Health Insurers in the Spotlight in the Wake of CEO Slaying

Monitor Mondays

1:00:22

Join us for an engaging episode of The Innovators and Investors Podcast, hosted by Kristian Marquez, where we explore the vibrant intersection of technology, investment, and entrepreneurship. This week, Kristian welcomes two dynamic guests: Kevin Weber, Managing Director at Amex Ventures, and Ayal Karmi, Co-founder and CEO of Nakuda. In this episode, Kevin shares his fascinating career journey, including his transition from corporate finance and M&A to venture capital at Amex Ventures, where he focuses on early-stage investments in sectors like fintech, AI, and cybersecurity. As Kevin describes his investment thesis, he emphasizes the importance of strategic partnerships and the alignment of their investments with American Express’s core business objectives. Our conversation then shifts to Ayal Karmi, who delves into the innovative solutions Nakuda is bringing to the market. As the company pioneers a system for AI agents to make seamless payments online, Ayal discusses the challenges and opportunities in automating the checkout process and enhancing transaction authenticity. Listeners can expect to gain valuable insights into the investment landscape, the evolving field of AI agents, and best practices for founders seeking to navigate the venture capital space. Furthermore, Kevin and Ayal offer advice on how to approach corporate venture capital, the significance of understanding investor expectations, and the future of agentic payments. Don’t miss this enlightening discussion that highlights the transformative power of technology and the shared mission of fostering innovation in today’s rapidly evolving market. Subscribe now to stay updated on the latest insights and trends in the world of innovation and finance! For more details, visit our website and read Ayal’s insightful blogs on Substack, https://substack.com/@nekuda? about autonomous payments to stay informed about the latest in AI technologies. Enjoy the episode! Learn more about Kevin's work https://www.americanexpress.com/us/business/american-express-ventures/ Connect with Kevin on LinkedIn https://www.linkedin.com/in/kevin-weber-b77b8028/ Think you'd be a great guest on the show? Apply https://finstratmgmt.com/innovators-investors-podcast/ Want to learn more about Kristian Marquez's work? Check out his website at https://finstratmgmt.com/…

about a year ago 28:41

MP3•Episode home

Have you ever had your insurance company deny payment for your claim?

Have you ever had your insurance company stall or deny a pre-authorization?

How long did it take to get the authorization for the medication you’ve been using to keep yourself alive for the past few years? Was it maddening?

During the next edition of Monitor Mondays, physician and attorney Dr. John K. Hall will examine the frustration that modern health insurance has become – especially in the context of the recent fatal shooting of a prominent health insurance chief executive officer (CEO).
Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Legislative Update: Adam Brenman, senior healthcare legislative affairs analyst for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Chapters

1. Health Insurers in the Spotlight in the Wake of CEO Slaying (00:00:00)

2. Ronald Hirsch, MD (00:01:45)

3. Knicole Emanuel, Esq (00:05:50)

4. RACmontior Commercial (00:11:56)

5. David Glaser, Esq (00:12:38)

6. Cate Brantley, JD (00:18:13)

7. RACmontior Commercial (00:22:18)

8. John K. Hall, MD (00:23:16)

9. Closing (00:27:55)

356 episodes

#Government #RACmonitor #Fitness #Medicine #Podcasting Education #RAC #Audit #Healthcare #News #Oig #CMS #Omha #Alj #Regulatory #Medicaid #Medicare

Health Insurers in the Spotlight in the Wake of CEO Slaying

Monitor Mondays

published about a year ago

MP3•Episode home

Have you ever had your insurance company deny payment for your claim?

Have you ever had your insurance company stall or deny a pre-authorization?

How long did it take to get the authorization for the medication you’ve been using to keep yourself alive for the past few years? Was it maddening?

