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
331 episodes
Denials Going from Bad to Worse
Denials in healthcare are a problem.Recently, though, the problem seems to be getting worse, especially with the misapplication of the Two-Midnight Rule by Medicare Advantage (MA) plans, according to Nick Hut, senior editor for Healthcar...
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Season 13
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Episode 613
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28:52
Sex, Lies and Turmoil
A pediatrician under investigation related to accusations that she had engaged in sexual relations with a male patient, having lied about it when applying for another healthcare position, was recently sentenced for making false statements.<...
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Season 13
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Episode 612
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27:30
The Two-Midnight Rule: Presumption of Risk
Could you and your care team be at risk when you upgrade a patient from observation to inpatient simply because the patient passed a second midnight in the hospital, based on the Centers for Medicare & Medicaid Services (CMS) contentious Tw...
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Season 13
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Episode 611
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26:48
False Claims Act Violation: Unnecessary Drug Testing Flags Feds
The U.S. Department of Justice (DOJ) has reported that one of America’s largest urine drug-testing companies has agreed to pay $27 million to resolve allegations of unnecessary drug testing and illegal remuneration to physicians.The Fal...
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Season 13
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Episode 610
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26:56
340B Drug Rebates: Old Debate Revived, But Shot Down
A major drug company’s attempt to turn 340B drug pricing program discounts into rebates made big headlines in recent weeks. Maureen Testoni, president and CEO of 340B Health, will review how this potentially major upheaval came about, how 340B ...
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Season 13
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Episode 609
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27:58
Violence in America’s Hospitals
As violent crime has trended slightly downward throughout the United States over the last year, a wound to this country’s collective psyche that appears reluctant to close is workplace violence in America’s hospitals.Reporting the lead s...
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Season 13
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Episode 608
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28:04
Whistleblower Report: Oak Street Health Agrees to Pay $60M to Resolve Alleged False Claims Act Liability in Medicare Advantage Patient Recruitment Scheme
Oak Street Health, headquartered in Chicago and a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the False Claims Act by paying kickbacks to third-party insurance agents i...
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Season 13
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Episode 607
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28:41
Exposing Challenges to Getting Paid by Medicare Advantage
You need to get paid properly for surgical procedures on the Centers for Medicare & Medicaid Services (CMS) Inpatient-Only (IPO) List, according to Mary Beth Pace, vice president of care management at Trinity Health, and also the special gu...
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Season 13
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Episode 606
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29:00
How to Ensure Correct Inpatient Status
What’s wrong with this picture?With more than 10 years of the Centers for Medicare & Medicaid Services (CMS) Two-midnight Rule now behind us, one would presume that most healthcare professionals should know what determines an inpatie...
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Season 13
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Episode 605
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30:12
New Study Reveals America’s Big Hang-up with Healthcare
A comprehensive new survey featuring responses from more than 1,500 U.S. patients reveals that they are not only frustrated by poor provider support, but also are experiencing tangible health setbacks – especially when waiting to refill prescri...
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Season 13
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Episode 604
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28:58
Federal Officials Announce Medical Relief in Wake of Hurricane
In response to the devastation caused by Hurricane Debby, now Tropical Storm Debby, the Centers for Medicare & Medicaid Services (CMS) has announced additional resources and flexibilities to support the affected states of Florida, Georgia, ...
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Season 13
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Episode 603
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27:15
There’s a New Sheriff in Town: New DOJ Program Intends to Snare Even More FCA Fraudsters
The U.S. Department of Justice (DOJ) has a new whistleblower reward initiative called the DOJ Corporate Whistleblower Awards Pilot Program.The Program, which seeks to fill gaps left by existing whistleblower reward programs, incentivizes...
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Season 13
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Episode 602
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28:37
FY 2025 IPPS: The Clinical Report
The Inpatient Prospective Payment System Final Rule for Acute Care and Long-Term Care hospitals in the 2025 fiscal year (FY) continues to generate interest from providers, payers, hospital administrators, vendors, and consultants. But what are ...
