Podcast appearances and mentions of constantine cannon

We're delighted to welcome back Poppy Alexander, a founding partner at the law firm Whistleblower Partners, a law firm dedicated to representing whistleblowers reporting fraud and misconduct in:·      Healthcare·      Procurement·      Securities and Commodities·      Taxes·      Money Laundering and Sanctions Evasion·      Customs·      Environmental Remediation·      Vehicle SafetyPoppy represents whistleblowers and government entities in qui tam lawsuits, as well as under the various agency whistleblower programs including those administered by the Internal Revenue Service, Securities and Exchange Commission, FinCEN, Commodity Futures Trading Commission, and Department of Transportation.  Poppy's practice focuses on issues of international corruption and financial misconduct, with a specialty in the Foreign Corrupt Practices Act and money laundering cases.  She writes and speaks regularly about emerging topics in financial fraud, including sanctions violations, SPACs, and cryptocurrency.We last spoke with Poppy back in July of 2022 when she had already established an impressive track record representing whistleblowers at Constantine Cannon. She graduated from Harvard Law School in 2012. She was the co-editor-in-chief of the Harvard Civil Rights-Civil Liberties Law Review and an active participant in the Human Rights Clinic, working on issues related to corporate accountability for human rights violations in Africa and military abuses in Southeast Asia. She was awarded the Dean's Award for Community Leadership in recognition for her contributions to the school community. Poppy has been named to the Super Lawyers Rising Stars list every year since 2016. Prior to law school, Poppy worked on election reform issues before beginning graduate work at the University of California, Berkeley, where she studied political and critical theory. We've invited Poppy here tonight to talk about her new work, and her new firm, Whisteblower Partners.Topics Discussed Include:Poppy's new law firm, Whistleblower Partners. Why Poppy left her old firm to establish this new legal partnership in March 2024.  She describes a comprehensive approach to whistleblowers and not just file cases. The laws Whistleblower Partners uses in environmental cases and how they have changed since the episode we published in July 2023. Qui tam False Claims Act, SEC, IRS, Act to Prevent Pollution from Ships (APPS), and various wildlife protection laws. Examples of Whistleblower Partners victories.Pitfalls of whistleblowing and filing lawsuits and administrative tips programs.Further Reading / Support the Show.Visit us at climatemoneywatchdog.org!

The Two-Midnight Rule was first announced 10 years ago, October 2013, by the Centers for Medicare & Medicaid Services (CMS). Even today, though, the Rule remains an ongoing source of confusion for physicians as well as revenue cycle and finance experts.However, it also will take on new importance, as CMS promises that Medicare Advantage (MA) plans will begin to follow the Rule in 2024.During the next live edition of the popular and long-running Internet broadcast Monitor Mondays, physician and attorney Dr. John K. Hall will summarize the current state of the Two-Midnight Rule and offer insights of its use into the next decade.Other broadcast segments will also include these instantly recognizable features:• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.• The Whistleblower Report: Famed whistleblower attorney Mary Inman, partner in the law offices of Constantine Cannon, will report on the latest news concerning whistleblowers.• The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

The beleaguered False Claims Act, which traces its origins to the Civil War, came before the Supreme Court this past Tuesday, when the Court heard oral arguments in a consequential and closely watched case involving one of the Government's most effective tools for fighting healthcare fraud. Specifically, the issue is whether and when a defendant's contemporaneous subjective understanding or beliefs about the lawfulness of its conduct are relevant to whether it knowingly violated the Act. This case involves accusations that supermarket pharmacies Safeway and SuperValu overcharged Medicare and Medicaid for generic drugs by misrepresenting the usual and customary prices they charged for the drugs.During the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner at the law offices of Constantine Cannon, will provide background and context on the case that the Court is expected to issue a ruling for in June, at the end of its term. Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Legislative Update: Adam Brenman, legislative analyst for Zelis, will report on current healthcare legislation.The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts Spotify

In this episode of Antitrust Matters, Constantine Cannon partner, Matthew L. Cantor, discusses economic and antitrust issues raised by the conduct of certain large hospital systems.  Joining him on the podcast as guests are Duke University Professor of Law, Barak Richman, and CEO of the policy group known as the Catalyst for Payment Reform, Suzanne Delbanco. 

Welcome to the award-winning FCPA Compliance Report, the longest running podcast in compliance. In this episode, I am joined by with Mary Inman, partner at Constantine Cannon. We discuss the recently released US Fraud statistics and preventative measures with Inman. Inman explains that the US Department of Justice put out statistics on the False Claims Act for 2022, with healthcare dominating the recovered funds. Inman goes on to discuss how whistleblowers can still launch cases, even if the government does not join in, as well as encourage listeners to report fraud to their respective insurance department if it later results in higher premiums for their organization. Key Topics: ·      The Increase of Managed Care Plans in Medicare [00:05:16] ·       The Power of Whistleblowing and the Impact of Joining Government Cases [00:09:19] ·      Medicare and Medicaid Fraud in California and Florida [00:13:21] ·       Impact of Insurance Fraud on Premiums [00:17:44] ·      The False Claims Act and the Escobar Decision [00:26:09] Notable Quotes 1.      "And they were basically paying kickbacks to their they know who the physicians are, who are their largest prescribers of their drugs. And they were paying kickbacks to encourage them to basically discourage them from prescribing their competitors' products and to direct it to them."  2.     "What happened here is that Mallinckrodt improperly calculated their rebate by claiming that drug that they developed in 1990 was actually termed a new drug in 2013. And so that allowed them to greatly decrease the amount of the rebate that they would have owed to the Medicaid program.""  3.    "It's another kind of false billing scenario. It was notable to me that we had 2 big settlements." 4.     "The whistleblower had accused the Association of basically shifting costs that it shouldn't have been reimbursing onto the Florida Medicaid program.   Resources: Mary Inman on Linkedin Constantine Cannon Tom Fox on LinkedIn Learn more about your ad choices. Visit megaphone.fm/adchoices

We all like to think that if we saw wrongdoing, we'd do the right thing - that when confronted with a problem that goes against our ethics or morals, we'd speak up or take action. But what if calling bullshit meant damaging or ending your career, your family relationships, or even compromising your personal safety?  Show Notes: Learn about Mary Inman's incredible work at Constantine Cannon here.  Read about Kyle Welch and Stephen Stubben's research on whistleblowing.  Check out Dana Gold's Newsweek article about keeping whistleblowers safe.  See omnystudio.com/listener for privacy information.

In this week's episode of the ArtTactic Podcast, we're joined by Pierre Valentin, partner at Constantine Cannon and also founder and chair of International Catalogue Raisonné Association. First, Pierre tells us what exactly a catalogue raisonné is. Then, he identifies some of the most common ways they are used by different market participants. Also, Pierre reveals how catalogue raisonnés have evolved in the past year fews. Lastly, Pierre offers advice to living artists to ensure they will be able to more easily create a catalogue raisonné of their work later in their career.

Lance has a fantastic interview with Mary Inman and Ed Baker who are lawyers from Constantine Cannon and represent whistleblowers for fraud in Medicare Advantage and other managed care programs.

Part II of the Constantine Cannon interview discussing SEC OIG FBI and other groups you prefer not to see after a whistleblower claim goes ignored by senior leadership.

Without admitting guilt, a Florida health system entered into a $20 million settlement under the False Claims Act with the U.S. Department of Justice (DOJ) to resolve allegations that it made donations to increase Medicaid contributions. The whistleblower filed the suit alleging that the system made improper cash donations to a local charity in a scheme to increase the system's Medicaid funding. At a time when the False Claims Act is under scrutiny, this story—to be reported by famed whistleblower attorney Mary Inman—is relevant and consequential. What lessons can be learned from this not-to-charitable scheme? Listen and learn when Inman, a partner in law office of Constantine Cannon, joins the next live edition of Monitor Mondays.Other segments will include these instantly recognizable broadcast segments: The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of healthcare regulations and the SDoH.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment. Legislative Update: Folana Houston, assistant general counsel for Zelis, who will be substituting for Matthew Albright, will report on current healthcare legislation.  

Welcome to Reimagining Company Culture, a series discussing emerging trends and priorities shaping the future of workplace culture and employee wellbeing. We highlight thought leaders who are constantly evolving their strategy and can provide insight to folks about how to address new business challenges.  AllVoices is on a mission to create safe, happy, and healthy workplaces for all, and we're excited to learn from experts who share our mission. In this episode of Reimagining Company Culture, we're chatting with  Mary Inman, Partner at Constantine Cannon LLP.   Mary specializes in representing whistleblowers worldwide under the US whistleblower reward programs, including the SEC, CFTC, IRS, DOT and FinCEN programs.Tune in to learn Mary's thoughts on the role of the Chief Compliance Officer, the myth around employee feedback, advice for startups looking to create high trust, and more!About AllVoices In today's workforce, people often don't feel empowered to speak up and voice their opinions about workplace issues, including harassment, bias, and other culture issues. This prevents company leadership from making necessary changes, and prevents people from feeling fulfilled, recognized, and included at work. At AllVoices, we want to change that by providing a completely safe, anonymous way for people to report issues directly to company leaders. This allows company leadership real transparency into what's happening in their companies—and the motivation to address issues quickly. Our goal is to help create safer, more inclusive companies.

