The American Health Law Association (AHLA) is the largest nonprofit, nonpartisan educational organization devoted to legal issues in the health care field with nearly 14,000 members. As part of its educational mission, AHLA's Speaking of Health Law podcasts offer thoughtful analysis and insightful commentary on the legal and policy issues affecting the health care system. AHLA is committed to ensuring equitable access to our educational content. We are continually improving the user experien ...
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Sean is the host of “The Compliance Guy” a live production dedicated to the intersection of regulatory compliance and the business of medicine. The show provides timely, accurate, and easy to digest information to healthcare professionals. The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape. Sean M. Weiss (AKA – The Compliance Guy) has been an industry respected name for more than 25-years. A physician and health system ...
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Allinfoodz covers a variety of food, and foodservice-related topics that aim to answer core questions regarding our food decisions: How, and why we eat food? The process of creating, serving, and eating food can be a personal or social event. Most people think about food frequently during any given day. Furthermore, there are often underlying reasons that might drive how we make our food choices and decisions, whether we are consuming, or offering food to others. Allinfoodz provides a space ...
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Health Care Corporate Governance: Implications of Corporate Officerships
25:23
25:23
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25:23
Rob Gerberry, Senior Vice President and Chief Legal Officer, Summa Health, speaks with Michael Peregrine, Partner, McDermott Will & Emery, about the nature, role, and purpose of corporate officerships. They discuss general principles related to the roles and fiduciary duties of officers and the specific duties of the Chairman of the Board, CEO, sec…
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Season 7 - Episode 50 - #TerryTuesday - Independence and Objectivity in Auditing!
30:05
30:05
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Summary In this conversation, Sean and Terry discuss the critical importance of conducting audits in healthcare practices, emphasizing the need for both internal and external reviews to ensure compliance and accuracy in coding and billing. They highlight real-world examples of practices that have suffered due to a lack of audits and the biases that…
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Site-Neutral Payment Policy Considerations in Health Care Transactions
41:01
41:01
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41:01
Caroline Reignley, Partner, McDermott Will & Emery LLP, and Travis Lloyd, Member, Bass Berry & Sims PLC, discuss site-neutral payment policy, an issue that is top of mind for many hospitals and health systems given the shifting legal landscape and congressional interest. They cover the history of site-neutral payments; issues related to relocation,…
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Trends and Developments Related to Health Care Fraud Settlements
32:43
32:43
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32:43
Joe Wolfe, Attorney, Hall Render Killian Heath & Lyman PC, speaks with Marissel Descalzo, Partner, Tache Bronis and Descalzo PA, about the current landscape of health care fraud settlements and enforcement activity. They discuss what triggers a false claim and accompanying investigation, what drives whistleblowers, patterns with respect to false cl…
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Season 7 - Episode 49 - #TerryTuesday - When It's Clear As Mud!
