The Compliance Guy

The one and only Ronald Chapman II of the Chapman Law Group joins Sean to discuss their latest (5 in 12 months) of acquittals for Dr. Loey Kousa. Sean and Ron lay out what went right for the defense and why the prosecution's case failed. If you are a provider charged with a crime in healthcare or an attorney looking for strategies to ensure a level playing field and due process for your client then this episode is a must!

Here is the latest episode of The Compliance Guy! SummaryIn this episode of The Compliance Guy, Sean M Weiss and Terry Fletcher discuss various topics related to compliance, telehealth, and revenue cycle management. They emphasize the importance of accurate documentation in medical records, the impact of government shutdowns on telehealth services, and the responsibilities of EMR companies in ensuring accurate data entry. The conversation highlights the consequences of inaccurate documentation and the need for providers to maintain compliance in their practices.TakeawaysThe government shutdown impacts telehealth services.Compliance applies to various aspects of business and healthcare.Inaccurate documentation can lead to serious consequences.Every medical encounter must support the billed service level.EMR systems can default to incorrect coding, causing issues.Providers must ensure their documentation is accurate and up-to-date.The responsibility for medical record accuracy lies with the provider.EMR companies may have liability for errors in their systems.Documentation should stand on its own without unnecessary coding.Providers need to advocate for better EMR functionality.

SummaryThe 2026 Compliance Roundtable discusses critical issues in healthcare compliance, focusing on prior authorizations, telehealth, clinical laboratories, and incident two billing provisions. Experts (Joe Rivet, Terry Fletcher, Scott Kraft, Stephanie Allard, Jordan Johnson, and David Duhaime) share insights on the challenges faced by providers, the impact of legislation, and the evolving landscape of healthcare regulations. The conversation highlights the need for reform and the importance of understanding the complexities of compliance in the healthcare industry.TakeawaysPrior authorizations serve as a gatekeeper to control healthcare costs.The burden of prior authorizations can create barriers to timely care.Congress is considering reforms to the prior authorization process.Medicare Advantage plans often complicate access to care compared to traditional Medicare.Virtual supervision has changed the definition of direct supervision in healthcare.Incident two billing provisions pose significant compliance risks for providers.The error rate in incident two billing is alarmingly high.PAMA cuts to laboratory services could negatively impact patient care.AI in healthcare presents risks related to patient information security.The importance of understanding the nuances of healthcare regulations is critical for compliance.

SummaryIn this episode, Sean M Weiss and Terry Fletcher discuss the implications of AI in healthcare, particularly focusing on AI scribes and the importance of patient consent. They explore the challenges and responsibilities healthcare providers face in ensuring patient privacy and compliance with regulations. The conversation highlights the need for transparency in AI usage and the potential risks associated with it, emphasizing the importance of patient safety and accountability in the evolving landscape of healthcare technology.TakeawaysAI scribes are becoming a significant issue in healthcare.Patients often rush through signing consents without understanding them.There is a lack of clarity on what patients are agreeing to when they consent to AI usage.Healthcare providers must ensure compliance with regulations regarding AI.Patients should be informed about their rights to opt out of AI scribing.The responsibility for AI outputs lies with the healthcare provider.AI is rapidly changing the landscape of healthcare operations.There is a need for better safeguards and regulations around AI in healthcare.Patient safety must be prioritized over efficiency in healthcare practices.Healthcare providers need to adopt a patient-centered approach in AI implementation.Navigating AI in Healthcare: Consent and ComplianceThe Rise of AI Scribes: What Patients Need to Know