Sarah “Poppy” Alexander is a partner in Constantine Cannon's San Francisco office.She represents whistleblowers and government entities in qui tam lawsuits, as well as under the various agency whistleblower programs including those administered by the Internal Revenue Service, Securities and Exchange Commission, The Department of the Treasury's Financial Crimes Enforcement Network (FinCEN), Commodity Futures Trading Commission, and Department of Transportation.  Poppy's practice focuses on issues of international corruption and financial misconduct, with a specialty in the Foreign Corrupt Practices Act and money laundering cases.  She writes and speaks regularly about emerging topics in financial fraud, including sanctions violations, Special Purpose Acquisition Companies or SPACs, and cryptocurrency.  Poppy has been selected to the Northern California Super Lawyers Rising Stars list every year since 2016.Prior to joining Constantine Cannon, Poppy was an associate attorney at Rosen, Bien, Galvan & Grunfeld LLP, where she worked to ensure prisoners received appropriate medical and mental health care and adequate accommodations for disabilities in jails and prisons.Poppy maintains an active pro bono practice, with a particular emphasis on protecting the rights of children and adults in detention and protecting communities harmed by corporate bad acts abroad.  Poppy is also a board member for the Impact Fund, an organization devoted to funding and supporting cutting edge civil rights litigation.Poppy graduated from Harvard Law School, where she was the co-Editor-in-Chief of the Harvard Civil Rights-Civil Liberties Law Review and an active member of the Harvard Human Rights Clinic. Poppy spent one of her law school summers at the ACLU Reproductive Freedom Project, fighting for abortion rights and the rights of pregnant women. After law school, Poppy clerked for the Honorable Martha Craig Daughtrey of the U.S. Court of Appeals for the Sixth Circuit in Nashville, TN.Poppy holds an M.A. in Political Theory from the University of California, Berkeley, and a B.A. from Yale College.Support the show

Many organizations struggle with a culture of silence in which critical concerns are neither welcomed nor raised, essential feedback is unshared, and vital ideas are left unsaid. But how do you measure a lack of something? How do you deal with something that isn't there? What strategies and habits need to be implemented to deal with silence? This final episode of Season 5 is a recording of an online live Healthy Culture Initiative event with Megan Reitz and Mary Inman. Listen in on this critical conversation between your host, Tobias, and these guests as they explore how to deal with a culture of silence. Megan Reitz is a facilitator, teacher, speaker, executive coach, researcher, and author dedicated to exploring and finding ways to improve the way people interact with one another in the workplace. She is Professor of Leadership and Dialogue at Ashridge Executive Education – part of Hult International Business School. She is ranked as one of the top 50 management thinkers in the world by Thinkers50 and is on the 2021 HR Most Influential List of Thinkers by HR Magazine. Megan is the co-author of "Speak Up: Say what needs to be said and hear what needs to be heard". Mary Inman is a lawyer and partner in Constantine Cannon's London Office. She launched the firm's international whistleblower practice and specializes in representing whistleblowers worldwide under American reward programs. Mary is a recognized expert and frequent author and speaker on areas related to the application of the American whistleblower laws internationally and the use of whistleblower laws worldwide. Duration: 01:22:03

Frances Haugen. Susan Fowler. Edward Snowden. Erika Cheung. As the tech industry continues to face a reckoning, whistleblowers inside of companies are playing a huge role in bringing important information to light. Sarah Alexander – everybody calls her Poppy — is a partner at the law firm Constantine Cannon, and works with whistleblowers all over the world. From the first meeting to what she calls the “cold-shower talk” about the hardships that come with going public, Alexander's job is to help whistleblowers bring about the change they seek. It's not easy for anyone involved, she said. But it might be getting easier.Alexander joined the Source Code podcast to explain how whistleblowing works, why there have been so many high-profile whistleblowers in the tech industry, how companies and governments alike can better support whistleblowers, and much more.For more on the topics in this episode:Poppy Alexander on TwitterConstantine CannonThe Tech Worker HandbookBeing a tech whistleblower is dangerous and expensive. Now there's a guide to the risks.This was the year tech workers found their powerFor all the links and stories, head to Source Code's homepage.

In the conclusion of this two-part episode, Jeff Shinder and David Scupp talk with Lloyd Constantine and Steve Cannon about the founding of Constantine Cannon and the unique paths that brought them to practicing antitrust law at pivotal and interesting times in U.S. antitrust history.  Lloyd and Steve talk about the early days of the law firm, some of its most notable cases as lawyers, and much more. Make sure to listen to part one to catch up on the discussion!

Learn more about Mr. Kim's whistleblowing award on the Constantine Cannon website and the NHTSA website.------------------Fraud in America Social Links

In this two-part episode, Jeff Shinder and David Scupp talk with Lloyd Constantine and Steve Cannon about the founding of Constantine Cannon and the unique paths that brought them to practicing antitrust law at pivotal and interesting times in U.S. antitrust history.  Lloyd and Steve talk about the early days of the firm, some of its most notable cases, and much more. Make sure to stay tuned for Part 2 of this conversation!

In this Episode of the FCPA Compliance Report, I visit with Mary Inman, partner at Constantine Cannon. She runs the firms International Whistleblower practice from London. Highlights of this podcast include: The power of internal whistleblowing. EU whistleblower Directive.  FCA whistleblowers. SEC bounty program as a model for other federal agencies. CFTC whistleblower awards. Where is whistleblower regulation headed.  Resources Mary Inman on Constantine Cannon website.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Once suspended by COVID-19, claim audits are now back on the frontburner – Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), and Medicare Administrative Contractor (MAC) audits, plus Targeted Probe-and-Educate (TPE) audits are the new (or renewed) normal. It's open season on providers, which is why, in large measure, the next live edition of Monitor Mondays will feature reports on how audits now being conducted by governmental and third-party contractors are making America “Audit Nation.”Monitor Mondays will have the latest national audit news updates from well-respected broadcast consultants, including:Monday Rounds: Physician and attorney John H. Kall, substituting for Dr. Ronald Hirsch, will make his Monday Rounds, but also will begin a two-part series exploring the landmine liability faced by utilization management (UM) and compliance professionals. Hall is the founder of Aegis Consulting Services.RAC Report: Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Court Report: Famed whistleblower Mary Inman, partner at the law offices of Constantine Cannon, will report on the $25 million Medicaid fraud settlement in Massachusetts, the largest ever in the Bay State.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listeners Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.

As healthcare attorney Knicole Emanuel recently reported here on RACmonitor, in 2022 providers can expect a “frenzy” of audits –  although it seems to be happening already now, as some hospitals are executing crisis standards of care while coping with an influx of COVID-19 patients (namely, unvaccinated patients who have contracted the deadly Delta variant).The result is that many hospitals are on the brink of disaster, their resources stretched to the breaking point. Joining the next upcoming broadcast of Monitor Mondays will be John Zelem, MD, former general surgeon-turned-healthcare consultant. Dr. Zelem will report the lead story on the broadcast about the long-feared rationing of medical care now being practiced at hospitals in Idaho, Montana, and Alaska. Other hospitals are expected to soon adopt similar crisis standards of care.Monitor Mondays will also have the latest national audit news updates from well-respected broadcast consultants, including:DOJ and Medicare Advantage: Famed whistleblower attorney Mary Inman, partner in the law of office of Constantine Cannon, will report on the U.S. Deptartment of Justice filing a civil complaint against a data-mining company affiliated with a Medicare Advantage (MA) plan for allegingly cheating the government out of tens of millions of dollars, thus enabling the plan to overcharge for treating patients.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return with another installment of his popular segment.RAC Report: Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.

They take no breaks.Auditors for the government and payers continue to work around the clock, auditing Medicare and Medicaid claims, looking for low-hanging fruit, hoping to ding providers for mistakes made when submitting bills for medical services. Monitor Mondays will have the latest national audit news during the next live edition of the trusted weekly news and information Internet radio broadcast.Featured updates from well-respected Monitor Mondays consultants include the following:Lead Story: Famed whistleblower attorney Mary Inman, partner at Constantine Cannon, will report on the second-largest Medicare Advantage fraud settlement under the False Claims Act (FCA). California's Sutter Health will pay the government $90 million for allegedly submitting inaccurate and unsupported medical information on tens of thousands of patients.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listeners Survey.

Medicare and Medicaid auditors are becoming more and more aggressive, threatening the livelihood of providers willing to accept such federally covered beneficiaries.Should there be an act of Congress to pass legislation to address this? How long will aggressive auditing that allows third parties to run roughshod over providers continue? To learn the extent of recent auditing activities, listen to the next live edition of Monitor Mondays, coming your way on Monday, Aug. 9 at 10 a.m. EST.You'll also learn about the extraordinary move by the U.S. Department of Justice (DOJ) to intervene in whistleblower lawsuits brought by Constantine Cannon against Kaiser Permanente, one of the nation's largest managed care organizations (MCOs), which has been accused of knowingly submitting false claims for risk-adjusted payments to the Centers for Medicare & Medicaid Services (CMS). Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will return to the broadcast next Monday to report on this developing story.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return to make his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listeners Survey.

