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Compliance Conversations is a biweekly podcast for healthcare professionals and compliance officers who want to stay on top of the compliance game. Host CJ Wolf has in-depth conversations with industry experts to explore the riddles and complexities of the compliance world. Wolf chats with fellow compliance experts, auditors, physicians and government officials. Compliance Conversations is produced by Healthicity.
135 Episodes
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The CRUSH initiative (Comprehensive Regulations to Uncover Suspicious Healthcare) is more than just another acronym, it’s a signal of where healthcare regulation is headed next. In this episode of Compliance Conversations, CJ Wolf is joined by Lisa Taylor, a seasoned Chief Compliance Officer, to break down what this request for information (RFI) means for organizations today—and what it could become tomorrow. What You’ll Learn Why RFIs matter and how they shape future rules...
Telehealth remains one of the most dynamic and closely watched areas in healthcare compliance. In this episode of Compliance Conversations, CJ Wolf welcomes back telehealth compliance expert Keisha Wilson, founder of KW Advanced Consulting, for a timely discussion on the latest telehealth developments, including newly extended flexibilities, evolving documentation requirements, and the audit risks organizations cannot afford to ignore. With key telehealth provisions now extended t...
Medical decision making shouldn’t feel like a coding puzzle, and your documentation shouldn’t read like a template checklist. In this episode, CJ Wolf is joined by Amanda Reikowsky, a coding quality audit & education supervisor at Hackensack Meridian Health and founder of CodeWise Solutions, LLC, to break down what MDM documentation should look like today—and why the best notes focus on the story and rationale behind care. What you’ll learn The most common MDM documentat...
Mentorship can be the difference between feeling stuck and building a career with real direction. In this episode of Compliance Conversations, CJ Wolf is joined by Barbara Shaw, a seasoned healthcare coding, auditing, and risk adjustment professional who has made mentoring new coders a meaningful part of her work, especially through her involvement as an AAPC local chapter officer. Barbara shares why mentorship is so rewarding, how she structures mentoring relationships in a realistic w...
Compliance risks don’t always start in obvious places—and that’s what makes them dangerous. In this episode of Compliance Conversations, host CJ Wolf talks with Amy Bailey of HBE Advisors about the real-world compliance failures she sees most often across hospitals and physician groups nationwide. Drawing on decades of experience with investigations, self-disclosures, and Corporate Integrity Agreements, Amy shares practical insights compliance leaders can apply immediately. In thi...
Refunds and overpayments sit at the intersection of compliance, finance, and legal risk. In this episode of Compliance Conversations, CJ Wolf speaks with David Glaser, healthcare attorney and in Fredrikson’s Health Law group, about how organizations can navigate refund decisions with greater confidence and clarity. Drawing from years of advising providers nationwide, David explains: The difference between binding law and non-binding guidance Navigating refunds How far Me...
In this episode of Compliance Conversations, host CJ Wolf sits down with Jill Fallows Macaluso, Corporate Vice President and Chief Compliance Officer at Novo Nordisk, to explore how ethical culture, psychological safety, and empowered risk-taking can transform compliance from a regulatory obligation into a strategic asset. Jill shares insights from more than two decades in a highly regulated industry, discussing how organizations can move beyond check-the-box compliance and build cultur...
In this episode of Compliance Conversations, healthcare compliance expert Jessica Zeff, the Founder & CEO of Simply Compliance, shares real-world insight into why structured, electronic case management is essential for demonstrating compliance, managing risk, and responding efficiently to audits and investigations. What You’ll Learn What compliance case management actually looks like in practice Why consistency and categorization matter for risk analysis Common mista...
Critical care coding isn’t just about time at the bedside. In this new episode of Compliance Conversations, CJ Wolf and Maya Turner discuss how recent CPT® guidance expands what’s billable, from telehealth consults to pre-arrival care coordination. Key Takeaways: When critical care starts (and where it doesn’t) CPT® vs. CMS Guidance— and what happens when they differ How to handle transport, telehealth, and overlapping E/M services Ways to help providers feel recogn...
As federal deadlines, a shutdown, and stalled legislation churn the rules, telehealth coverage looks different across Medicare, Medicaid, and commercial payers. In this episode, CJ Wolf, MD and Keisha Wilson (Founder/CEO of KW Advanced Consulting) breaks down what’s actually covered right now—and how to stay compliant without disrupting care. You’ll learn: Where Medicare telehealth reverted and where behavioral health remains an exception How to use ABNs correctly (and why ti...
