The Compliance Guy

What do you do when you receive "The Letter"? Everyone gets at least one from a payer/investigator/contractor that makes your belly gurgle and sends you searching for the Imodium AD! Take a listen to this episode for the Do's and Don'ts and how best to respond to the dreaded letter! 

In this episode I take on the lack of auditing standards in healthcare and push for standardization... There is no doubt we work in one of the most regulated and complex industries and at times it leads to a misinterpretation of Acts, Guidelines, Laws, Regulations and Statutes, and because of the complexities we deal with, it also leads to folks to taking shortcuts that in the long-run lead to cri...

In this episode Sean and Terry provide a comprehensive list of acronyms in healthcare from the obvious to the obscure. There is also talk of The Show Friends, Sean's beard, and much more. There is also, a complete list of Sean and Terry's Acronyms available on LinkedIn on Sean's feed. 

In this 20 minute episode I discuss the dos and don'ts of handling an onsite investigation/audit and steps to take prior to something like that ever happening. 

In this episode I take on provider legibility. I know you are on an EMR but take a listen to this 13 minute episode to find out how a technical violation results in significant demands for refund by payors. I break down how payors try to use sampling and extrapolation without actually using the words but findings other synonyms to try to make it look less like they are doing something they should...

In this episode Sean and Terry take on non-compliant providers and the liability it creates for "anyone" who knowingly submits claims in violation of the False Claims Act... Sean also gets to practice his Latin, which is quite entertaining! 

In this quick 15 minute episode Sean discusses the 2022 FCA increases for penalties and discusses the False Claims act and qui tam lawsuits. 

Joining Sean is special guests Attorney Colin Callahan of Flannery / Georgalis and Eric Rubenstein, Ret. OIG Agent of Advize Healthcare. The roundtable discussion will be Private Equity (PE) and the pitfalls of engaging both as the investor and as the portfolio company.  There is ton to explore and we are sure you will walk away with a better understanding of how best to engage with PE! ...

In this episode Sean takes on the Eliminating Kickbacks in Recovery Act of 2018 (EKRA), the little known law passed in 2018... Congress enacted EKRA, a law to fight patient brokering and recovery profiteering. The law prohibits accepting or paying kickbacks for referrals to recovery homes, clinical treatment facilities, or laboratories. EKRA combats opioid related fraud. Give me 20 minutes and I w...

In this episode Sean and Terry take on HIPAA and OSHA in a Post Pandemic Work World... The do's and don'ts and all the in-betweens. The wheels on the bus while they do go round and round, start to come off in this one and you don't want to miss it! 

In this episode of The Compliance Guy Monday Coding and Compliance Roundtable, you missed an outstanding panel discussion with Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I Stephanie Allard, CPC, CEMA, RHIT John Paul Spencer and Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM!  Tremendous interaction by the viewers and out standing topics:  1. Macro statements an...

In this 15 minute episode Sean tackles the issues with routine waiver of copays and/or deductibles, professional courtesy, and the potential implications with the FCA, Health Care Fraud Statute, Anti-Kickback Statute, and Stark Law.  Sean addresses the Special Fraud Alert from OIG on why it's illegal for "charged-based" providers, practitioners and suppliers to Routinely Waive Copayment and D...

In 16 minutes Sean breaks down the 2010 Affordable Care Act (ACA) and its mandate on establishing a compliance program (Core Elements). The breakdown includes:  1. Mandatory Compliance and Enforcement 2. The implementation of the 60-Day Rule and how it actually works 3. The Relator (qui tam) Bar and Effective Changes under ACA

In this episode, Sean and Terry take on questions from listeners and subscribers...  Topics:  1. Telehealth  2. Documentation Requirements for Telehealth  3. Use of Locum Tenens  4. Independent Dispute Resolution (IDR - Surprise Bills) 

The Compliance Guy Coding and Compliance Roundtable this week was simply put, Awesome! Guests Stephanie Allard, CPC, CEMA, RHIT Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I John Paul Spencer and Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM provided outstanding insight on a variety of topics and the engagement from the audience was fantastic!  Topics Include: 1. La...

Colin Callahan of Flannery Georgalis, LLC sat down with Sean on Friday, August 12, 2022 to discuss the R uan ruling by the Supreme Court. This ruling has and will continue to impact the litigation landscape significantly for matters tied to the Substance Control Act (SCA)! High profile cases have already been impacted and several that are pending decisions by Prosecutors to dismiss or move forward...

Steve Gallion, CEO of Medtrainer sits down to discuss all things compliance with Sean on this episode! The discussion covers the current landscape, ramped-up enforcement actions, and a bit about economics! Such an outstanding discussion with one of the industry's thought leaders! Don't miss this one!  About Steve Gallion Chief Executive Officer Steve’s passion for people and eye for market op...

Sean sat down with Scott Kraft, Senior Compliance Auditor for DoctorsManagement, LLC to discuss strategic defense litigation services and how those played a key role in the outcome of the United States v. Rajendra Bothra, et. al case on June 28th, 2022!  Here are some of the headlines in what is one of the Nation's largest heath care fraud cases.  "How 4 doctors beat the feds in botched...

Dr. Maheu joins Sean on this episode to discuss telehealth in behavioral health and the impact it is having on patient care. This is such an important episode for so many reasons especially coming out of the pandemic of the past 2 years! Do not miss this episode with one of the industry's leading voices on this topic!  About Marlene M. Maheu, PhD Dr. Marlene Maheu started publically addressin...

On this episode of TCG - The #TerryTuesday episode Karen N. George of Buchalter Law Firm joins Sean and Terry Fletcher to discuss payer contracting and all the ins and outs to ensure success!  Such a great episode!  About Karen N. George: Karen George is an attorney at Buchalter in the Los Angeles office and is a member of firm’s Health Care Practice group. Karen specializes in managed c...

On this episode Terry Fletcher, Scott Kraft and Paul Spencer join Sean for their Monday Coding and Compliance Roundtable to discuss Cloning and Clinical Plagiarism and who is actually accountable for compliance within an organization.  This was a live stream with great audience participation and outstanding interaction between the panelists!  

Alice Harris and Jenna Godlewski of Nexsen Pruet - Health Law Team join Sean to discuss The 2022 Strategic Plan also known as the "CMS Framework. The ladies identify Six Trends to Follow for the remainder of 2022 and well beyond, but they only scratched the surface! Here is the link to their article: Understanding the CMS 2022 Strategic Plan:  Six Trends to Follow (nexsenpruet.com) The Six Tr...

In this episode Sean takes on Modifier 25 and all the problems that comes with it. Critical explanations for how to properly define the modifier (significant and separately identifiable), NCCI Edit changes for 2022, OIG Report on Modifier 25, and how CMS and other payers are scrutinizing your claims!  Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_po...

In this episode Terry joins Sean to discuss Transitional Care Management and Chronic Care Management and all of the auditing, billing, coding, and compliance information you need to get it right!  These are not profit centers, at least how they are structured so be careful and avoid the pitfalls associated with these services!  Thank you for making us a Top 25 Podcast: https://blog.feeds...

On this episode Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM, Scott Kraft, Stephanie Allard, CPC, CEMA, RHIT Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I and John Paul Spencer join Sean live to discuss a variety of coding and compliance issues being uncovered in their daily auditing, coding and compliance activities on behalf of clients all across the United States!&nb...