36:09
36:09
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Summary In this episode, Sean and Terry discuss various topics related to healthcare compliance. They start by sharing their recent experiences, including Sean's trip to Alaska. Then, they dive into the theme of the episode, which is when things are as clear as mud in the healthcare community. They discuss the challenges of finding clear guidelines…
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Season 7 - Episode 48 - Monday Auditing, Coding and Compliance Roundtable
1:01:15
1:01:15
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Summary The conversation revolves around the topic of padding medical bills and the importance of clear communication with patients regarding their financial responsibilities. The speakers discuss instances where unnecessary charges are added to the bill, such as billing for lifestyle medicine codes during a visit for a finger fracture or adding ch…
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Form 990: What Health Care Organizations Need to Know
49:22
49:22
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49:22
Nicholas Kump, Senior Associate, King & Spalding LLP, speaks with Kim Baltz, Director of Tax, Bon Secours Mercy Health, and Zack Fortsch, RSM US LLP (retired), about how health care organizations can navigate the Form 990. They discuss why the Form 990 is important, logistics for completing and submitting the Form 990, key parts and schedules in th…
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Digital Health Care for the Cognitively Impaired
50:07
50:07
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50:07
Tara Sklar, Faculty Director, Health Law & Policy Program, University of Arizona James E. Rogers College of Law, and Kathryn Huber, MD, Kaiser Permanente, discuss the prevalence of cognitive impairments as the U.S. population ages and the implications this has for the future of digital health care. They cover the legal and regulatory landscape and …
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Fraud and Abuse Investigations: Tips from the Trenches
39:16
39:16
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39:16
Ritu Cooper, Shareholder, Hall Render Killian Heath & Lyman PC, Greg Demske, Partner, Goodwin Procter LLP, and Melissa Wong, Partner, Holland & Knight, discuss strategies that health care organizations can employ when dealing with fraud and abuse investigations. They cover the full life cycle of an investigation, sharing their own insights and expe…
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Bridging the Gap: Early Career Professionals in the Health Law Industry
49:02
49:02
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49:02
Alé Dalton, Partner, Bradley Arant Boult Cummings LLP, speaks with Mara Smith-Kouba, Counsel, Bristol Myers Squibb, and Avery Schumacher, Associate, Epstein Becker & Green PC, about the experiences and challenges of Millennial and Gen Z health law professionals. They discuss the takeaways from a survey of early career professionals by Major, Lindse…
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1
Health AI Governance: Navigating the Complexities and Risks
37:48
37:48
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Jon Moore, Head of Consulting Services and Client Success and Chief Risk Officer, Clearwater, speaks with Leah Voigt, Chief Compliance Officer, Corewell Health, and Dr. Mark Sendak, Population Health and Data Science Lead, Duke Institute for Health Innovation, about the policies, procedures, and structures that guide the application of artificial i…
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Hospitals and House Slippers: Shifting Care to the Patient’s Home
32:20
32:20
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Hope Levy-Biehl, Partner, Davis Wright Tremaine LLP, and Ryan Thurber, Shareholder, Polsinelli PC, discuss the growing trend of shifting patient care for acute illnesses into the home. They cover the federal hospital at-home waiver, state-level developments, special considerations related to the at-home care model, factors driving the growth of the…
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Season 7 - Episode 47 - #TerryTuesday - Navigating the Challenges of Telehealth Services and Billing
42:49
42:49
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In this episode, Sean and Terry discuss the recent incident where Sean accidentally went live with colorful language during a recording. They also dive into the proposed changes to the telehealth services and fee structure for 2025. Terry explains the challenges and limitations of telehealth services, especially when it comes to billing and coding.…
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Medical Marijuana: Legal and Practical Considerations for Long Term Care Providers
40:38
40:38
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40:38
Ashlee Gray, General Counsel, Transforming Age, and Aleah Schutze, Of Counsel, Steptoe & Johnson PLLC, discuss how long term care providers can navigate the legal and practical considerations of medical marijuana. They cover the current legal and regulatory landscape, legal and compliance risks for providers, and best practices for providers regard…
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Value-Based Care Arrangements and How to Operate Within the Stark and AKS Safe Harbors
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50:10
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50:10
James L. Burke, Hall Render Killian Heath & Lyman PC, and Carmen Johnson discuss how to use value-based enterprise (VBE) within the Stark and Anti-Kickback safe harbors to advance health systems’ needs. They cover the four components of VBE, the Stark and Anti-Kickback VBE rules, and how creating a VBE can be a good strategy and significantly reduc…
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Season 7 - Episode 46 - #TerryTuesday - Privilege or No Privilege "That is the Question"
29:50
29:50
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This is a controversial topic depending on which side of the yellow line you stand on... The question is does all work with a consultant require attorney client privilege... This is a great discussion for those of you looking to engage in coding and billing audits.
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Season 7 - Episode 45 - Monday Auditing, Coding, and Compliance Roundtable
58:35
58:35
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58:35
This was a great live show! Sean was joined by Terry, Christine, and Paul to discuss Medical Decision-Making for levels of EM service when Rx Management is involved. There was a lot to unpack in this episode so don't miss this one!