Like the recent surge of coronavirus infections in many parts of the country, audits are springing up everywhere – with no end in sight. Commercial and government auditors are seizing on any and all perceived errors in medical claims, calling for reviews and other deleterious actions. It's audit time in Audit Nation. Adding insult to injury is a new ruling handed down by the 5th Circuit Court allowing the U.S. Department of Justice (DOJ) to dismiss a whistleblower's False Claims Act (FCA) suit. What does this decision mean for whistleblower cases? And, more generally, what does it mean for whistleblower outsiders who do their own independent analyses and investigations to launch an FCA case? Famed whistleblower Mary Inman, partner in the London office of Constantine Cannon, will return to the Monitor Mondays broadcast this week with an exclusive report on this developing story.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return to make his Monday Rounds with another installment of his popular segment. RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers. Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listeners Survey.

UnitedHealthcare is the latest insurer to join the growing lineup of payors that want to second-guess patients and deny payment for emergency department (ED) services after they've been rendered.As reported here on Monitor Mondays last week, UnitedHealthcare plans to extend no coverage or limited coverage to ED claims, retroactively – including any claims the giant insurer deems non-emergent. Our own Dr. John K. Hall will report on this recent development during the next edition of the Monitor Mondays broadcast, offering tips on how to prepare for the consequences of these denials.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return to make his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.Court Report: Famed whistleblower attorney Mary Inman, partner at the London office of Constantine Cannon, will return to the broadcast to report on the latest wrinkle in the whistleblower lawsuit launched by Integra Med Analytics. The Department of Justice (DOJ) has intervened in one Integra case against 11 nursing homes.

"As much as you feel you're trying to do the right thing, the unforseen implications just knock you from every side." Join your host, Tobias Sturesson, and his guests, Bianca Goodson and Mary Inman, for this episode on The Leading Transformational Change podcast. In this vulnerable and compelling conversation, you will learn how most whistleblowers report internally first, without being heard, before choosing to blow the whistle. This episode discusses how organizations can create environments where red flags are addressed instead of hidden. Bianca Goodson served as the CEO of Trillian Management, a South-African consulting firm and a subsidiary of Trillian Capital. In 2017, she blew the whistle on Trillian, which uncovered vast corruption in both government and private sectors. Mary Inman is a lawyer and partner in Constantine Cannon's London Office. She launched the firm's international whistleblower practice and specializes in representing whistleblowers worldwide under American reward programs. Mary is a recognized expert and frequent author and speaker on areas related to the application of the American whistleblower laws internationally and the use of whistleblower laws worldwide. Duration: 46.09

“Incoming!” are the typical dreaded shouts heard from soliders hunkered down in bunkers when shelling begins.Today, across America, you can hear the same cries when it comes to claims auditing. Audits are incoming. Third-party auditors, governmental auditors, even auditors from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) looking at COVID-related claims are incoming – and the onslaught is occurring in rural hospitals as well as big city health systems and teaching facilities alike.Does this portend a future of escalating audits? During the next live edition of Monitor Mondays, an all-star lineup of audit and regulatory experts will come together in a 60-minute edition of the venerable weekly broadcast.The live broadcast includes the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will make his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.The Court Report: Famed whistleblower Mary Inman, a partner in the London office of Constantine Cannon, will report on three notable whistleblower suits, all involving well-known healthcare brands.The Analysis: E&M 2021 Guidelines: Senior healthcare analyst Frank Cohen, director of business intelligence for DoctorsManagement, will report on his latest analysis of evaluation and management (E&M) 2021 guidelines for office visits; noteworthy will be his analysis of medical necessity audits.Utilization Management versus Utilization Review: Dr. John Zelem, founder of Streamline Consulting Services, will return to the broadcast to explain why utilization management and utilization review are not to be used interchangeably, yet they are, with increased frequency.Jab City, USA: Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Warren Alpert Medical School of Brown University, and an authority on the coronavirus will return to the broadcast to report on vaccine rates in the U.S. – as most experts warn that herd immunity is not likely to be achieved in the near future.Law and Order: Monitor Mondays’ own physician and attorney, Dr. John K. Hall, will report on the 11th Circuit Court of Appeals decision in the American College of Emergency Medicine versus Blue Cross and Blue Shield of Georgia. Understanding and applying the court's decision will help you and your team when faced with denials for services provided in your emergency department.

Now I usually I don't like to play cupid, but this one seems like a perfect match. Today's 100th episode is brought to you by Eden Data. Eden Data is a cybersecurity advisory firm focused on helping startups and disruptive internet-based companies build and refine their IT security and compliance. Operating as the organization's virtual Chief Information Security Officer, they help protect brand reputation by securing data privacy, they enable industry scalability by ensuring compliance regardless of what market you enter, they'll manage the process we all know and dread - audits, and they lead just about anything else you can think of around cybersecurity. Here's the best part- they do it all in a fixed cost, monthly subscription so you aren't getting burned with expensive service hours with no end in sight. Check them out at Edendata.com. And now, back to our episode!  -----------------------------  In today's episode, we will be talking with our good friend, James Glenn and his attorney, Michael Ronickher of Constantine Cannon. James worked at a Cisco partner in Denmark when he alerted them about a security flaw in the surveillance camera software. He fought and ultimately won a settlement against Cisco for $8.6 million. Listen to the ONLY interview James has given about the case and how he persevered for nearly 10 years in getting justice.  You can connect with James in the following ways: Instagram: @xlcoldj Twitter: https://twitter.com/@XLColdJ  At Tech & Main, we want to be YOUR technology partner.  Let our 20+ years of expertise help you achieve the outcomes that are best for your business: cybersecurity, cloud, SD-WAN and data center services.  We have engineers and project managers available to assist you. Call our office at 678-575-8515, email us at info@techandmain.com or visit us at www.techandmain.com.  Thanks for listening! --- Send in a voice message: https://anchor.fm/techandmain/message

Now I usually I don't like to play cupid, but this one seems like a perfect match. Today's 100th episode is brought to you by Eden Data. Eden Data is a cybersecurity advisory firm focused on helping startups and disruptive internet-based companies build and refine their IT security and compliance. Operating as the organization's virtual Chief Information Security Officer, they help protect brand reputation by securing data privacy, they enable industry scalability by ensuring compliance regardless of what market you enter, they'll manage the process we all know and dread - audits, and they lead just about anything else you can think of around cybersecurity. Here's the best part- they do it all in a fixed cost, monthly subscription so you aren't getting burned with expensive service hours with no end in sight. Check them out at Edendata.com. And now, back to our episode! ----------------------------- In today's episode, we will be talking with our good friend, James Glenn and his attorney, Michael Ronickher of Constantine Cannon. James worked at a Cisco partner in Denmark when he alerted them about a security flaw in the surveillance camera software. He fought and ultimately won a settlement against Cisco for $8.6 million. Listen to the ONLY interview James has given about the case and how he persevered for nearly 10 years in getting justice. You can connect with James in the following ways: Instagram: @xlcoldj Twitter: https://twitter.com/@XLColdJ At Tech & Main, we want to be YOUR technology partner.  Let our 20+ years of expertise help you achieve the outcomes that are best for your business: cybersecurity, cloud, SD-WAN and data center services.  We have engineers and project managers available to assist you. Call our office at 678-575-8515, email us at info@techandmain.com or visit us at www.techandmain.com.  Thanks for listening! --- Send in a voice message: https://anchor.fm/techandmain/message

Mathilde Houet-Weil, Avocat à la Cour Weil & Associés France, chairs this fascinating panel discussion on whistleblowing in the time of Covid-19 and potential disclosures arising out of the pandemic. The panel includes the following distinguished speakers: John Devitt, Chief Executive Officer, Transparency International, Ireland Mary Inman, Partner, Constantine Cannon, USA Jean Ewang, Consultant, Cliffe Dekker Hofmeyr Inc, South Africa Key issues addressed by the panel include: How the global health crisis has created new challenges in relation to whistleblowing; How it is now more important than ever that employees can blow the whistle without fear of retaliation; How organisations and governments have adapted to the crisis and what needs to be done to further protect whistleblowers.

How exposing the truth at work can cost you your career. Theo Leggett speaks to whistleblowers Ian Foxley and Bianca Goodson, both of whom found it impossible to get a new job after exposing wrongdoing at their respective employers. Psychotherapist David Morgan describes the emotional toll on those who choose to expose wrongdoing, and why the majority stay silent. And whistleblower lawyer Mary Inman, partner at the law firm Constantine Cannon, argues that companies need to start seeing whistleblowing as a help rather than a threat. (Picture credit: Getty Images)

With the purchase by UnitedHealthcare (UNC) of Change Healthcare, providers are contemplating notable differences between two sets of quidelines. Change Healthcare owns InterQual criteria, while UHC has traditionally used MCG criteria.Becoming familiar with the variances in terms of observation timeframes, screening methodologies, severity of illness thresholds, and intensity of service thresholds for levels of care will be the topic reported on by Kelvin Valera, MD, a healthcare consultant and physician advisor, during the next edition of Monitor Mondays.Other segments to be featured during the live broadcast include the following:Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report. Court Report: Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will report that the pharmaceutical company Roche and Medicare Advantage insurer Humana have agreed to pay $12.5 million to the U.S. government to resolve allegations that the companies violated the anti-kickback statute – marking the first False Claims Act (FCA) settlement resulting from a pharmaceutical company’s alleged payment of kickbacks to a Medicare Advantage Organization.