SummaryIn this episode of The Compliance Guy Podcast, host Sean Weiss speaks with Evan Gottlob, a former federal prosecutor turned defense attorney, about the complexities of regulatory compliance in healthcare law. They discuss the decision-making process behind prosecutions, the impact of indictments on healthcare professionals, and the importance of protecting whistleblowers. Evan shares insights on civil investigative demands and the drivers behind False Claims Act cases, emphasizing the need for organizations to build a culture of compliance to prevent legal issues. The conversation highlights the challenges faced by healthcare providers and the legal landscape surrounding compliance and fraud.TakeawaysProsecutors must ensure they have a strong case before charging individuals.Indictments can have devastating effects on healthcare professionals' careers.The grand jury process is often biased towards the prosecution.Complex white-collar cases can be easier to present due to more evidence.Civil Investigative Demands (CIDs) can lead to criminal investigations.Whistleblowers play a crucial role in exposing fraud in healthcare.Organizations must take employee concerns seriously to prevent retaliation.Building a culture of compliance is essential for healthcare organizations.Legal representation is critical when facing investigations.The healthcare industry is plagued by significant fraud and waste.

SummaryIn this episode, Sean Weiss and Terry Fletcher discuss the critical importance of complete and accurate medical documentation in healthcare. They explore the consequences of incomplete records, the role of electronic medical records (EMRs), and the need for accountability among healthcare providers. The conversation emphasizes that clinicians must take responsibility for their documentation to ensure compliance and support medical necessity. The episode also touches on the complexities of medical coding and the importance of clear communication in clinical records.TakeawaysIncomplete documentation can lead to compliance issues.Providers must accept accountability for their documentation.EMRs should not be blamed for incomplete records.Documentation must support medical necessity and clinical judgment.Auditors need complete records to defend against claims.Assumptions in documentation can lead to errors.Clear definitions in coding are essential for accurate billing.Providers should not rely on templates to convey critical information.Documentation standards change regularly and must be adhered to.Healthcare professionals must work together to ensure complete records.

SummaryIn this episode, Sean Weiss and Terry Fletcher discuss the new year and the importance of compliance in healthcare. They highlight the upcoming legislative changes affecting telehealth, the roles of medical students, and the challenges of documentation and accountability in healthcare practices. The conversation emphasizes the need for proper training, understanding of roles, and the importance of doing the right thing in healthcare to avoid risks and ensure compliance.TakeawaysJanuary 30th is a critical date for telehealth funding.Medical students have limited roles compared to licensed providers.Documentation must be accurate and compliant with regulations.Providers must personally perform key components of services.Using medical students for billing can lead to compliance issues.Training and understanding roles are essential in healthcare.Fraud and abuse can result in significant penalties.Healthcare providers must be proactive in audits and compliance.Integrity in healthcare is crucial, even when not being watched.Proper billing practices are necessary to avoid legal repercussions.

Sean was joined by Dr. Carolyn Ward, Director of Clinical Strategy for Particle Health to discuss challenges with interoperability and other dynamic challenges facing healthcare professionals... About Dr. Ward: Carolyn Ward is a dynamic and driven internal medicine physician with a passion for physician empowerment and data-driven decision making. With over eight years of experience in healthcare, including as Chief Resident at Rutgers Robert Wood Johnson Medical School, she has established herself as a leader in the field. As the Director of Clinical Strategy at Particle Health, Carolyn has taken her experience to the next level. She is responsible for developing the clinical product roadmap for the organization, ensuring that providers and patients are represented throughout the research and development process.Carolyn's mission is to enable simple and secure access to actionable patient data through Particle's modern API platform. She believes that the health data system must be more cohesive to prevent digital friction and to promote positive patient outcomes. Carolyn is an ideal fit for podcasts targeting audiences of C-suite executives and founders for health tech companies, physicians, and women in tech. She can offer unique insights on topics such as healthcare interoperability, AI in health data management, digital health innovation, and value based care innovation. Her knowledge, experience, and her passion make her an outstanding guest for any podcast looking to explore the challenges facing the industry and the opportunities for innovation.