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Legislative Update: Adam Brenman, senior healthcare legislative affairs analyst for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Chapters

1. Health Insurers in the Spotlight in the Wake of CEO Slaying (00:00:00)

2. Ronald Hirsch, MD (00:01:45)

3. Knicole Emanuel, Esq (00:05:50)

4. RACmontior Commercial (00:11:56)

5. David Glaser, Esq (00:12:38)

6. Cate Brantley, JD (00:18:13)

7. RACmontior Commercial (00:22:18)

8. John K. Hall, MD (00:23:16)

9. Closing (00:27:55)

356 episodes

#Government #RACmonitor #Fitness #Medicine #Podcasting Education #RAC #Audit #Healthcare #News #Oig #CMS #Omha #Alj #Regulatory #Medicaid #Medicare

All episodes

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6 hours ago29:27

29:27

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1
Tariffs: The Impact on Drugs 30:00

14 days ago30:00

30:00

Welcome to a strange new world. Recent tariffs announced by the Trump Administration are likely to impact drug manufacturing, since many drug components are produced outside the U.S., in nations such as in India, giving rise to state laws. Many states limit overseas involvement relative to the Health Insurance Portability and Accountability Act (HIPAA). Florida, for example, prohibits the offshoring of certain patient data, requiring such storage to be within the U.S. Responding to this emerging crisis, the producers of RACmonitor and Monitor Mondays have invited Lexi Morrison, director of operations at MedPharma, to be the program’s special guest during the next live edition of the venerable Internet broadcast, coming up at 10 a.m. EST on Monday, May 19. The long-running broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Adam Brenman, senior government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.…

1
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21 days ago33:18

33:18

On the surface, it was the perfect scam: kickbacks to docs in exchange for public speaking engagements, in order to induce them to prescribe drugs. That’s apparently what Gilead Sciences thought. But a whistleblower blew the whistle, and Gilead admitted to paying hundreds of thousands of dollars to high prescribers of their HIV drugs to serve as speakers at programs at luxury restaurants. Famed whistleblower attorney Mary Inman, partner at Whistleblowers Partners, LLP, will report the savory details during the new live edition of Monitor Mondays, coming up at 10 a.m. EST on Monday, May 12. The long-running broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Folan Houston, assistant general counsel for Zelis, will report on the news at the intersection of healthcare and congressional action. • Field Report: Dr. Drew Updike continues his reporting on recent efforts by the Trump Administration to prevent providers from undertaking gender-affirming treatments for America’s LGBTQ+ population.…

1
340B In the Crosshairs 28:01

28 days ago28:01

28:01

Once again, the venerable 340B Drug Pricing Program finds itself in the crosshairs of critics – this time, from the U.S. Congress. Recently, Sen. Bill Cassidy (R-La.), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a report outlining his office’s investigation into the program. During the next live edition of Monitor Mondays, 340B Health CEO Maureen Testoni will return to the broadcast to offer her response to the senator’s investigation. The long-running broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news at the intersection of healthcare and congressional action.…

1
Audit Alert: Immigration in Healthcare 29:58

5 weeks ago29:58

29:58

Nearly every day, on any news service, images of people being quickly led away is chilling as the current Administration continues its sweep of rounding up and deporting suspected illegal immigrants. Thus, in this current climate of increased audits, investigations and scrutiny on immigration, it is essential that healthcare organizations sponsoring foreign nationals for employment, ensure that documentation, policies, and practices are updated and fully compliant. During the next live edition of the venerable Monitor Mondays live Internet radio broadcast, seasoned immigration attorney Matthew Webster will walk you through such essential issues as H-1B visas, L-1 visas and employment-based green cards. Webster is also expected to report on requirements from the Department of Labor (DOL) and the United States Citizenship and Immigration Services (USCIS). Webster, senior immigration attorney at the law firm of Fredrikson & Byron, will discuss the impact of material changes when H-1B amendments are required. The long-running broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on congressional action taking place in Washington, D.C.…

