episode, Captain Integrity Bob Wade discusses the DOJ Civil/Criminal Updated Enforcement Plan with Jillian Willis, Partner at Nelson Mullins. Hear how the DOJ (Department of Justice) is committed to investigating & prosecuting white-collar crime, how the Corporate Whistleblower Awards Pilot Program incentivizes whistleblowers, why compliance...

Send us Fan Mail Wondering how the One Big Beautiful Bill will impact healthcare if it passes the Senate? In this episode, Captain Integrity Bob Wade shares all you need to know. Hear how a substantial number of Medicaid beneficiaries would lose their status, how rural hospitals could reopen, why the annual increases in the Medicare conversion factor will decrease, the most important takeaways Bob...

Send us Fan Mail Are there ethical considerations in physician compensation arrangements? In this episode, Captain Integrity Bob Wade explains why the answer is a resounding YES. Hear the difference between ethics, compliance, and integrity, why physician compensation models could cause physicians to conduct themselves in an unethical manner, the value society has placed on different occupations,...

Send us Fan Mail Is timely and accurate completion of medical records all about the money? In this episode, Captain Integrity Bob Wade explains why there’s a whole lot more involved. Hear how medical records impact reimbursement and more, how they help establish the physician from a quality standpoint, how they allow for continuity between subsequent providers, the biggest issue when it comes to m...

Send us Fan Mail What keeps you up at night in compliance? That’s the question Captain Integrity Bob Wade asks several compliance officers in this episode, recorded from the HCCA’s 29th Annual Compliance Institute in Las Vegas. Hear why you should go to conferences, the biggest concerns compliance officers have today, why we should be more open about compliance, the wide variety of compliance prof...

Send us Fan Mail Can you charge a payer lower than Medicare or Medicaid? In this episode, Captain Integrity Bob Wade explores when you can, and when you can’t. Hear why you need to look for the average or median of all expected payments, why you should remove the low and extravagant charges, how Medicare is not entitled to the lowest price you charge anyone, the origin of the most favored nation c...

Send us Fan Mail What’s a referral under the Stark Law and Anti-Kickback Statute (AKS)? In this episode, Captain Integrity Bob Wade dives into the definition. Hear what defines a referral, the 3 specialties that don’t refer, why a referral under the AKS is much broader in comparison with the Stark Law, the history of a famous saying, and the value of a memorable slogan. Learn more at CaptainIntegr...

Send us Fan Mail In Fiscal Year 2024, the federal government collected $2.9 billion in False Claims Act settlements (FCA). In this episode, Captain Integrity Bob Wade explains what happened. Hear how the qui tam bar is still active, why Stark Law and Fair Market Value issues (FMV) are still very big issues for compliance, how the Department of Justice (DOJ) gives you credit for cooperation & s...

Send us Fan Mail There are critical steps you need to take if you’re issued a Civil Investigative Demand (CID). In this episode, Captain Integrity Bob Wade explains how it works & what to do. Hear what happens if you fail to respond to a CID, why a legal hold is a must, how to be organized when submitting the documents, the difference between a CID and a subpoena, and some Fig Newtons nostalgi...

Send us Fan Mail Hospital-employed physicians can be investors in Ambulatory Surgery Centers (ASCs). In this episode, Captain Integrity Bob Wade wraps up his breakdown of ASCs. Hear what needs to happen for a physician to invest with a hospital in an ASC, why any items or services provided must be consistent with the safe harbors, how the Hospital-Physician ASC works, how many one-third income tes...

Send us Fan Mail All safe harbors require the one-third income test. In this episode, Captain Integrity Bob Wade continues his breakdown of Ambulatory Surgery Centers (ASCs). Hear how the one-third income test works, when a second one-third test is needed, what the Return on Investment (ROI) needs to be based on, the 4 types of ASCs safe-harbored under the Anti-Kickback Statute (AKS), and how to a...

Send us Fan Mail In the case of Ambulatory Surgery Centers (ASCs), the Stark Law does not apply. In this episode, Captain Integrity Bob Wade kicks off his breakdown of ASCs. Hear the pros & cons of ASCs from a patient’s perspective, why the Stark Law does not apply, why ASCs need to be billed under the composite rate, how block booking works for physicians, and the story of Bob’s daughter’s AC...