Headlines change. Your mandate doesn’t. In this Compliance Conversations episode, CJ Wolf, MD, and Brian Burton, Healthicity Chief Compliance & Privacy Officer, cut through the noise to show how to keep programs objective, patient-first, and audit-ready—even amid shutdowns, delayed rules, and shifting priorities. What you’ll learn Enforcement reality check: Why fraud, waste, and abuse actions keep moving—and how to prepare. Backlogs & timing: Practical impacts ...
CJ Wolf sits down with Jacklyn DeMar (President and Chief Executive Officer of The Anti-Fraud Coalition) and Elin Kunz (testifying expert and former whistleblower) to explore the False Claims Act (FCA), the realities of retaliation, and how compliance programs move from “paper tiger” to practice. What You’ll Learn FCA in plain English: How cases start, why most settle, and the government’s role Real-world whistleblowing: Documenting concerns, building evidence, and choosing c...
Artificial intelligence is no longer a future concept; it’s here, embedded in healthcare systems, vendor platforms, and even your day-to-day operations. But with innovation comes risk. In this episode of Compliance Conversations, host CJ Wolf, MD, talks with Santosh Kaveti, Founder and CEO of ProArch, about: Emerging AI Risks: From shadow AI to model drift Governance & Education: Why AI literacy across your workforce matters Explainability: The critical requirement c...
Artificial intelligence is transforming healthcare, from ambient documentation to virtual assistants. But as opportunities grow, so do risks. How can compliance and security leaders enable innovation while ensuring patient safety and regulatory alignment? In this episode of Compliance Conversations, CJ Wolf talks with Walter Haydock, former national security advisor and founder of StackAware. Together they unpack: ISO 42001: The emerging “SOC 2 for AI” standard The balance be...
In this episode of Compliance Conversations, CJ Wolf sits down with Melinda Hawk, recognized as Healthicity’s Revenue Cycle Manager of the Year, to talk about her career journey, leadership lessons, and the power of collaboration between compliance and revenue cycle teams. What You’ll Learn: Insights from 35 years in home health and hospice The importance of compliance-revenue cycle communication Strategies to mentor and prepare the next generation Practical ways to...
In this episode of Compliance Conversations, CJ Wolf speaks with Eddie Qureshi, CEO of Rainfall Health, to break down the new CMS TEAM Model—and what it means for your hospital’s future. What You’ll Learn: Which hospitals are impacted (and how to check the list) Why CMS is shifting post-acute accountability to hospitals What compliant documentation, coordination, and reporting looks like How AI and integrated tools can make all the difference Thank you for ...
In this episode of Compliance Conversations, CJ Wolf, MD, is joined by Rui Ribeiro, Co-Founder and CEO of Jscrambler, to dive into the client-side security threats healthcare organizations often overlook. From patient portals to embedded video players, Rui explains how browser-based vulnerabilities are creating new risks that healthcare teams need to be aware of. You’ll learn: Why client-side protection could be the next step in HIPAA evolution How healthcare can follo...
In this powerful episode of Compliance Conversations, CJ Wolf interviews Dave Cardelle, RPh, Chief Strategy Officer at AMS, who shares practical insights on CMS’s shifting enforcement landscape and the real-world impact of hospital price transparency. What You’ll Learn: What makes a machine-readable file compliant (and what doesn’t) Why average negotiated rates are the most challenging—and most scrutinized—data element How automation and governance can save your hospital...
In this episode of Compliance Conversations, CJ Wolf welcomes back Maya Turner, a nationally recognized expert in medical coding and consulting. Together, they explore how value-based care and ancillary services are transforming provider reimbursement, especially in a telehealth-enabled world. You'll learn: What value-based care really means (and why it matters) The billing codes you may be overlooking How to streamline documentation and consent Why ancillary staff ...
Aaron Burnett, CEO of Wheelhouse Digital Marketing Group, joins CJ Wolf to decode the complex world of healthcare marketing, privacy laws, and risk mitigation. What You’ll Learn: The evolving legal landscape: OCR guidance, AHA lawsuits, FTC enforcement Why third-party tracking is out—and what to use instead How to collaborate across marketing, IT, and compliance What “data destiny” really means for covered entities Emerging solutions like media mix modeling and...
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