Welcome to the Great Women in Compliance Podcast, co-hosted by Lisa Fine and Mary Shirley.   When we think about lawyers in the Compliance context, a number come to mind. Those who represent us in the event of government action taking place, those who help us with investigations, those who help us objectively evaluate our Compliance program, those who give us advice on a point of law when we need it, those who are appointed to us as monitors and so on. One area that doesn’t get a lot of attention is the role of the lawyer as whistleblower representative. This Great Women in Compliance Podcast sheds some light on this advocate role by way of our interview with Mary Inman who heads up the International Whistleblower Practice at Constantine Cannon. In her legal practice, Inman represented the high profile Theranos whistleblower Tyler Schulz, among others. We draw on this fascinating experience to bring you Part 1 of a two-part series on whistleblowing starting with Inman’s perspective as an advocate for whistleblowers and ending with the view from the other side of the fence as the whistleblower with Erika Cheung, another of the Theranos whistleblowers. Inman, who is the epitome of effervescence, does some level setting for us by explaining the role of a whistleblower lawyer and why a whistleblower might want one. She gives her view on whether there are any differences between male and female whistleblowers based on her extensive experience and as someone who has spent her entire career in private practice, shares a tip on avoiding burnout. You can subscribe to the Great Women in Compliance podcast on any podcast player by searching for it and we welcome new subscribers to our podcast which is hosted on the Compliance Podcast Network. Lisa and Mary have extended the Great Women in Compliance brand to the booking “Sending the Elevator Back Down: What We’ve Learned from Great Women in Compliance” (CCI Press, 2020) which can be found on Amazonand features valuable wisdom and advice from Great Women in Compliance across the world. If you’ve already read the booked and liked it, will you help out other women to make the decision to leverage off the tips and advice given by rating the book and giving it a glowing review on Amazon?  As always we’re so grateful for all of your support and if you have any feedback or suggestions for our 2021 line up, or would just like to reach out and say hello, we always welcome hearing from our listeners. Join the Great Women in Compliance community on LinkedIn here.

Amid the chaos created by the coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) released two major final rules this week: the 2021 Physician Fee Schedule and the Outpatient Prospective Payment System (OPPS), with the latter having been widely anticipated. Both final rules portend significant new regulatory changes for providers, patients, and payors. Given the gravity of these new changes, the next upcoming Monitor Mondays broadcast will encompass a special live open door forum to answer questions from listeners.Segments to be featured during the live broadcast include the following:Court Report: Famed whistleblower attorney Mary Inman, partner in the London law office of Constantine Cannon, will return to the broadcast to report on three major whistleblower cases.COVID-19: Frontline physician John Foggle will provide a real-time update on the raging spread of the coronavirus — at a time when Centers for Disease Control and Prevention (CDC) Director Robert Redfield is predicting that the U.S. death toll from COVID-19 could eclipse 450,000 by February.Monday Focus: Utilization Review: Dr. John Zelem, founder of Streamline Solutions Consulting, Inc., will report on the role of utilization review amid the pandemic.Rural Health Report: The nation’s rural communities are reported to be ravaged by COVID-19. Leslie Marsh, the CEO for Lexingtion Regional Health Center, will report on how her facility is being impacted by the pandemic.The Special Report: Andrew Dombro, MD will report on the impact of COVID-19 on providers and patients engaged in chronic care management.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen will also conduct the Monitor Mondays Listeners Survey.

A whistleblower recently exposed an alleged risk-adjustment scheme that was apparently designed to artificially inflate reimbursement provided under Medicare Part C, aka Medicare Advantage (MA).The accompanying lawsuit alleged that GHC hired an outside vendor to review and “improve” its risk adjustment scores. According to the whistleblower, GHC submitted tReporting our lead story on this matter during the next live edition of Monitor Mondays will be Max Voldman, JD, an associate of Constantine Cannon.Other segments to be featured during the live broadcast include the following:Special Report: Bereavement: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will don her case management hat to report on how hospital personnel are dealing with the death of patients in the wake of COVID-19, which has claimed the lives of more than 259,000 here in the U.S. Ellen will also conduct the Monitor Mondays Listeners Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.

In this episode, we talk with one of the world’s leading lawyers for whistleblowers, Mary Inman of Constantine Cannon. Mary tells us the story behind the famous whistleblowers at Theranos and Boeing and offers insight on the often-heroic sacrifices of those who see it as their duty to the common good to stand up for better behavior in business.  Mary challenges us to rethink how we view whistleblowers and inspires us to see them as she does—forward indicators of risk.

The Centers for Medicare & Medicaid Services (CMS) will reimburse a greater number of relative value units (RVUs) associated with office-based evaluation and management (E&M) visits, the agency announced recently.In order to achieve budget neutrality, CMS will reduce the payment per RVU. With this change, CMS is allocating a larger proportion of its total spending to office-based physicians, at the expense of surgeons and hospital-based physicians.Here’s the rub: organizations that utilize RVUs in their physician compensation arrangements and continue to pay the same 2020 rates per RVU on the increased number of 2021 RVUs will experience a dramatic decline in operating income. Reporting our lead story during this edition of Monitor Mondays is Adam J. Klein, who heads ECG’s Financial Services practice.Other segments to be featured during the live broadcast include the following:Whistleblower Update: Famed whistleblower Mary Inman, partner in the law office of Constantine Cannon, returns to the broadcast to report on two whistleblower cases that have dropped from the radar screen, but nevertheless are essential for re-examination.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen will also conduct the Monitor Mondays Listeners Survey.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

California is one of two states in the country that rewards whistleblowers for bringing forward information about private insurance fraud. A recent $24 million settlement with pharmaceutical giant Abbvie over the marketing of the company’s blockbuster drug, Humira, demonstrates the law’s effectiveness.The settlement agreement was reached last week following allegations that the company violated California’s Insurance Frauds Prevention Act. Abbvie agreed to the settlement despite continuing to deny any wrongdoing.On the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will provide details on this important news story.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report. SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conducts the Monitor Mondays Listener Survey.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

While much of today’s healthcare news is righty focused on the efforts to stave off the global coronavirus pandemic, there is other news to report – and Monitor Mondays will have a complete wrap-up on all of it during the next edition of the weekly Internet radio broadcast, while also looking ahead.And given the tendency of the Centers for Medicare & Medicaid Services (CMS) to issue waivers and guidance with a unique style of ambiguity, a great deal of confusion also continues to come from hospitals and health systems in their efforts to remain compliant – while at the same time tending to their mission of delivering patient care amid the crisis. So during this special 60-minute live edition, we’ll also have our panelists standing by to answer your questions.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, will file the Monitor Mondays RAC Report.Monday Focus: Kathy Pride, executive vice president of coding and documentation services for Panacea Health, will report on two interim final rules, including an expansion and relaxation of guidelines for telehealth services.Court Report: Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will report on two prominent examples of the need for independent regulatory oversight: the removal of the Inspector General of the U.S. Department of Health and Human Services (HHS), and news that Rick Bright, former director of the Biomedical Advanced Research and Development Authority, has filed a whistleblower complaint with the Office of Special Counsel, claiming that he was transferred to a “less impactful position” at the National Institutes of Health (NIH) after he was reluctant to promote the use of drugs such as hydroxychloroquine to treat COVID-19 patients.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on regulatory ambiguity during the pandemic.Outpatient Therapy Update: Nancy Beckley, president of Nancy Beckley and Associates, will return to the broadcast to report on inequities for outpatient therapy providers as it pertains to payment, reimbursement, telehealth, and service delivery.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment. Special Report: RACmonitor investigative reporter Edward C. Roche, PhD, JD, will provide a status report on COVID-19 testing in the United States.COVID Q&A: Navigating COVID-19 guidance continues to be a major challenge for healthcare professionals – and that is why Monitor Mondays will devote additional time during this live broadcast to answer your questions. Returning to the broadcast will be Matt Lambert, MD, an emergency medicine physician and chief medical officer for Curation Health.

AmerisourceBergen, one of the nation’s largest pharmaceutical wholesalers, must turn over records to pension fund shareholders probing to determine wrongdoing by the drug distributor’s board for the company’s multi-billion-dollar legal exposure from the nationwide opioid crisis.AmerisourceBergen was already facing two congressional investigations, plus a Drug Enforcement Administration (DEA) probe. Reporting on this developing story is famed whistleblower attorney Mary Inman, a partner in the London law office of Constantine Cannon.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors.Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter.SDoH Report: Ellen Fink-Samnick has the latest news on a report from NPR about life experience and income inequality in the USA. Ellen will also conduct the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment where he will discuss the new Important Message from Medicare.