SummaryIn this episode, Sean Weiss discusses the complexities surrounding ancillary providers and their billing practices, particularly focusing on CMS and commercial payer rules. He explains the definitions and roles of ancillary staff, the intricacies of incident to billing, and the compliance requirements for split shared services. The conversation emphasizes the importance of understanding these regulations to ensure proper reimbursement and avoid potential pitfalls in healthcare billing.TakeawaysUnderstanding the roles of ancillary staff is crucial for compliance.CMS defines ancillary staff as non-independent billers.Incident to billing allows non-physician services to be billed under a physician's NPI.Direct supervision by a physician is required for incident to billing.Split shared services have specific requirements for billing under a physician's NPI.Documentation must capture substantive portions of services provided.Regular audits of staff roles and job descriptions are necessary.Understanding payer guidelines can help avoid billing denials.Compliance gaps can lead to recoupments and legal issues.Healthcare attorneys can assist with complex compliance issues.

SummaryIn this episode, Sean M Weiss engages with Richa Kaul, CEO of Compliance with a Y, discussing the critical role of governance, risk, and compliance (GRC) in today's data-driven world. They explore the mission behind the organization, the importance of risk assessments, and the challenges posed by rapid advancements in AI technology. Richa emphasizes the need for ethical considerations in AI development and the necessity of human intervention in AI processes. The conversation highlights the balance between innovation and regulation, particularly in the context of data privacy and security.TakeawaysCompliance with a Y focuses on protecting consumer data through enterprise security.Risk assessments are crucial for both large and small organizations.GRC stands for Governance, Risk, and Compliance, and is increasingly important.AI technology is evolving rapidly, outpacing current regulations.Ethical AI development requires human oversight and intervention.Organizations must prioritize security over mere compliance.The healthcare sector is a significant focus for Compliance with a Y.AI can enhance risk visibility but should not replace human judgment.Regulations need to adapt to the fast-paced changes in technology.Integrity in business practices is essential for long-term success.

SummaryIn this episode, Sean M Weiss discusses the critical role of compliance officers in healthcare organizations, emphasizing their responsibilities, best practices, and the importance of regulatory compliance. He highlights the need for a proactive approach to risk assessment, the do's and don'ts of compliance, and the necessity of independence and objectivity in the compliance role. The episode concludes with a call to action for compliance officers to leverage available resources and foster a culture of compliance within their organizations.TakeawaysThe compliance officer is crucial for organizational integrity.Compliance programs must adhere to OIG's seven core elements.Regular risk assessments are essential for identifying vulnerabilities.Training and education are vital for compliance success.Independence in the compliance role prevents bias and conflicts.Separation between compliance and legal functions is necessary.Empowering compliance officers can reduce enforcement risks.Fostering a culture of compliance is a competitive advantage.Ignoring red flags can lead to significant penalties.Utilizing OIG and CMS resources enhances compliance effectiveness.oig.hhs.gov/compliance/ cms.gov/medicare/compliance-and-audits justice.gov/criminal/criminal-fraud/page/file/1562831/dl

SummaryIn this episode of the Compliance Guy podcast, Sean M Weiss reflects on the challenges and lessons learned in 2025 regarding compliance in healthcare. He emphasizes the importance of building a robust culture of compliance to prepare for the upcoming year, 2026, which is expected to bring increased scrutiny from federal agencies. Weiss outlines essential steps for healthcare organizations to strengthen their compliance programs, including conducting risk assessments, integrating HIPAA requirements, implementing training programs, and engaging third-party auditors. He concludes with a call to action for organizations to proactively adapt to regulatory changes and foster a culture of compliance.TakeawaysBuilding an effective compliance program is crucial.2025 was a challenging year for compliance professionals.Conducting a thorough compliance risk assessment is essential.Strengthening HIPAA privacy rule compliance is necessary.Implementing employee training programs is vital for compliance culture.Engaging third-party auditors can provide objective evaluations.Leadership oversight is critical for compliance success.Monitoring regulatory developments is necessary for adaptation.Cultivating a resilient compliance culture minimizes legal risks.Proactive compliance enhances operational integrity and patient trust.