Send us Fan Mail  You don’t have to accept what is given to you. In this episode, Captain Integrity Bob Wade dives into Medicaid reimbursement litigation with Knicole Emanuel, Partner at Nelson Mullins. Hear why litigation is an option to fight low Medicaid rates, why you don’t need to accept the reimbursement rates presented, how medical equity works, the David vs. Goliath case Knicole worked on,...

Send us Fan Mail The Comp RVU is not the same as the wRVU. In this episode, Captain Integrity Bob Wade continues his discussion on wRVUs & more with Matt BonDurant, Co-Founder & SVP at ProCARE. Hear why Comp RVUs and wRVUs both have complexities, why everyone is handling it differently, the fundamental problem in the industry, examples of modifiers, and who is involved with Comp RVUs. Lear...

Send us Fan Mail There’s a lot to consider when it comes to RVUs (Relative Value Units). In this episode, Captain Integrity Bob Wade breaks down wRVUs & more with Matt BonDurant, Co-Founder & SVP at ProCARE. Hear what a Comp RVU is, the nuts & bolts of RVUs, why RVUs are so complicated, how to approach benchmark data, and Bob’s story from Philmont Scout Ranch. Learn more at CaptainInte...

Send us Fan Mail The 29th Annual Compliance Institute is not to be missed. In this episode, Captain Integrity Bob Wade gives a preview for the conference - which takes place on April 28-May 1, 2025 at the ARIA Resort & Casino in Las Vegas - with Dan Roach, Interim CEO of HCCA (Health Care Compliance Association). Hear what the HCCA does, why the 29th Annual Compliance Institute is a great oppo...

Send us Fan Mail Pooled compensation models are legal. In this episode, Captain Integrity Bob Wade discusses the compliance & legal risks when it comes to pooled compensation models. Hear how to make sure the units going into the pool are Fair Market Value (FMV), how to carefully select pool participants, how the compensation should be divided, Bob’s swimming pool analogy, and some trivia abou...

Send us Fan Mail With seemingly more & more whistleblowers every day, it’s becoming that much more important to monitor physician compensation arrangements. In this episode, Captain Integrity Bob Wade shares the best practices for oversight of physician compensation arrangements. Hear why it’s all about process, it’s also about documentation, it’s important to obtain good advice from lawyers &...

Send us Fan Mail When is the violation of the Anti-Kickback Statute a False Claims Act liability? In this episode, Captain Integrity Bob Wade explains the scenario given a recent district court decision. Hear how the “But For” Causation Standard works under the False Claims Act (FCA) and Anti-Kickback Statute (AKS), how the language has changed under the Anti-Kickback Statute, why the issues broug...

Send us Fan Mail Drumroll, please! In this episode, Captain Integrity Bob Wade announces the 2024 “Winners” for Most Egregious US Healthcare Profiteering. Hear why patient care should always be over profits for organizations, why medical necessity is still a primary issue we should be concerned about, why you shouldn’t sell body parts until you get consent, why the award’s named after Martin Shkre...

Send us Fan Mail Not every entity that touches a Designated Health Service is deemed to be a DHS entity as defined under the Stark law. In this episode, Captain Integrity Bob Wade explains why. Hear how a DHS entity is determined, how physicians can still be owners of entities that touch a DHS, what happens if an entity is under arrangement, the 2 major categories of DHS entities, and an example i...

Send us Fan Mail We have a system that is not geared to ensure we get the healthcare we need. In this Part 2, Captain Integrity Bob Wade continues his discussion of The Big Lie in My Healthcare Bill: Why I Don’t Owe What My Insurer Fails to Pay with Author Frank Lobb. Hear the average error amount in a healthcare bill, how fighting a healthcare bill can impact your credit score, who you should fig...

Send us Fan Mail Many episodes of Stark Integrity have been focused on healthcare providers. This one is for patients. In this episode, Captain Integrity Bob Wade dives into The Big Lie in My Healthcare Bill: Why I Don’t Owe What My Insurer Fails to Pay with Author Frank Lobb. Hear how Frank became interested in the healthcare billing issue, how healthcare billing works, why the healthcare industr...

Send us Fan Mail Hear Captain Integrity Bob Wade read his original Stark Law holiday poems, “‘Twas the Night before the Subpoena,” “Rudy the Seasoned Compliance Officer,” “Jolly OIG Agent,” and “The 12 Days of Compliance.” Share the poems with your team and learn more at CaptainIntegrity.com