Rural hospitals are an endangered species in America, with extinction a real possibility. In fact, the North Carolina Rural Health Research and Policy Analysis Center report that more than 120 hospitals have closed nationwide since 2005, with nearly 70 percent (or 83) of those closures occurring since 2010. Adding insult to injury is the recent announcement from the Centers for Medicare & Medicaid Services (CMS) that Monday, Dec. 2 is the deadline for critical access hospitals (CAHs) to submit a hardship exception to avoid the “Medicare downward payments.” To qualify, those hospitals must illustrate the use of certified electronic health record technology (CEHRT) in order to meet the reporting requirements of the Medicare Promoting Interoperability Program and demonstrate “meaningful” use.Delivering a State of the Union report on America’s rural hospitals during this edition of Monitor Mondays will be Maggie Elehwany, vice president of government affairs and policy for the National Rural Health Association.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel will report on the latest activities by the Recovery Audit Contractors (RACs), and other third-party Medicare claims auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Court Report: The U.S. Supreme Court recently turned away two cases that tested the scope of the False Claims Act. Reporting this story will be famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon.Risky Business: Healthcare attorney David Glaser will join the broadcast with his trademark segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Many hospitals are likely in the throes of preparing to implement the Centers for Medicare & Medicaid Services (CMS) Discharge Planning Conditions of Participation Final Rule, including how to reconcile the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The new rule becomes effective Friday, Nov. 29, 2019.“CMS has spent the last two years working on the IMPACT Act, and they are now ready to implement,” reports Mary Beth Pace, vice president of care management at Trinity Health. “Does the CoP resemble anything akin to what you thought they would come out with? It does not to us. Let me reflect on our initial shock, and then our action.”For a field report on how one major health system is preparing for this major new policy, RACmonitor has invited Ms. Pace to be the special guest during the next edition of Monitor Mondays.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel will report on the status of the Medicaid lawsuit filed after more than two dozen plaintiff Virginia behavioral healthcare providers had their managed care contracts terminated by six defendant managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Fraud Report: The manager of multiple medical clinics in Brooklyn and Queens, New York, was found guilty for his role in a nearly $100 million healthcare kickback and money laundering scheme, according the U.S. Department of Justice. Reporting this story will be famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon. Risky Business: Healthcare attorney David Glaser will join the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Direct or indirect past affiliation with an individual the Centers for Medicare & Medicaid Services (CMS) deems to be a bad actor could trigger revocation from Medicare.The new rulemaking this so, 52 CFR, Section 424.519, Disclosures of Affiliations, authorizes CMS to deny or revoke enrollment based on disclosures of certain affiliations the agency determines to pose an undue risk of fraud, waste, or abuse.Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Andrew Wachler, a managing partner at Wachler and Associates. Mr. Wachler also discusses what constitutes an “affiliated entity” and what events must be disclosed.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit in which more than two dozen Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Court Report: Famed whistleblower attorney Mary Inman reports on Tenet Healthcare’s proposed $66 million False Claims Act settlement. Inman is a partner in the London office of Constantine Cannon.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on problematic issues facing providers.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on a trending topic that is attracting significant media attention. Ellen also conducted the Monitor Mondays Listener Survey. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Acts of Congress plus regulatory cuts by the Centers for Medicare & Medicaid Services (CMS) are estimated to reduce federal payments to hospitals by $256.6 billion from 2010 to 2029, according to a study released this week and commissioned by the American Hospital Association (AHA) and the Federation of American Hospitals.Reporting on this developing story during this edition of Monitor Mondays is former CMS official Matthew Albright, chief legislative affairs officer for Zelis Healthcare.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.War on Drugs: Famed whistleblower attorney Mary Inman, partner at the London law office of Constantine Cannon, reports that major drug manufacturers and distributors are proposing deals that could be worth up to $50 billion to help resolve the nationwide litigation of the pharmaceutical industry’s liability for America’s opioid crisis. SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Resources from Ellen Success over Stress, DePaul University Grant, Robert Wood Johnson Foundation Grant to Purpose Built Communities, CVS FundingRisky Business: Healthcare attorney David Glaser will return to Monitor Mondays with his trademark segment in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

The Centers for Medicare & Medicaid Services (CMS) reportedly will collect information from hospitals about the prices they pay for drugs through the 340B discount program.How will the information gathered by CMS be used, moving forward? And why is this action being taken by CMS? The agency has a history of attempted cuts to 340B reimbursement; the most recent such action by CMS occurred last December, after which a federal judge ruled against the move.Reporting our lead story during this edition of Monitor Mondays is Maureen Testoni, president and CEO of 340B Health.Other segments featured on this episode include:Court Report: Federal law enforcement personnel recently took down a fraudulent scheme involving 35 defendants associated with telemedicine companies and cancer genetic testing laboratories. The defendants have been charged for their alleged participation in fraudulently billing Medicare more than $2.1 billion for CGx tests. Reporting this story is famed whistleblower attorney Mary Inman, a partner in the London office of Constantine Cannon.RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays to report on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Despite an order from the U.S. District Court for the District of Columbia for the federal government to reduce the backlog of Medicare appeals, the requirements for victory in front of an Administrative Law Judge (ALJ) remain the same.During this edition of Monitor Mondays, David Mullens, a California healthcare attorney, will address some of those fundamentals.Other segments to appear during the podcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Court Report: Famed whistleblower attorney Mary Inman, a partner in the London office of Constantine Cannon, reports on the latest development in the False Claims Act lawsuit filed by Integra Med Analytics last year against Providence St. Joseph Health. Inman previously reported on this story last August, noting that Integra was seeking $188.1 million related to alleged upcoding of Medicare claims.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey. Click here for Ellens resourceRisky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Two suicides, and a provider-driven into bankruptcy – and all because two ex-employee criminals looking for some fast cash lied to the state under the pretext of being whistleblowers tipping off Medicaid auditors, creating a cascade of unbelievable tragedy. RACmonitor Editorial Board member, investigative reporter, and New York attorney Edward Roche returns Monitor Mondays with this exclusive story about a durable medical equipment (DME) provider facing auditors who, in his words, had gone rogue.Other segments to appear during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.The Court Report: Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, reports on a controversial decision made last week, when U.S. District Judge David Ezra, sitting in Texas, dismissed a whistleblower’s complaint alleging that an executive with Baylor University Medical Center created an upcoding scheme to overcharge Medicare.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. See Ellens Survey ResultsRisky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Obtaining an injunction in federal court to lift a suspension of access to Medicare or Medicaid funds is rare, according to healthcare attorney Knicole Emanuel. As she was preparing to file such an injunction in federal court recently, the prepayment review suspension was lifted. Emanuel, a partner in the Potomac Law Firm and a regular panelist on Monitor Mondays, reports on the possible reasons that might explain such a mystery during this edition of Monitor Mondays.Other segments to appear includes:IRF Report: Angela Phillips, considered to be one of the nation’s foremost authorities on inpatient rehabilitation facilities (IRFs), reports on the final rule for the IRF prospective payment system for the 2020 fiscal year.The Court Report: Famed whistleblower attorney Mary Inman, a partner in the London office of Constantine Cannon, reports on a $57 million fraud scheme that involved laundering money through a hospital.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

There was a time when therapy documentation was the focus of Recovery Audit Contractor (RAC) audits. Under the Patient-Driven Payment Model (PDPM), however, reimbursement for Medicare Part A patients being treated in skilled nursing facilities (SNFs) will be driven by patient condition, rather than therapy minutes. And this creates a target-rich opportunity for auditors, because certain documentation can easily lead to higher reimbursement – and the likelihood of audits leading to claim denials. Reporting on this development during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group.Other segments to appear during broadcast include:Court Report: The Reckitt Benckiser Group has agreed to pay $1.4 billion to resolve its potential criminal and civil liability related to a federal investigation of the marketing of the opioid addiction treatment drug Suboxone. Whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, reports on how an addiction specialist filed a False Claims Act (FCA) motion leading to the largest settlement in U.S. history related to the opioid crisis.Monday Focus: Senior healthcare analyst Frank Cohen returns to Monitor Mondays with a unique perspective on artificial intelligence (AI). Cohen reports on how the more accurate term for the ubiquitous AI should be “augmented intelligence,” as it relates to non-clinical areas of healthcare.SDoH Report: Ellen Fink-Samnick, nationally recognized expert on the social determinants of health (SdoH), will have the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Most likely your facility has been hit with claim denials for providing emergency department level-of-care coding. Such denials are not new, and in fact, RACmonitor and Monitor Mondays have been reporting about these denials for a number of years. But how can you and your team effectively deal with them? What tools and techniques are available? During this edition of Monitor Mondays, John K. Hall, MD, founder of The Aegis Firm and the newest member of the RACmonitor editorial board, will make his debut appearance on the broadcast to report on how payers are denying claims and how best to avoid them. Other segments to appear during the live broadcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group. False Claims Act Report: The U.S. Attorney’s Office in Chicago announced this week that a Chicago-area physical therapy center and four nursing facilities have agreed to pay $9.7 million to resolve civil allegations that they violated the False Claims Act by providing unnecessary services to increase Medicare payments. The owner of the skilled therapy service provider was excluded from the Medicare program for five years. On hand to explain the significance of this unusual case will be famed whistleblower Mary Inman, partner in the London office of Constantine Cannon. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will make his Monday Rounds with another installment of his popular segment.