SummaryIn this episode, Sean M Weiss and Terry Fletcher discuss the complexities of compliance in healthcare, particularly as the year comes to a close. They explore the importance of understanding revenue cycle management, the disconnect between clinical and payer policies, and the necessity of reading contracts thoroughly. The conversation emphasizes the need for common sense in clinical practices and the critical role of compliance programs in healthcare settings.TakeawaysThe importance of understanding revenue cycle management as the year ends.There is often a disconnect between clinical policies and payer policies.Providers must read and understand their contracts before signing.Medicare sets the standard for many insurance companies' policies.Insurance companies prioritize profit over patient care.Common sense is crucial in clinical practices and billing.Services should only be billed once completed, not prematurely.A written compliance plan is essential for healthcare practices.Compliance programs should be dynamic and regularly updated.Payer policies must align with clinical practices for effective compliance.

SummaryIn this episode of the Compliance Guy podcast, Sean M Weiss interviews Dr. Raj Bothra, who shares his harrowing experience of being wrongfully accused of Medicare fraud and excessive narcotics distribution. Dr. Bothra discusses the complexities of the case, the role of the DOJ and FBI, and the injustices he faced during his trial. He emphasizes the need for judicial reform and advocates for awareness about the flaws in the legal system that can lead to wrongful accusations. The conversation highlights the importance of understanding the legal landscape for healthcare professionals and the impact of the opioid crisis on the judicial process.TakeawaysThe trial was pivotal in shaping legal defenses against the DOJ.Dr. Bothra's background includes significant humanitarian work.The charges against Dr. Bothra were based on flawed data.The judicial system can be biased against defendants.Dr. Bothra spent 1,300 days in prison without trial.The opioid crisis influenced the prosecution's approach.Expert testimonies were crucial in Dr. Bothra's acquittal.The grand jury system needs reform to ensure fairness.Dr. Bothra's story is a cautionary tale for healthcare professionals.There is a pressing need for judicial reform to prevent future injustices.

SummaryIn this episode, Sean M Weiss and Terry Fletcher discuss the complexities surrounding Additional Documentation Requests (ADRs) from Medicare Advantage plans. They emphasize the importance of compliance, the legal obligations of providers, and the potential consequences of ignoring these requests. The conversation also touches on the ongoing investigations into Medicare Advantage fraud and the need for providers to navigate these challenges carefully while maintaining good relationships with payers.TakeawaysResponding to ADRs is a legal obligation for providers.Ignoring ADRs can lead to serious consequences.Providers should negotiate terms if requests are unreasonable.HIPAA allows disclosures for payment-related activities.Payers are permitted to request specific documentation for audits.Maintaining a good relationship with payers is crucial.Providers can ask for clarification on ADR requests.Documentation requests should be fulfilled within narrow parameters.The OIG investigates Medicare Advantage plans for fraud.Providers should utilize electronic means for submitting documentation.

SummaryIn this episode, Sean M Weiss discusses the critical role of compliance officers in healthcare organizations, emphasizing their responsibilities, best practices, and the importance of maintaining objectivity and independence. He outlines the do's and don'ts of compliance, highlights essential resources for compliance officers, and stresses the need for separation between compliance, legal, and operations to ensure effective oversight and ethical conduct.TakeawaysThe compliance officer is pivotal in safeguarding organizational integrity.Compliance officers must adhere to laws like the False Claims Act and HIPAA.Regular risk assessments are crucial for identifying high-risk areas.Establishing anonymous reporting mechanisms encourages whistleblowing.Ignoring red flags can expose organizations to significant risks.Objectivity and independence are essential for effective compliance.Resources from OIG and CMS are vital for compliance programs.Separation of compliance from legal and operations is necessary.Fostering a culture of ethical conduct mitigates potential liabilities.Compliance is a continuous process that requires vigilance and adaptation.