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Season 13
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Episode 601
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31:07
“Do the Crime, Pay the Fine:” DaVita to Pay$34 million to Resolve Allegations of Illegal Kickbacks
Denver-based DaVita Inc. has agreed to pay slightly more than $34 million to resolve allegations that it violated the False Claims Act (FCA).The U.S. Department of Justice (DOJ) reported in a news release that DaVita paid kickbacks to induc...
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Season 13
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Episode 600
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27:28
End of the Road for the ALJs?
Could the end be near for the administrative law judges of the Centers for Medicare & Medicaid Service (CMS). What about the Office of Medicare Hearings and Appeals (OMHA)? Could these entities be gone from the audit landscape?Case i...
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Season 13
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Episode 599
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30:07
Handle with Care: Taking Steps for Safe Transitions
Have you ever wondered how professional movers carefully pack everything? From expensive china to precious crystal stemware, they seem to have a knack and knowledge for how to prepare.When it comes to healthcare, how safe is the transiti...
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Season 13
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Episode 598
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29:12
No More Chevron? What Happens Next?
For nearly four decades, a judicial principle known as “Chevron deference” has guided the federal courts as they reviewed litigation associated with federal agencies. Chevron deference allowed legislators to leave statutes somewhat vague, assum...
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Season 13
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Episode 597
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29:25
Special Alert: DOJ Cracks Down on Nearly 200 Involved in Major Healthcare Fraud Schemes
In a late-breaking press release, the U.S. Department of Justice (DOJ) announced late Thursday that the agency had charged nearly 200 individuals accused with involvement in various healthcare fraud schemes estimated at $2.7 billion. Charges we...
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Season 13
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Episode 596
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28:55
How a Different Type of Whistleblower Created a Lesson Worth Learning
A recent federal court decision in New Jersey demonstrates the viability of a different kind of whistleblower – in this case, a privately defrauded party.The most common type of a whistleblower under the False Claims Act (FCA) tends to b...
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Season 13
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Episode 595
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28:57
The Human Touch at the Intersection of Artificial Intelligence and Denied Claims
Artificial intelligence (AI) is fast becoming a fixture in healthcare revenue cycle management (RCM), where finance leaders are desperate for ways to relieve understaffed departments struggling under unprecedented volumes of third-party audit d...
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Season 13
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Episode 594
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28:50
OIG On the Prowl: Semi-Annual Report to Congress
They’re looking for fraudsters, going on the prowl for bad actors, as revealed in the latest semi-annual report to Congress compiled by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). In this latest rep...
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Season 13
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Episode 593
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31:15
Jail Time, or Hefty Fine?
Most healthcare investigations by the U.S. Department of Justice (DOJ) result in settlements. Many times, the complete details of the settlements in underlying government cases are not fully disclosed. But sometimes, a provider ends up at trial...
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Season 13
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Episode 592
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28:40
New Medical Technologies: Are They Audit-Proof?
A deep dive into microbiology can reveal an up-close look at the cells that make up organs of the human body – and corresponding cancer treatments that leave no trace of damage.The science of medicine appears to be moving at the speed of...
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Season 13
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Episode 591
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27:01
Healthcare Whistleblower Roundup: Recent Settlements Reach Nearly $10 Million
Two recent settlements to resolve allegations of violating the False Claims Act – both involving the virulent COVID-19 – are the latest in a series of actions that will be reported on during the next edition of Monitor Mondays by famed whistleb...
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Season 13
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Episode 590
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28:21
The AI Arms Race in Healthcare Auditing: Handicapping Winners and Losers
The arms race is heating up.On one side there are healthcare providers, and on the opposing side, an army operated by the auditors. Who will be the winners and losers?Are you safe? And how do you protect your facility from claim d...
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Season 13
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Episode 589
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29:07