Daniel Levinson, former head of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), will make his first broadcast appearance on Monitor Mondays since his announced retirement earlier this year.During his 15-year stint as the nation’s top healthcare watchdog, Levinson oversaw investigations into controversial health issues, including what was described as the largest healthcare fraud takedown in history in July 2017, when more than 400 defendants in 41 judicial districts were charged with participating in schemes involving about $1.3 billion in false billings to Medicare and Medicaid. Other segments to appear on the broadcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Court Report: Reporting on the major Insys Therapeutics settlement announced Thursday is famed whistleblower Mary Inman, a partner in the London office of Constantine Cannon.Monday Focus: The U.S. House of Representatives Ways and Means Committee will hold a hearing next Wednesday on "Medicare for All," the proposal that would shift the U.S. to a single-payer healthcare system. Continuing his reporting on this hot-button topic will be Dennis Jones, administrator of patient financial services at Montefiore Nyack Hospital in Nyack, N.Y.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

The fight is on, and combatants are sparring over how to implement a legislative ban on surprise balance billing. In recent congressional testimony, providers, payers, and hospitals have clashed on how to keep patients from being stuck with huge expenses, with each side blaming the other for being intransigent. One of the major issues is how out-of-network doctors should be reimbursed, and at what rate. Reporting our lead story during this edition of Monitor Mondays will be Matthew Albright, chief legislative affairs officer for Zelis and the former Director of the Administrative Simplification Group of the Centers for Medicare & Medicaid Services (CMS).Other segments to appear on the broadcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group. Emanuel begins this broadcast as a permanent Monitor Mondays panelist.Court Report: Intermountain Healthcare recently settled a high-profile case alleging unnecessary heart procedures. On hand to explain the significance of this case is famed whistleblower Mary Inman, a partner in the London office of Constantine Cannon.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on social determinants of health (SdoH), returns to the broadcast as a permanent panelist. And in this edition of Monitor Mondays, she will explain why so many consultants appear to be jumping on the SDoH bandwagon – and why this could be problematic.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

A federal judge has upheld a lower court’s ruling that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced the 2018 Medicare reimbursement rate for drugs covered by the federal 340B Program. U.S. District Court Judge Rudolph Contreras, sitting in the District of Columbia, issued the ruling recently in the matter of American Hospital Association v. Alex M. Azar, HHS Secretary, ordering HHS back to the drawing board and warning it to act with haste to make a correction. Reporting our lead story during this edition of Monitor Mondays is RACmonitor national correspondent Timothy Powell. Other segments to appear on the broadcast include:Court Report: Two more pharmaceutical companies have agreed to pay $125 million to resolve allegations that they paid kickbacks through co-pay assistance foundations. Famed whistleblower attorney Mary Inman has an update on this story, which she first reported on April 15. Inman is a partner in the London office of Constantine Cannon. Monday Focus: What are the issues when trying to project the results of an audit to a larger population of providers? Senior healthcare analyst Frank Cohen with DoctorsManagement reports on the myth surrounding pass/fail rates for providers. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and will also conduct the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers. Link for Davids segment: The new guidance about co-location of space in hospital-based space, New DOJ guidance about Cooperation in False Claims Act CasesMonday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment. Links for Dr. Hirsch's segment: PREOPERATIVE MEDICAL TESTING BEFORE CATARACT SURGERY, Reduce Low-Value Preoperative Care

The Centers for Medicare & Medicaid Services (CMS) is inviting state Medicaid directors to partner with them to test new approaches to better serve those who are dually eligible for Medicare and Medicaid.More than $300 billion is spent annually by CMS and states to care for the dual-eligibles, and many of the 12 million of those beneficiaries have multiple chronic conditions, and often have socioeconomic risk factors that can lead to poor outcomes. Could the CMS initiative suggest cost-cutting, administrative burden reductions, or true innovation? RACmonitor national correspondent J. Paul Spencer, a senior health consultant for DoctorsManagement, reports our lead story during this edition of the long-running Monitor Mondays live broadcast.Other segments to appear on the broadcast include:Court Report: Famed whistleblower attorney Mary Inman reports on the guilty verdict handed down Thursday by a federal grand jury in Boston that found Insys Therapeutics founder John Kapoor and four other executives guilty of criminal racketeering in bribing physicians to prescribe powerful opioids to patients who didn’t need them. Inman is a partner in the London office of Constantine Cannon.2020 IPPS Proposed Rule: Social determinants of health (SdoH) are back in the news, since CMS is proposing to make homelessness a CC (complication and comorbidity) for the purposes of Inpatient Prospective Payment System (IPPS) coding. Does the CMS action signal that SDoH are a growing concern in the nation’s healthcare landscape? Continuing our reporting on this hot topic is nationally recognized SDoH authority and author Ellen Fink-Samnick.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, will report on all the latest hot topics and will also conduct the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

The Centers for Medicare & Medicaid Services (CMS) recently announced that 800 hospitals will be penalized this year for yielding poor results in the Hospital-Acquired Condition (HAC) Reduction Program, including 110 hospitals that are being penalized for the fifth year in a row (the HAC Reduction Program has only been in existence for five years). The Code of Federal Regulations does not allow a hospital to appeal the determination of poor results in this program, whereas if you are penalized by a Recovery Audit Contractor (RAC) or a Zone Program Integrity Contractor (ZPIC), you do have the right to appeal. With courts now finding that Medicare reimbursements are a property right, is 42 CFR 412.172 unconstitutional because it disallows an appeals process for a decrease in Medicare payments? Reporting this latest development during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group.Other segments to appear on the broadcast include:Monday Focus: The American Hospital Association (AHA) and the National Quality Forum have released a guide to help hospitals and health systems deliver tele-behavioral health services to improve patient outcomes and enhance access to behavioral healthcare. An estimated 44 million Americans have a behavioral health disorder. Reporting this developing story is Kathy Seward, MD, chief medical officer for qlēr Solutions Inc., a telemedicine company providing psychiatric care to patients throughout the United States in partnership with hospitals and health systems. Big Pharma Lawsuits: Three pharmaceutical companies – Jazz Pharmaceuticals plc, Lundbeck LLC, and Alexion Pharmaceuticals, Inc. – have agreed to pay a total of $122.6 million to resolve allegations that they violated the False Claims Act by paying kickbacks to Medicare and Civilian Health and Medical Program (ChampVA) patients through purportedly independent charitable foundations. Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, has the latest news on this major story. The IRF Countdown Continues: The Inpatient Rehabilitation Facility (IRF) countdown to Oct. 1, 2019 will end with the change to use quality indicators for case-mix group (CMG) for payment calculation. Reporting this story is one of the nation’s foremost IRF authorities, Angela Phillips, president of Images & Associates and longtime RACmonitor editorial board member and Monitor Mondays panelist. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

In the final installment of a two-part series on prescription drug prices, during this edition of Monitor Mondays we will report on the latest initiative on a new “war on drugs” – the anticipated rollout by the Health Resources and Services Administration (HRSA) of a new secure website that hospitals, clinics, and health centers can use to see what price they should be paying for any drug covered under the 340B federal drug program. Reporting on this development will be Maureen Testoni, Esq., president and CEO for 340B Health. Other segments to appear on the broadcast include:Monday Focus: J. Paul Spencer, senior healthcare consultant for DoctorsManagement and a RACmonitor national correspondent, reports on the latest update to the American Medical Association’s (AMA’s) 2021 evaluation and management (E&M) changes. https://www.racmonitor.com/an-overview-of-ama-s-e-m-revisions-for-2021/Whistleblower Report: MedStar Health of Maryland has agreed to pay the government 35-million dollars to resolve allegations of under the False Claims Act that it paid kickbacks to a cardiology group. Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, has the latest news on this major story. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and conducts the Monitor Mondays Listener Survey. Click to view SNF Prospective Payment PDFRisky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers. Monday Rounds: Howard A. Stein, DO, associate director of medical affairs for Centrastate Medical Center, makes his Monday rounds in the absence of Ronald Hirsch, MD.

In the first portion of a two-part series on prescription drug prices, during this edition of Monitor Mondays we report on the Centers for Medicare & Medicaid Services (CMS) Drug Spending Dashboards with data for 2017.First released in May of last year, the new dashboards include information on manufacturers that are responsible for price increases, plus pricing and spending data for thousands of more drugs across Medicare Parts B and D and Medicaid. Reporting Part I of the series will be Timothy Powell, a regulatory expert and a RACmonitor national correspondent. During Part II, scheduled for April 1, Maureen Testoni, president and CEO for 340B Health, will report on the state of the union of the drug discount program.Other segments to appear on the broadcast include:The Roche Report: Edward C. Roche, RACmonitor investigative reporter and New York attorney, reports on the use of artificial intelligence (AI) to detect fraud in social health insurance programs.CHS Whistleblower Lawsuit: Two former Community Health Systems (CHS) employees have alleged that CHS submitted hundreds of millions of dollars in false claims to the U.S. Department of Health and Human Services (HHS) for federal incentive payments under the CMS interoperability program for electronic health records. The whistleblowers allege that CHS received more than $450 million in incentive payments between 2012 and 2015. Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, has the latest news on this major story.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and will conduct the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Could the Empire State be among the first to introduce a single-payer healthcare system?The latest news coming from Albany would seem to indicate that; now that both state legislative branches are under control of the Democrats, such an option is likely viable. Currently on the table is the New York Health Act (NYHA), which is proposed to extend coverage to New Yorkers who currently have no access to healthcare.Reporting our lead story during this episode of Monitor Mondays will be Dennis Jones, a New Yorker and the administrator of patient financial services at Montefiore Nyack Hospital in Nyack, N.Y.Other segments to appear on the broadcast include:Monday Focus: Revised E&M Codes: As expected, the American Medical Association’s (AMA’s) CPT® editorial board last month approved major changes to documentation and code selection guidelines for evaluation and management (E&M) codes. The changes were announced last week and are expected to become effective in 2021. Reporting this developing story is Shannon DeConda, founder and president of the National Alliance of Medical Coding Specialists—NAMASWhistleblower Report: Walgreens is facing a whistleblower’s False Claims Act challenge. The lawsuit alleges that pharmacies that the giant retail purchased in 2012 overcharged Medicaid for generic drugs by steeply discounting them to cash-paying customers. Famed whistleblower attorney Mary Inman, a partner in the London office of Constantine Cannon, has the latest news on this major story.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, returns to report on all the latest hot topics.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Extrapolation Changes: Part II: The Centers for Medicare & Medicaid Services (CMS) made significant changes in statistical sampling methodology for overpayment estimation. Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, continues reporting on the changes and what they mean to providers.