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Season 7 - Episode 44 - #TerryTuesday - Words Matter
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22:43
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Terry and Sean take on the importance of words in the medical record. There is no slowing of the audit trend so providers better buckle up!
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Measuring the Effectiveness of Your Compliance and Ethics Program, Using CMS's Requirements of Participation
47:41
47:41
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47:41
Joseph Zielinski, Compliance and Privacy Officer, CarDon & Associates, and Michelle R. Adams, Associate General Counsel, Ensign Services, discuss how to measure a long-term care facility’s compliance and ethics program. They cover why compliance is so important in the context of long-term care facilities, existing compliance and ethics frameworks, …
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Social Determinants of Health: Integrating Data, Law, and Whole Person Care
43:43
43:43
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43:43
Eric Setterlund, Partner, Bradley Arant Boult Cummings LLP, speaks with Melissa Soliz, Partner, Coppersmith Brockelman PLC, Annie Harrington, Chief Legal Officer, Pyx Health, and Sarah Raybin, Counsel, Vanderbilt University Medical Center, about how to launch a successful social determinant of health (SDOH) platform for sharing data among a patient…
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Health Care Corporate Governance: Implications of Current Antitrust and Competition Enforcement
13:46
13:46
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Rob Gerberry, Senior Vice President and Chief Legal Officer, Summa Health, speaks with Michael Peregrine, Partner, McDermott Will & Emery, about how the Biden Administration’s antitrust and competition enforcement initiatives are impacting health care board duties. They discuss how health care antitrust risk and enforcement have changed and how hea…
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Loper Bright and Jarkesy: What Do They Mean for the Health Care Industry?
38:13
38:13
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38:13
The health care industry is still parsing the effects of the Supreme Court’s recent decisions in Loper Bright Enterprises v. Raimondo, which ends Chevron deference, and SEC v. Jarkesy, which entitles defendants to a jury trial when the government seeks civil penalties. Chip Hutzler, Partner, HMS Valuation Partners, speaks with Greg Demske, Partner,…
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Season 7 - Episode 43 - #TerryTuesday - Flat-lining!
29:09
29:09
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In this episode Terry and Sean take on what it means to flat-line with your coding and how to avoid unnecessary scrutiny!
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American Hospital Assn. v. Becerra: What’s Next for Tracking Technologies?
24:09
24:09
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24:09
On June 20, a federal judge in Texas sided with the American Hospital Association in its lawsuit against the Department of Health and Human Services’ (HHS’) updated guidance on the use of tracking technologies. Andrew Mahler, Vice President, Consulting Services, Privacy & Compliance, Clearwater, speaks with Carolyn V. Metnick, Partner, Sheppard Mul…
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The Lighter Side of Health Law – Norm’s Farewell
8:48
8:48
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For more than six years and nearly 80 episodes, Norm Tabler has entertained AHLA with his unique take on recent health law and other legal developments. Now, Norm bids farewell to the Lighter Side of Health Law. To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.…
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Season 7 - Episode 42 - Defending Your Claims Action
29:21
29:21
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29:21
This one is a head-scratcher for The Compliance Guy for so many reasons... Not going to give it away but this is a really good episode you are gonna want to catch!
