Monitor Mondays
Join Chuck Buck every Monday when he welcomes RACmonitor contributing editors and special guests for the latest regulatory audit news and information from CMS, OIG and OMHA. And gain valuable context and perspective that can only be found when you’re listening to the long-running and popular Monitor Mondays. Register to attend live here: https://racmonitor.medlearn.com/racmonitor/podcasts/
Episodes
368 episodes
Is the UPIC Fraud Prevention System Broken?
The Unified Program Integrity Contractors (UPICs) are household names in healthcare compliance.But their track record tells a troubling story, according to senior healthcare analyst Frank Cohen. These Medicare fraud enforcement contracto...
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Season 14
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Episode 649
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30:29
A Reign of Terror for Providers
There just might be a reign of terror being experienced at many of America’s hospitals and health systems. Professionally delivered patient care apparently seems to be getting hijacked by auditors compelled to deny claims of omission.Aid...
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Season 14
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Episode 648
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30:02
Invalid Prescriptions Trigger CVS Omnicare Whistleblower Lawsuit
Although the lawsuit was filed by a pharmacist in New Mexico, a federal judge in New York has ordered CVS Omnicare to pay $949,000 to settle a False Claims Act (FCA) case.According to news sources, the Pharmacy Benefits Manager (PBM) all...
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Season 14
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Episode 647
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28:21
340B: Fighting Back Against Big Pharma
Federal legislation has been introduced that is intended to help the beleaguered 340B Health organization via an effort to ban pharmaceutical companies from restricting access to the drug pricing discount program of the same name, through commu...
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Season 14
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Episode 646
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28:09
The Changing Audit Landscape
The rugged audit landscape has changed – and not for the better.Today, there are more potential pitfalls and traps to capture the unprepared and impact them with huge fines and possible incarceration. In fact, the Centers for Medicare &a...
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Season 14
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Episode 645
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28:44
An OPPS Oops?
The Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule for the 2026 fiscal year has been released.Tucked inside the Proposed Rule from the Centers for Medicare & Medicaid Services (CMS) is...
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Season 14
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Episode 644
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30:00
Medicaid Madness
It’s a Medicaid Madness mess.For many years, Medicaid has been providing support for America’s most vulnerable populations. But now, Medicaid finds itself as a pawn, being manipulated for political gain between two opposing forces: those...
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Season 14
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Episode 643
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29:30
Chevron Deference: What Difference Has a Year Made?
Looking back and looking ahead, we must reckon with a major shift in America’s judicial landscape: the elimination of the so-called Chevron Deference. Last year, at about this same time, physician and attorney Dr. John K. Hall was the special g...
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Season 14
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Episode 642
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29:35
Breaking News: A Major Regulatory Shift
The Transparency in Coverage (TiC) Final Rule represents one of the most significant regulatory shifts in healthcare pricing since the implementation of the Patient Protection and Affordable Care Act.During the next live edition of Monit...
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Season 14
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Episode 641
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28:52
Fraud, Waste, and Abuse: The 2025 Triple Crown
Call it a trifecta, triumvirate, or the Triple Crown of 2025.“Fraud, waste, and abuse” is the current triple-negative buzzword in America’s lexicon. And it’s being used to describe lots of things. But when that phrase is used by the U.S....
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Season 14
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Episode 640
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31:52
Compliance Quicksand: Sepsis
Clinical denials by payers for sepsis continues. The problem: the definition of the enigmatic condition does not meet their propriety definitions.Enter Dr. James Kennedy, who will be the special guest during the next live edition of the lon...
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Season 14
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Episode 639
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30:15
Medicaid Madness
The nation’s Medicaid program has seen better days. Recently, the federal government’s program to provide healthcare coverage to America’s low-income and vulnerable citizens was used as a bargaining chip as congressional Republicans were in the...
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Season 14
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Episode 638
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31:13
Whistleblower Update: Rheumatologist Sentenced to Jail, Must Forfeit Maserati and Other Possessions
During the next edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner at Whistleblower Law, will provide an update on a whistleblower case that some consider “beyond bad.”You’ll learn why a Texas rheumatologist who...
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Season 14
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Episode 637
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29:27
Tariffs: The Impact on Drugs
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...
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Season 14
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Episode 636
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30:00
Speak No Evil: Asking Docs to Weigh In Became a $202 Million False Claims Act Settlement
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...
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Season 14
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Episode 635
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33:18
340B In the Crosshairs
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 (H...
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Season 14
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Episode 634
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28:01
Audit Alert: Immigration in Healthcare
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 incre...
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Season 14
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Episode 633
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29:58
FY 2026 IPPS: Hospital Strategy for Risk Adjustment, Equity, and Reimbursement
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 &...
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Season 14
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Episode 632
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29:20
HHS, CMS Latest Apparent Battlegrounds for Social Wars Being Waged by Trump Administration
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 th...
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Season 14
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Episode 631
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30:38
Caught in the Crossfire: How to Avoid Pay-and-Chase Enforcement Tactics
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...
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Season 14
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Episode 630
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31:29
Wound Care: An Open Source for Audits
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 repres...
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Season 14
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Episode 629
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29:56
Advanced Beneficiary Notice: A Doctors’ Day Observance
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 b...
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Season 14
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Episode 628
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30:41
At the Intersection of CDI and the False Claims Act
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-f...
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Season 14
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Episode 627
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30:15
Why Complications are Complicated
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 le...
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Season 14
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Episode 626
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31:43
DEVELOPING STORY: No Public Comment Allowed for HHS Rulemaking
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” ...
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Season 14
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Episode 625
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32:41