Pick up any healthcare news feed or relevant state or federal initiative, and no doubt you will see the "surprise billing" issue headlining. The issue of a patient not knowing that a provider is not in their network is important, but there is another major cause of surprise bills: insurance plans denying legitimate claims for emergency care as "non-emergent." Prudent acts among patients are ignored, common sense is discarded, and ethical conduct is cast aside in order to insist that patients pay astronomical bills for services that truly constitute emergency care. These battles can take years. One such case will be discussed during this edition of Monitor Mondays; reporting our lead story will be Holly Louie, herself once an emergency department nurse.Other segments to appear on the broadcast include:Monday Focus: Bogus Charity Write-offs: The Patient Protection and Affordable Care Act (PPACA) created a new provision in Section 501 of the Internal Revenue Code that applies to facilities licensed as hospitals under state law, with new requirements for uncompensated care. The law also imposed new reporting requirements on hospitals. Running afoul of this issue could be a significant compliance violation, as you’ll learn when Timothy Powell reports on what many experts believe could be a major compliance bust.United Behavioral Health Lawsuit: On Tuesday, a federal court in California found that United Behavioral Health (UBH) denied claims based on internally developed medical necessity criteria that were far more restrictive than generally accepted standards for behavioral healthcare. Famed whistleblower attorney Mary Inman, a partner in the London office of Constantine Cannon, will have the latest news on this major story.Extrapolation Changes: The Centers for Medicare & Medicaid Services (CMS) made significant changes in statistical sampling methodology for overpayment estimation. Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, reports on the changes and what they mean to providersRisky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

On Tuesday, the Healthcare Association of New York (HANY) informed its reported 210 member hospitals that the Empire State would not use the UnitedHealthcare (UHC) Sepsis-3 criteria when reviewing claims to validate sepsis for payment. New York state law defines sepsis with systemic inflammatory response syndrome (SIRS) criteria, otherwise known as Sepsis-2.Dennis Jones, the administrator of patient financial services for Montefiore Nyack hospital, was there Tuesday when HANY made the announcement during its regularly scheduled managed care advisory group meeting. Jones, who was among the earliest correspondents to join Monitor Mondays in 2010, will return to the broadcast this coming Monday and report on this newly developing story. Also reporting on Sepsis-3 will be Denise Wilson, vice president of Intersect Healthcare + AppealMasters.The broadcast rundown also will include:False Claims Act: Nationally recognized whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will report on Intermountain taking its challenge of False Claims Act (FCA) to the Supreme Court.The Audit Report: Healthcare attorney Knicole Emanuel, partner in the Potomac Law Group, will report on the latest activities by auditors, including the Recovery Audit Contractors (RACs).Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, will return to report on all the latest hot topics.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will be making his Monday Rounds with another installment of his popular segment.

Never before has the responsibility of an organization to provide clear, facility-specific guidelines and in-depth training for coders been more apparent than it is today – especially now with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) poised to conduct diagnosis-related group (DRG) validation audits. Reporting our lead story during this edition of Talk Ten Tuesdays will be Cari Greenwood who will discuss how your team should intensify training –- particularly when it comes to assigning correct codes for high-frequency, problem-prone, and high-cost diagnoses.Other segments to be featured on the broadcast include:News Desk: Mary A. Inman, partner at Constantine Cannon’s London office, reports on the expected dismissal of the $188.1 million False Claims Act lawsuit filed by Med Analytics, LLC against Providence Health, now Providence St. Joseph, for allegedly upcoding various diagnoses.RegWatch: Leading healthcare technology consultant Stanley Nachimson returns with his popular segment, RegWatch, through which he reports on the latest regulatory changes coming out of Washington, D.C.Tuesday Focus: The Office of Disease Prevention and Health Promotion (ODPHP), on behalf of the Federal Interagency Steering Committee for Adverse Drug Events, recently released its final version of the National Action Plan for Adverse Drug Event Prevention (ADE Action Plan). Reporting on this developing story will be Ronald Hirsch, MD, vice president of R1 Physician Advisory Services.CDI Report: ICD10monitor contributor Glenn Krauss continues his reporting on clinical documentation integrity, but this time, he will focus on the recent decision by HHS OIG to conduct DRG validation audits.TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., reports on an issue that recently caught her attention during her popular TalkBack segment.

During this edition of Monitor Mondays, nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, reports on the expected dismissal of the $188.1 million False Claims Act lawsuit filed by Med Analytics, LLC against Providence Health, now Providence St. Joseph, for allegedly upcoding various diagnoses. According to news reports, the United States declined to intervene in the case, and the allegations are likely to be dropped on Jan. 14, 2019.The broadcast rundown also will include:Monday Focus: Lawmakers in Michigan have approved permanent medical marijuana licensing rules, including a provision to allow dispensaries to deliver the drug to cardholders' homes. RACmonitor investigative reporter and New York attorney Edward Roche will report on the adoption of cannabis therapy in Medicare.The Audit Report: Becky Charlton, RN, denials/appeals coordinator at Blessing Hospital in Quincy, Ill., reports on her hospital’s plans to appeal a denied claim for an inpatient stay by KEPRO,a Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO). The episode generated national attention when it was reported that KEPRO revealed the existence of a secret CMS memo.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility.100 Percent Error Rates, Every time: Senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement, reports on why he’s suspicious when auditors that review claims report 100 percent error rates, all the time.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, returns to report on all the latest hot topics.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.

The Centers for Medicare & Medicaid Services (CMS) is expected to release its final rule concerning provider-based clinics early in November. The proposed changes are expected to impact compliance and reimbursement. Reporting this developing story during this edition of Monitor Mondays is author, educator, and consultant Duane Abbey, who will discuss how the proposed changes are likely to impact Medicare providers.The broadcast rundown also will include:False Claims Act: Famed whistleblower attorney Mary A. Inman, a partner at Constantine Cannon’s London office, reports that DaVita Medical Group has agreed to pay $270 million to CMS to settle False Claim Act allegations over questionable billing practices that led Medicare Advantage plans to receive inflated Medicare Part C risk adjustment payments.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility.Legislative Update: In California, there’s a bill on the November ballot (SB 1152) that would amend an existing law by establishing a uniform discharge planning process that takes into account the unique needs of homeless patients. Reporting on this proposition is Marvin Mitchell, director of case management and social services at San Gorgonio Memorial Hospital, east of Los Angeles.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.

As expected, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule in an attempt to alleviate regulatory burdens on certain Medicare providers. The proposal will revise 42 CFR Parts 403, 416, 418, 441, 460, 482-86, 488, 491, and 494. Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group. The broadcast rundown also will include: Monday Focus: Giant healthcare insurer UnitedHealth is back in the news, this time for being named in a lawsuit involving Medicare Advantage. Nationally recognized whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, reports the details of this developing story. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Florence Watch: Marvin D. Mitchell, director of case management and social services at San Gorgonio Memorial Hospital, reports on the long-term consequences of Florence and its impact on Medicare and Medicaid beneficiaries. Monitor with us™

A False Claims Act lawsuit has been filed by Integra Med Analytics against Providence St. Joseph Health, seeking $188.1 million related to alleged upcoding of Medicare claims. According to media reports, Integra made the discovery of allegedly unwarranted major complication and comorbidity secondary codes. In its investigation, Integra identified J.A. Thomas and Associates (JATA) as the clinical documentation improvement consultancy for Providence. The lawsuit alleges Providence and JATA were "pushing doctors to make unwarranted diagnoses" and "using leading queries to change doctors' original diagnoses." Reporting our lead story during this edition of Monitor Mondays will be False Claims Act attorney Mary Inman, partner in the London law office of Constantine Cannon. Also on board reporting the data analytics associated with this developing story will be senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement. The broadcast rundown also will include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monday Focus: Michael Salvatore, MD, FACP reports on the ancient practice of alchemy and how its modern-day equivalency is turning health into disease. Dr. Salvatore is the physician advisor and medical director of the palliative care team at Beebe Healthcare in Delaware. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron continues his reporting on the perennial question, “should I refund an overpayment?” He will pose the question as a listener quiz. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics. Monitor with us™