1
FY 2026 IPPS: Hospital Strategy for Risk Adjustment, Equity, and Reimbursement 29:20

6 weeks ago29:20

29:20

The fiscal year (FY) 2026 Inpatient Prospective Payment System (IPPS) proposed rule introduces significant reforms to hospital reimbursement, risk adjustment, and performance measurement. Key changes include the Centers for Medicare & Medicaid Services (CMS) transition to HCC Version 28, the use of the Community Deprivation Index (CDI) for socioeconomic risk adjustment and expanded inclusion of Medicare Advantage data in quality metrics. Launching in 2026, the proposed rule mandates episode-based payments with enhanced pricing accuracy. Hospitals must adapt by updating financial models, realigning quality strategies, and fostering cross-departmental collaboration. These changes emphasize equity, accountability, and transparency, all of which is designed to help in the positioning hospitals to lead in a value-driven healthcare environment. Strategic readiness is critical to thrive under IPPS 2026. Reporting this story, during the next live edition of Monitor Mondays, will be the broadcast’s special guest Penny Jefferson. The long-running broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Legislative Update: Folana Houston, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C. • News Update: Dr. Drew Update will have an update to his recent reporting on transgender treatment practices.…

1
HHS, CMS Latest Apparent Battlegrounds for Social Wars Being Waged by Trump Administration 30:38

7 weeks ago30:38

30:38

A flurry of national news reports continues to document the large-scale restructuring taking place at the U.S. Department of Health and Human Services (HHS), where 10,000 jobs were reportedly slashed earlier this month, a move also impacting the workforce at the Centers for Medicare & Medicaid Services (CMS). An estimated 300 CMS workers are expected to be affected by this action, while NPR reported that the HHS teams focusing on sexual violence prevention were also eliminated – on the first day of April’s Sexual Assault Awareness Month. Also recently, RACmonitor and Monitor Mondays have come into possession of a CMS memo, dated March 5, in which the agency warns that it may take action to prevent hospitals and other providers suspected of using “dangerous chemicals and surgical mutilation of children” relative to gender dysphoria, which the agency claims have “proliferated.” In fact, other executive actions taken by the Trump Administration also appear to have anticipated deleterious impacts on the health of America’s LGBTQ+ population. It seems part of an overarching theme in which the Administration is waging social wars using gutted federal agencies more as a weaponized tactic than as a mechanism to serve the public. Reporting this story during the next live edition of Monitor Mondays will be physician Drew Updike, a recognized leader in hospital utilization management, denials, clinical documentation integrity (CDI), coding, and hospital operations. The long-running broadcast will also include these instantly recognizable features: • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C. • Monday Rounds: Dr. Shaemarke Magan, medical director for CaroMont Health in Gastonia, North Carolina, will make his Monday rounds, substituting for Dr. Ronald Hirsch.…

1
Caught in the Crossfire: How to Avoid Pay-and-Chase Enforcement Tactics 31:29

8 weeks ago31:29

31:29

A recent case, United States v. Junyi Liu, reveals how a $23 million fraud scheme exemplifies vulnerabilities in America’s healthcare system – as you’ll discover when senior healthcare analyst Frank Cohen joins the next Monitor Monday broadcast. You’ll also learn about the challenges legitimate providers face when navigating complex regulations – and more about the government’s aggressive “pay-and-chase” enforcement tactics, plus why innocent practitioners often get caught in the crossfire. During the next live edition of the venerable weekly Internet broadcast, Cohen will also report on potential policy reforms. The long-running broadcast will also include these instantly recognizable features: • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C. • Monday Rounds: Dr. Bonney Olney, director of Level of Care Service for R1 RCM, will make her Monday rounds, substituting for Dr. Ronald Hirsch.…