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Season 7 - Episode 41 - Monday Auditing, Coding and Compliance Roundtable
52:50
52:50
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52:50
We had a great program on Monday with Terry Fletcher CPC CEMC CCC CCS CCS-P CMC ACS-CA SCP-CA PACS QMPM Christine Hall Stephanie Allard, CPC, CEMA, RHIT Scott Kraft and John Paul Spencer and their take on some hard-hitting issues: 1. Practices wanting to use RNs or MAs to do post of visits after 90-global surgery 2. Medical necessity for E/M servic…
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Delphine O’Rourke, CEO, 8Fold Inc., speaks with Ramona Thomas, General Counsel & Vice President of Risk and Compliance, Planned Parenthood of Orange and San Bernardino Counties, about the recent Supreme Court decisions that impact women’s health. They discuss FDA v. AHM and the use of mifepristone in medication abortions, Moyle v. United States and…
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Palliative Care: Regulation, Oversight, and Reimbursement
37:27
37:27
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Edo Banach, Partner, Manatt Phelps & Phillips LLP, and Keith Lagnese, Chief Medical Officer, Sutter Care at Home, discuss the structure and delivery of palliative care. They cover issues related to regulation, oversight, and reimbursement. Edo and Keith spoke about this topic at AHLA’s 2024 Long Term and Post-Acute Care Law and Compliance in San Di…
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Health Care System Governance Structures: Trends and Issues
50:52
50:52
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Dan Grauman, Managing Director and CEO, Veralon, speaks with Cristina Cavalieri, SVP and University Counsel, Thomas Jefferson University Hospital, and Jeannie C. Frey, SVP, Chief Legal Officer and General Counsel, CHRISTUS Health, about health care system governance structures. They discuss the drivers of health care governance structure changes, h…
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Season 7 - Episode 40 - #TerryTuesday - G2211 and Some Payors Refusal to Pay
27:49
27:49
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Terry Fletcher CPC CEMC CCC CCS CCS-P CMC ACS-CA SCP-CA PACS QMPM and #TheComplianceGuy, addressed critical issues in the latest #TerryTuesday episode. In this episode, we delved into current events affecting our country, marking a significant departure from our usual content. Listeners can fast forward to the 15-minute mark for an insightful discu…
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Recent E/M Changes and Highlights from the 2024 MPFS Final Rule
45:37
45:37
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Valerie G. Rock, Principal, PYA, and Kristin M. Bohl, Member, Bass Berry & Sims PLC, discuss the 2024 Medicare Physician Fee Schedule (MPFS) Final Rule, specifically changes related to Evaluation and Management (E/M) visits. They cover CMS’ Framework for Health Equity and requirements related to clinical integration, community-based organizations, …
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Season 7 - Episode 39 - Dana McMahon Chief Compliance Officer / Stryker
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34:39
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Sean sat down with Dana McMahon, Chief Compliance Officer for Stryker to discuss all the great things she and her team are doing to ensure a culture of compliance and to lead Stryker into the future. Beyond that Dana is the Global President for Stryker Women's Network (see bio below)! This is one great discussion you do not want to miss! Bio Dana s…
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Terry and Sean sat down to discuss credentialing vs contracting. What are the main differences, how do you handle various aspects of each and the pitfalls to avoid.
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Season 7 - Episode 37 - Monday Auditing, Coding and Compliance Roundtable
1:02:12
1:02:12
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The full panel was back this week taking on an array of topics impacting healthcare organizations across the country! Join Stephanie, Paul, Scott, Christine and Terry as they discuss and debate HCC Coding Issues, No Charging Physicians and others who refer to the practice and so much more...
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Women’s Health Watch: Trends in Innovation and Investment
42:07
42:07
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42:07
Delphine O’Rourke, CEO, 8Fold Inc., speaks with Naseem Sayani, General Partner, Emmeline Ventures, about how the current legal and regulatory landscape is impacting innovation and investment in women’s health. They discuss the connection between investment and innovation and access to health care, where investment and innovation are taking place, h…
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Alexis L. Angell, Shareholder, Polsinelli PC, Lindsey P. Ridgway, Vice President, Deputy General Counsel, Integris Health, and Scott Nichols, Partner, Nichols Brar Weitzner & Thomas, share their insights and experiences on a range of medical staff issues. They cover physician behavior and professionalism concerns, physician health issues, HR and pe…
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This episode Terry and Sean take on adding services to your revenue mix and the costs for doing so if "Medical Necessity" is not met. There is a ton to unpack in the episode. Sean also blogged about this topic on LinkedIn Monday, July 1, 2024... take a look at that blog!