SummaryIn this conversation, Terry Fletcher and Sean M Weiss discuss the recent announcement by ChatGPT regarding its decision to cease providing health and legal advice due to a significant error rate. They explore the implications of this decision, the ongoing debate about the accuracy of AI chatbots, and the potential consequences of AI errors in professional fields.TakeawaysChatGPT announced it will stop providing health or legal advice.The error rate for ChatGPT is reported to be over 40%.Debate exists about the accuracy of AI chatbots.Significant hallucination rates in AI-generated content are concerning.The decision to stop providing advice may be influenced by legal pressures.AI's limitations in professional fields raise ethical questions.Users should be cautious when relying on AI for critical information.The conversation highlights the need for human oversight in AI applications.Misinformation from AI can have serious consequences.The future of AI in professional settings remains uncertain.

SummaryIn this episode of The Compliance Guy podcast, Sean M Weiss engages in a detailed conversation with attorney Summer McKeivier about the complexities of healthcare law, particularly focusing on incident two billing, healthcare fraud prosecutions, and the challenges faced by providers in navigating compliance issues. They discuss the current trends in healthcare fraud, the role of medical directors and Medicare Administrative Contractors (MACs), and the implications of inexperienced prosecutors in healthcare cases. The conversation also highlights the impact of accusations on healthcare professionals and the importance of understanding medical necessity in the context of local coverage determinations. Throughout the discussion, both Sean and Summer share insights from their experiences in the field, emphasizing the need for knowledgeable representation in healthcare law.TakeawaysSummer McKeivier is a leading attorney in healthcare law.Incident two billing is a significant issue in healthcare compliance.Wound care is currently a major focus for healthcare fraud investigations.CMS's definition of medical necessity often differs from providers' perspectives.Local Coverage Determinations (LCDs) do not have the effect of law.Medical directors may lack the necessary expertise in specific healthcare areas.Healthcare providers face challenges due to poorly written LCDs.Overpayment disputes can escalate if not addressed properly.Inexperienced prosecutors can lead to unjust accusations in healthcare cases.Accusations can severely impact healthcare professionals' ability to practice.

SummaryIn this episode of the Compliance Guy podcast, Sean M Weiss welcomes Don Self, a veteran in the medical billing industry, to discuss his extensive experience and insights. They explore Don's two recent books, touching on topics such as medical office management, evaluation and management services, and the importance of understanding ERISA. The conversation highlights the challenges faced by healthcare providers in documentation and billing, as well as the need for better practices in the industry. Personal anecdotes and reflections on mentorship add depth to the discussion, making it both informative and engaging.TakeawaysDon Self has over 40 years of experience in the medical billing industry.The importance of mentorship in professional growth is emphasized.Don's books are accessible and filled with practical advice.Evaluation and management services continue to challenge providers.Documentation practices have become more complex and subjective.Healthcare systems in other countries can offer valuable lessons.Local coverage determinations are crucial for understanding payment policies.ERISA provides significant protections for employees and providers.Many providers are unaware of their rights under ERISA.The conversation encourages proactive engagement with insurance carriers.

SummaryIn this episode of The Compliance Guy podcast, Sean M Weiss interviews Steven Adler, co-chair of litigation at Mandelbaum Barrett PC, focusing on non-compete agreements and restrictive covenants in healthcare. They discuss the complexities of these agreements, the rights of patients, and the implications of a recent case involving Dr. Timothy Vogel, a pediatric neurosurgeon. The conversation highlights the importance of legal counsel in navigating employment agreements and the enforceability of non-compete clauses.TakeawaysNon-competes are often negotiated and rarely go to trial.Restrictive covenants can include non-solicitation and confidentiality clauses.Patients have the right to choose their treating physician, even if a non-compete exists.Courts generally respect the doctor-patient relationship in these cases.The enforceability of non-compete agreements varies by state and circumstance.Legal counsel is crucial when signing employment agreements in healthcare.Many physicians mistakenly believe non-compete agreements are unenforceable.The geographic scope of non-compete agreements must be reasonable.Blue penciling allows courts to modify overly broad agreements.The credibility of witnesses can significantly impact trial outcomes.