1
Wound Care: An Open Source for Audits 29:56

9 weeks ago29:56

29:56

No matter the approach one might take for debridement, wound care continues to be an attractive source for audits – they inevitably arise and fester. Case in point: Wachler and Associates, a prestigious law firm in Michigan, currently is representing clients in some 18 wound care audit cases. That is why RACmonitor, producers of Monitor Mondays, has invited Andrew “Drew” Wachler, founder of Wachler & Associates, to be the special guest during the next live edition of the venerable weekly Internet broadcast. The long-running broadcast will also include these instantly recognizable features: • Breaking News: Famed whistleblower attorney Mary Inman, partner at Whistleblower Law, will report about a False Claims Act (FCA) settlement involving a Medicare Advantage provider. • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.…

1
Advanced Beneficiary Notice: A Doctors’ Day Observance 30:41

10 weeks ago30:41

30:41

National Doctors’ Day is actually Sunday, March 30, but the one-day nationwide observance is getting an early celebratory start during the next live edition of the venerable Monitor Mondays broadcast. Joining our esteemed panelists will be three well-known physicians: Drs. Stephanie Van Zandt, Clarissa Barnes, and Juliet Ugarte Hopkins. And each doc will have an “open mic” during the 30-minute live Internet broadcast. The long-running weekly broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.…

1
At the Intersection of CDI and the False Claims Act 30:15

11 weeks ago30:15

30:15

A clinical documentation integrity (CDI) professional who “knowingly … acts in reckless disregard of the truth or falsity of the information” may ultimately run into issues related to the federal False Claims Act (FCA). The Medicare Fee-for-Service (FFS) Compliance Program on the Centers for Medicare & Medicaid Service (CMS).gov website lists several CMS compliance programs designed to educate and support Medicare providers in “understanding and applying” FFS policies. If the hospital compliance department is not monitoring these resources, it would be prudent for CDI leadership to do so, according to CDI expert Cheryl Ericson, who will be the special guest during the next live edition of the long-running Monitor Mondays Internet broadcast. The venerable weekly Internet broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the latest news concerning healthcare legislation.…

1
Why Complications are Complicated 31:43

12 weeks ago31:43

31:43

Hospitals routinely measure, analyze, and track adverse patient harm events, collecting information about and reporting on certain types of such events in order to meet the Centers for Medicare & Medicaid Services (CMS) program and state legal requirements. Prior work plans of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) revealed that hospitals reported few harm events to state reporting systems. During the next live edition of Monitor Mondays, Dr. James Kennedy, president of CDIMD, will unwrap the January 2025 OIG proposal (OEI-06-18-00401) to evaluate hospital quality reporting, suggesting how hospitals’ clinical documentation integrity (CDI) and coding workflows can address errors of omission or commission. Access the OIG’s announcement at https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000907.asp. The venerable weekly Internet broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.…

1
DEVELOPING STORY: No Public Comment Allowed for HHS Rulemaking 32:41

13 weeks ago32:41

32:41

Across America, in sprawling university teaching facilities and in picturesque rural hospitals, administrators are dealing with a powerful tool called statistical extrapolation. When auditors say that they’re using statistical “sampling” to review your Medicare claims, what they are often doing is using extrapolation – which could take what might appear to be minor discrepancies in your billing and turn them into major financial obligations. To learn more about extrapolation and what it means for you and your team, the producers of RACmonitor have invited senior healthcare analyst Frank Cohen to be the special guest during the next live edition of Monitor Mondays. The venerable weekly Internet broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.…

1
Hot Off the Presses: Latest Issues Impacting Medicare Home Health Care, Hospice, and Medicaid Services 29:41

14 weeks ago29:41

29:41

During the next edition of Monitor Mondays, special guest Bill Dombi, senior counsel with Arnall, Golden, and Gregory, will offer an update on the hot-button issues affecting home healthcare, hospice, and long-term home care. These issues include the latest developments related to the Medicare Hospice Special Focus Program, the impact of the Medicare home health payment model, Medicare Advantage (MA) claim denials in post-acute care, and increasing threats to Medicaid support. The venerable weekly Internet broadcast will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the latest news concerning healthcare legislation.…

1
1.2 Billion in Fraudulent Claims for Wound Care Procedures 30:37

15 weeks ago30:37