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Current Trends in Payer/Provider Disputes
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38:51
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Jeff J. Wurzburg, Senior Counsel, Norton Rose Fulbright, Mackenzie S. Wallace, Partner, Thompson Coburn, and Elise D. Brennan, Partner, Conner & Winters LLP, discuss the lifecycle of payer/provider disputes and some of the current trends in this area. They cover considerations related to outstanding accounts receivable, the benefits of arbitration,…
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The Lighter Side of Health Law – June 2024
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AHLA's monthly podcast featuring health lawyer and blogger Norm Tabler's informative and entertaining take on recent health law and other legal developments. To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.By AHLA Podcasts
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Terry and Sean are back at it once again taking on the big issues impacting healthcare providers! It's all about risk mitigation and creating a culture of compliance!
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Season 7 - Episode 34 - Monday Auditing, Coding and Compliance Roundtable
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The Monday Roundtable is back with all new segments and compliance centered topics. Join Sean, Terry, Christine, Scott, Paul and Stephanie as they tackle the biggest issues in healthcare.
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Women’s Health Watch: Recent Litigation and the Comstock Act
44:06
44:06
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44:06
Delphine O’Rourke, CEO, 8Fold Inc., speaks with Adriana Benedict, General Counsel, Hey Jane, about recent litigation related to women’s health and how the Comstock Act is specifically being litigated in this area. They discuss the Supreme Court’s recent decision in FDA v. AHM; the FDA’s allowance of mail-order medication abortion; the history of th…
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Be Curious, Not Judgmental: Things the DOJ “Believes” You Should Consider
28:19
28:19
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Kate Taylor, Associate Principal, ECG Management Consultants, Caleb Knight, Member, Flaherty Sensabaugh Bonasso PLLC, and Marc Goldstone, Executive Vice President and General Counsel, Wellpath, discuss how the Department of Justice (DOJ) uses its enforcement mechanisms to ensure providers are complying with health care laws and regulations. They co…
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Understanding Privacy and Security Regulations in the Exploding Wellness Apps Market
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39:48
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Andrew Mahler, Vice President, Consulting Services, Privacy & Compliance, Clearwater, speaks with Sara Shanti, Partner, Sheppard Mullin, about the legal framework surrounding mental health apps and what is currently happening in the industry. They discuss issues related to data protection, transparency, and sharing, along with enforcement and litig…
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Nondiscrimination Requirements in Long Term Care Facilities: HHS’ Section 1557 Final Rule
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23:10
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Section 1557 is both the nation’s first civil rights law for health care and the first federal civil rights law to focus specifically on nondiscrimination in health care. Stefanie Doyle, Associate, Baker Donelson, and Bruce J. Lederman, President and Chief Executive Officer, Charles E. Smith Life Communities, discuss the provisions of the Section 1…
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Season 7 - Episode 33 - #TerryTuesday - Employment Requirement of Incident-To
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24:31
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Don't let the title fool you... this is not just another incident-to podcast. This episode focuses on the employee/employment requirement(s) and how organizations continue to make significant mistakes.
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Season 7 - Episode 32 - Monday Auditing, Coding and Compliance Roundtable
1:03:31
1:03:31
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Terry, Christine, Stephanie, Paul, and Scott were all back for this new episode of the Monday Roundtable. It was quite the discussion on various payor guidelines regarding G2211, The Anatomy of CPT Codes, Split/Shared Services, EMR as a Tool, and so much more...
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Women’s Health Watch: Current Legal Landscape and What to Expect from SCOTUS
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47:08
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Delphine O’Rourke, CEO, 8Fold Inc., speaks with Ramona Thomas, General Counsel & Vice President of Risk and Compliance, Planned Parenthood of Orange and San Bernardino Counties, about the legal landscape two years after the Dobbs decision and the two decisions expected from the Supreme Court related to reproductive health. They discuss FDA v. AHM a…
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Managing 2024's Top Compliance Risks and Opportunities
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38:13
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Anthony J. Burba, Partner, Barnes & Thornburg, Henry C. Leventis, United States Attorney, Middle District of Tennessee, and Ted Lotchin, Chief Compliance Officer, UNC Health, discuss new and developing risks and opportunities amid the changing health care compliance landscape. They cover the DOJ’s main areas of focus, key compliance trends and prio…
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