“Podiatrists should not be discriminated against any further. E&M (evaluation and management) requirements are the same as (those for) other providers, and we should be reimbursed justly,” one podiatrist recently wrote, expressing his opposition to the Centers for Medicare & Medicaid Services’ (CMS’s) proposed E&M reimbursement changes in the recently posted 2019 Medicare Physician Fee Schedule. “If Medicare is going to change E&Ms to only two codes, then all specialists should be changed,” another opined. “All I have to ask is what about optometrists? Why aren't you focused on them as well?” Reported by RACmonitor, the controversy centers on the proposal by CMS to reimburse new patient visits at a single flat rate for codes 99202-99205 (99201 would be paid at a lower rate), while a corresponding, lower flat rate would apply to established patient visit codes 99212-99215. Code 99211 would also be paid a lower rate. The level 1 codes don’t get the flat rate, because they don’t require the presence of a physician. Reporting on this developing story on this edition of Monitor Mondays will be Jeffrey D. Lehrman, DPM, diplomate of the American Board of Foot and Ankle Surgery. The broadcast rundown also will include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monday Focus: The proposed E&M changes are expected to impact providers’ bottom lines. But by how much? Senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement, has done the math and shares his analysis. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. False Claims Act Report: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, has an update on the $65 million settlement by Prime Healthcare to resolve allegations that its hospitals submitted false Medicare claims. Medicare Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare compliance. Monitor with us™

The 340B drug pricing program suffered a major setback Tuesday, when the U.S. Court of Appeals dismissed a key American Hospital Association (AHA) lawsuit to block $1.6 billion in cuts. The three-judge panel ruled that the lower court had properly dismissed AHA's case because the association failed to fulfill the legal prerequisites to judicial review. Reporting our lead story during this edition of Monitor Mondays will be healthcare attorney Knicole Emanuel, a partner at the Potomac Law Group. The broadcast rundown also will include: False Claims Act Report: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, has an update on Health Quest. The system and some of its subsidiaries have agreed to pay more than $14.7 million to the federal government and an additional $895,427 to the state of New York to resolve False Claims Act allegations that they submitted claims to government payers for evaluation and management (E&M) services that were billed two levels higher than was supported by the medical record. IRF Report: One of the nation’s leading Inpatient Rehabilitation Facility (IRF) authorities, Angela Phillips reports on the fact that IRFs that received a notice of non-compliance and believe the notice is in error have only until Aug. 7, 2018to submit a request for reconsideration. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monitor with us™

The state of Kentucky has introduced Medicaid work requirements. And the trend seems to be proceeding fast and furiously in other states looking to cut health and behavioral health benefits of Medicaid enrollees, with officials saying the costs can’t be met otherwise. Kentucky eliminated vision and dental benefits to 500,000 Medicaid enrollees within 36 hours of the federal decision. Imagine the impact to the readmissions quagmire if benefits continue to be cut for the most vulnerable and disenfranchised members of society, or those most impacted by the social determinants of health (SdoH). These costs are already eye-raising: $1.7 trillion is being spent annually on 5 percent of the population. Readmission penalties are barely being managed across all hospitals, especially the safety net facilities. What will the continued impact of forcing shifts in Medicaid benefits be for the patients who need them most? Reporting on this latest development during the next edition of Monitor Mondays is nationally recognized SDoH expert Ellen Fink-Samnick, author, consultant, and founder of EFS Supervision Strategies, LLC. The broadcast rundown also will include: Monday Focus: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, has an update on the largest-ever healthcare bust, involving more than $2 billion in fraudulent billings. According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monitor with us™

Not unexpected but widely feared among healthcare providers, regulations setting 340B ceiling prices and establishing civil monetary penalties for drug manufacturers that knowingly and intentionally exceed those limits were delayed for the fifth time, until 2019, by the Trump Administration in a final rule published on Tuesday, June 5 in the Federal Register. As the dust settles, America’s rural hospitals are expected to be impacted the most by an apparent lack of government enforcement, as the savings they receive from their participation in the 340B program —savings that are intended to keep doors open and allow for the provision of care for low-income and rural patients—are crucial to their survival. Reporting on this developing story during the next edition of Monitor Mondays will be Maureen Testoni, Interim President and Chief Executive Officer for 340B Health, a nonprofit organization of more than 1,300 hospitals and health systems participating in the federal 340B drug pricing program. Other segments to be featured on the broadcast include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will be making his Monday Rounds with another installment of his popular segment. Special Assignment: Senior healthcare analyst Frank Cohen will return to the broadcast to continue his reporting of alleged bias he is uncovering in extrapolation audits. Cohen is expected to report on how a Zone Program Integrity Contractor (ZPIC) turned a $4,000 overpayment into a $3 million overpayment using extrapolation. Monday Focus: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, will have an update on the major whistleblower case that is pitting Aetna against CVS for price spreading—this at a time when the two entities are trying to merge. Risky Business: Healthcare attorney David Glaser, with Fredrikson & Byron, will report on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, will continue to report on the vexing issue of Medicare Advantage. Monitor with us™

The Health Resources and Services Administration (HRSA), which administers Section 340B of the Public Health Service Act, has published a proposal to delay for another year the ceiling price and civil monetary penalties regulation that was originally issued by the outgoing Obama Administration in January 2017. It was formally published on Monday. National Correspondent Timothy Powell reported our lead story on this episode of Monitor Mondays on 340B. The broadcast rundown also will include: Monday Focus: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, reported on a whistleblower case that is attracting unprecedented media coverage—the nurse who knew too much. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, made his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, reported on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reported on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays National Correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continued to report on the vexing issue of Medicare Advantage. Monitor with us.™

The problem begins like a blip on the radar screen: a curious anomaly that gradually grows more menacing. That is what Andrew Hughes, MD, and Charles Locke, both at Johns Hopkins, are noticing: an uptick in denials related to level of care provided versus the level of care billed. The majority of the denials arise when documentation indicates that a patient is "stable for downgrade" and a transfer has been initiated but not yet effectuated due to a lack of an available bed, reported Dr. Hughes, who was the special guest on this edition of Monitor Mondays. Other segments to be featured on the broadcast include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, made his Monday Rounds with another installment of his popular segment. Whistleblower Update: Mary A. Inman, partner at Constantine Cannon's law offices in London, reported on the Aetna lawsuit filed against CVS Caremark accusing the pharmacy benefit manager of the giant retail pharmacy operation of improperly reporting Medicare generic drug prices to the Centers for Medicare & Medicaid Services (CMS). Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reported on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Medicaid Report: Healthcare attorney Knicole Emanuel, partner in the Potomac Law Group, returns to the broadcast with the final installment of her exclusive two-part reporting on a state-by-state review of states' Medicaid regulatory oversight. Monday Focus: The Bipartisan Budget Act of 2018 contains a number of healthcare issues that have caught the attention of author, educator, and consultant Duane Abbey, who outlined them during the broadcast. Monitor with us™

Patients and providers are reeling in Ohio, given the new Anthem BlueCross BlueShield emergency department (ED) policy, allowing the payer to decline claims for non-emergency ED visits. Advocates caution that Ohio patients might not visit the ED, fearful of not having their visits covered. Former ED physician-turned healthcare consultant Erica Remer, herself an Ohioan, reports on this developing story. Another headline grabbing story is the reported lawsuit filed by Envision Healthcare against UnitedHealthcare (UHC). Envision is using the giant insurer alleging the UHC "unilaterally" lowered payments of Envision's contracted physicians, according to Axios. Healthcare attorney Mary Inman, a partner at Constantine Cannon, reports on this developing story, calling in from the firm's London office. Yet another story about UHC is reported by Shannon DeConda, founder and president of the National Alliance of Medical Auditing Specialists (NAMAS). UHC, DeConda reports, is cracking down on emergency ED service codes of Level 4 and 5. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, returns to report on all the latest hot topics and the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on a developing story that some facilities are receiving CERT letters containing misleading information. Monitor with us™

"Anthem Blue Cross Blue Shield (BCBS) was set to implement a new processing edit with regard to the use of Modifier 25, effective March 1, 2018, but things didn't go as planned," reports Shannon DeConda, founder and president of the National Alliance of Medical Auditing Specialists (NAMAS), as well as the president of coding and billing services and a partner at DoctorsManagement, LLC. During this episode DeConda explains why Anthem is rescinding the new policy. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. IRF Update: Angela Phillips, one of the nation's foremost authorities on inpatient rehabilitation facilities (IRF), reports on Medicare guidelines for an "interrupted stay" in the IRF, and for how services should be billed for these patients. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron shares another example of a potentially troublesome issue that could pose a risk to your facility. Whistleblowers: Nationally recognized whistleblower attorney Mary Inman will reports on current whistleblower cases from the London offices of her firm, Constantine Cannon. Monitor with us™

In this week's episode of the ArtTactic Podcast, we're joined by four guests, Pierre Valentin, partner at Constantine Cannon, Tim Maxwell, partner at Boodle Hatfield, Craig Davies, partner at Rawlinson & Hunter and Fionnuala Rogers, art law consultant at Constantine Cannon, to discuss Brexit's impact on the UK art market. Specifically, we look at its potential effect on copyright, artist's resale right, VAT and the trade of endangered species. Each are contributors to a Brexit memoranda published by PAIAM, Professional Advisors to the International Art Market, a networking platform for professionals in the art market.