The Compliance Guy

In this segment Sean discusses the steps and provides insight to the various regulations and other critical information to ensure you get your investigation right. Taking the time to do a bona fide investigation whereby every I is dotted and T is crossed is paramount to avoiding problems.

In this episode Sean and Jenna Godlewski, Special Counsel for Nexsen Pruet sit down to discuss CMS' Supplemental Medical Review Contractor (SMRC) and the impact they're having on providers, hospitals and health systems.

In this episode Sean sits down with Amanda Waesch of Brennan Manna and Diamond (BMD) to discuss Stark Law and the enfocement changes in 2021 and those coming in 2022...

In this episode Sean sits down with Jenna Godlewski, Special Counsel for Nexsen Pruet to discuss the Supplemental Medical Review Contracto (SMRC) and the disruption they are causing in the health space for providers, hospitals and health systems. Noridian is the SMRC for The Centers for Medicare and Medicaid Services and their reach is quite broad as you will come to learn during this segment.

In this segment Sean sits down with Amanda L. Waesch of Brennan Manna and Diamond (BMD) to discuss the November of 2020 Final Rule on Stark Law and Profit/Gain Sharing. This segment is a must for all provider groups, hospitals and health systems!

In this segment Sean discusses the DOJ Criminal Division's Evaluation of Corporate Compliance Programs. Sean breaks down various aspects of what most consider a prosecutors playbook. A discussion of conducting internal audits and developing corrective actions to ensure listeners are intune with what is required ensures risk mitigation.

In this session Sean discusses appeal strategies with a central focus on Medicare. Appeals are technical in nature but are a lost art and this podcast you'll understand how and when to appeal to the different levels. Specific terms are defined, forms are addressed, and processes for the 5-levels are broken down. A full explanation of the structural changes put forth in the 2017 final rule that wer...

Fraud, Waste and Abuse continue to plague the healthcare system and drive consumer prices and medical practice costs sky-high. In this episode Sean discusses the ins and outs of conducting a fraud investigation in addition to various laws, statutes, regulations and Acts as well as requirements for a corrective action plan.

In this session Sean discusses how to determine whether a self-disclosure protocol through the OIG is the right decision for your medical practice/organization. This is an in-depth look into a complex process to ensure you make the right decision.

Sean discusses the importance of properly structured policies to ensure medical organizations position themselves to drive their "Culture of Compliance" and foster compliance with their employees. Sean also offers some outstanding giveaways to you the listener.

During this 45 minute podcast Sean provides providers and their staff the areas they need to focus to ensure a level playing field with payers. The areas of concentration are: 1. Ex Post Facto Laws and Guidance on post-payment reviews 2. Medical Necessity including Clinical Judgement and The Treating Physician Rule 3. Sources and Authoritative Guidance; where to look and what to avoid 4. Judgement...

In this episode we are joined by former Special Agent for the Office of Inspector General Eric Rubinstein, Chief Innovation Officer of OncoSpark Jordan Johnson and the Employmeny Law After Hours Podcast Team (Monica Andress and Bryan Meek)

https://www.youtube.com/watch?v=won0yKn6HUY&ab_channel=ComplianceGuyLIVE