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The Compliance Guy

The Compliance Guy

Author: Sean M. Weiss

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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 advocate, Sean engages with clients to ensure a “level-playing-field” and due process when allegations and/or accusations of impropriety are leveled by a payor or government investigation agency.

When Sean is not engaging in administrative, civil and criminal matters on behalf of more than 30 nationally recognized law firms and clients, he is serving as a third-party compliance officer for a dozen organization across the country ranging in size and specialty to ensure a “Culture of Compliance”!

Sean is a proud member in good-standing with the National Society of Certified Healthcare Business Consultants (NSCHBC), American Health Lawyers Association (AHLA), National Alliance of Medical Auditing Specialists (NAMAS), and the American Academy of Professional Coders (AAPC). Sean holds (CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC, CMC, CMIS, CMOM) national certifications from the Health Care Compliance Association, The National Alliance of Medical Auditing Specialists, The American Academy of Professional Coders and Practice Management Institute.

310 Episodes
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!
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.
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!
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 services and the fact that a face-to-face visit has occurred in the office not being the only required component to be able to bill. And so much more!
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 discussion on Untied Healthcare and Aetna's decision to stop covering the G2211. The reason? Misinterpretation of the concept of a longitudinal relationship by the majority and over-utilization of the code. Other payors are sure to follow! A heartfelt thank you to all the #linkedin family, friends, followers, and listeners for your continuous support and engagement. Join us as we navigate through the world of #COMPLIANCE. Peace and Love! Sean
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 serves as Chief Compliance Officer for Stryker and is responsible for overseeing the global compliance, privacy, and enterprise risk programs and functions. Under her leadership, the Compliance function has been focused on driving value for Stryker by partnering across the businesses to enable growth and manage risk. Dana also currently serves as the global president for Stryker Women’s Network, which seeks to improve Stryker’s results by fostering an open and inclusive culture, with a focus on attracting, developing, and retaining talented women. Dana has more than 20 years of experience in the life sciences industry. She joined Stryker in 2017 as Chief Legal Counsel, leading a global legal team advising on regulatory and quality, manufacturing and supply, technology and cybersecurity, commercial and government contracting, and privacy. Prior to Stryker, she served as Assistant General Counsel at Novo Nordisk, where during her 14-year career she held several positions of escalating responsibility within the legal team, overseeing support to the commercial, clinical, medical affairs, R&D, compliance, and government affairs organizations. Dana has worked extensively on matters related to product development and commercialization, market access and reimbursement, and compliance and risk management. Previously, Dana worked in private practice at O’Melveny in New York City. Dana received her law degree from New York University School of Law and her bachelor’s degree from Hamilton College.
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.
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...
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!
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!
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.
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.
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...
Brian Lobley brings over 20 years of experience leading healthcare businesses, operations, and strategy. Prior to joining tango, he served as the executive vice president, chief operating officer, and president of Health Markets at Independence Health Group, the parent company of Independence Blue Cross, LLC. He was responsible for leading Commercial, Consumer, and Medicare lines of business and the company’s group pharmacy business and Operations, Business Technology Services, Informatics, and Innovation departments. He provided oversight for the company’s subsidiaries: AmeriHealth New Jersey, and AmeriHealth Administrators.  He has also served on numerous boards across non-profit and for-profit sectors.  Brian earned his Bachelor of Science in Industrial Engineering at Lehigh University.
In this episode Sean and Terry take on Addendums, Corrections, and Late Entries, and when you can make them, when you shouldn't, and when clinical summaries are a better options.
Sean and Terry are back with an all new #TerryTuesday episode that you are not going to want to miss!
 The full panel! Scott Kraft, John Paul Spencer, Terry Fletcher CPC CEMC CCC CCS CCS-P CMC ACS-CA SCP-CA PACS QMPM, Stephanie Allard, CPC, CEMA, RHIT and Christine Hall CHC was back with all new topics! 1. Weight loss drugs and all the confusion on medical necessity 2. Physician disclaimers and the misnomers 3. Developing the next generation of coders, and the difficulties practices are having retaining experienced coders in this economy
Bryan Meek of Brennan, Manna, and Diamond joins Sean to discuss last weeks final rule issued by the Federal Trade Commission and what it means at this point, where things are headed and how to navigate through all the noise. Don't miss this episode!
Sean and Terry are at it again, taking on the most perplexing and head-scratching auditing, coding and compliance topics and bringing a sense of sanity to insane situations!
Most of the all star team was back for this one and it was an outstanding discussion of the G2211, Medical Necessity vs. Correct Coding, SNF Visits and Medical Necessity, and so much more!