Podcasts about fredrikson

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Best podcasts about fredrikson

Latest podcast episodes about fredrikson

Monitor Mondays
HHS, CMS Latest Apparent Battlegrounds for Social Wars Being Waged by Trump Administration

Monitor Mondays

Play Episode Listen Later Apr 14, 2025 30:38


A flurry of national news reports continues to document the large-scale restructuring taking place at the U.S. Department of Health and Human Services (HHS), where 10,000 jobs were reportedly slashed earlier this month, a move also impacting the workforce at the Centers for Medicare & Medicaid Services (CMS). An estimated 300 CMS workers are expected to be affected by this action, while NPR reported that the HHS teams focusing on sexual violence prevention were also eliminated – on the first day of April's Sexual Assault Awareness Month.Also recently, RACmonitor and Monitor Mondays have come into possession of a CMS memo, dated March 5, in which the agency warns that it may take action to prevent hospitals and other providers suspected of using “dangerous chemicals and surgical mutilation of children” relative to gender dysphoria, which the agency claims have “proliferated.” In fact, other executive actions taken by the Trump Administration also appear to have anticipated deleterious impacts on the health of America's LGBTQ+ population.It seems part of an overarching theme in which the Administration is waging social wars using gutted federal agencies more as a weaponized tactic than as a mechanism to serve the public.Reporting this story during the next live edition of Monitor Mondays will be physician Drew Updike, a recognized leader in hospital utilization management, denials, clinical documentation integrity (CDI), coding, and hospital operations.The long-running broadcast will also include these instantly recognizable features:• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Monday Rounds: Dr. Shaemarke Magan, medical director for CaroMont Health in Gastonia, North Carolina, will make his Monday rounds, substituting for Dr. Ronald Hirsch.

Monitor Mondays
Caught in the Crossfire: How to Avoid Pay-and-Chase Enforcement Tactics

Monitor Mondays

Play Episode Listen Later Apr 7, 2025 31:29


A recent case, United States v. Junyi Liu, reveals how a $23 million fraud scheme exemplifies vulnerabilities in America's healthcare system – as you'll discover when senior healthcare analyst Frank Cohen joins the next Monitor Monday broadcast.You'll also learn about the challenges legitimate providers face when navigating complex regulations – and more about the government's aggressive “pay-and-chase” enforcement tactics, plus why innocent practitioners often get caught in the crossfire.During the next live edition of the venerable weekly Internet broadcast, Cohen will also report on potential policy reforms.The long-running broadcast will also include these instantly recognizable features:• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Monday Rounds: Dr. Bonney Olney, director of Level of Care Service for R1 RCM, will make her Monday rounds, substituting for Dr. Ronald Hirsch.

Monitor Mondays
Wound Care: An Open Source for Audits

Monitor Mondays

Play Episode Listen Later Mar 31, 2025 29:56


No matter the approach one might take for debridement, wound care continues to be an attractive source for audits – they inevitably arise and fester. Case in point: Wachler and Associates, a prestigious law firm in Michigan, currently is representing clients in some 18 wound care audit cases.That is why RACmonitor, producers of Monitor Mondays, has invited Andrew “Drew” Wachler, founder of Wachler & Associates, to be the special guest during the next live edition of the venerable weekly Internet broadcast.The long-running broadcast will also include these instantly recognizable features:• Breaking News: Famed whistleblower attorney Mary Inman, partner at Whistleblower Law, will report about a False Claims Act (FCA) settlement involving a Medicare Advantage provider.• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Engineering Culture by InfoQ
Building Your Personal Brand and Making an Impact: Insights from Principal Engineer Pablo Fredrikson

Engineering Culture by InfoQ

Play Episode Listen Later Mar 28, 2025 24:27


This is the Engineering Culture Podcast, from the people behind InfoQ.com and the QCon conferences. In this podcast, Shane Hastie, Lead Editor for Culture & Methods, spoke to Pablo Fredrikson, a principal engineer at Bitso, about the importance of building a personal brand, sharing knowledge, and helping others in the tech industry. Read a transcript of this interview: https://bit.ly/41SoQbu Subscribe to the Software Architects' Newsletter for your monthly guide to the essential news and experience from industry peers on emerging patterns and technologies: https://www.infoq.com/software-architects-newsletter Upcoming Events: QCon London (April 7-10, 2025) Discover new ideas and insights from senior practitioners driving change and innovation in software development. https://qconlondon.com/ InfoQ Dev Summit Boston (June 9-10, 2025) Actionable insights on today's critical dev priorities. devsummit.infoq.com/conference/boston2025 InfoQ Dev Summit Munich (October 15-16, 2025) Essential insights on critical software development priorities. https://devsummit.infoq.com/conference/munich2025 QCon San Francisco 2025 (17-21, 2025) Get practical inspiration and best practices on emerging software trends directly from senior software developers at early adopter companies. https://qconsf.com/ InfoQ Dev Summit New York (Save the date - December 2025) https://devsummit.infoq.com/ The InfoQ Podcasts: Weekly inspiration to drive innovation and build great teams from senior software leaders. Listen to all our podcasts and read interview transcripts: - The InfoQ Podcast https://www.infoq.com/podcasts/ - Engineering Culture Podcast by InfoQ https://www.infoq.com/podcasts/#engineering_culture - Generally AI: https://www.infoq.com/generally-ai-podcast/ Follow InfoQ: - Mastodon: https://techhub.social/@infoq - Twitter: twitter.com/InfoQ - LinkedIn: www.linkedin.com/company/infoq - Facebook: bit.ly/2jmlyG8 - Instagram: @infoqdotcom - Youtube: www.youtube.com/infoq Write for InfoQ: Learn and share the changes and innovations in professional software development. - Join a community of experts. - Increase your visibility. - Grow your career. https://www.infoq.com/write-for-infoq

Monitor Mondays
Advanced Beneficiary Notice: A Doctors' Day Observance

Monitor Mondays

Play Episode Listen Later Mar 24, 2025 30:41


National Doctors' Day is actually Sunday, March 30, but the one-day nationwide observance is getting an early celebratory start during the next live edition of the venerable Monitor Mondays broadcast.Joining our esteemed panelists will be three well-known physicians: Drs. Stephanie Van Zandt, Clarissa Barnes, and Juliet Ugarte Hopkins. And each doc will have an “open mic” during the 30-minute live Internet broadcast.The long-running weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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.

Monitor Mondays
At the Intersection of CDI and the False Claims Act

Monitor Mondays

Play Episode Listen Later Mar 17, 2025 30:15


A clinical documentation integrity (CDI) professional who “knowingly … acts in reckless disregard of the truth or falsity of the information” may ultimately run into issues related to the federal False Claims Act (FCA).The Medicare Fee-for-Service (FFS) Compliance Program on the Centers for Medicare & Medicaid Service (CMS).gov website lists several CMS compliance programs designed to educate and support Medicare providers in “understanding and applying” FFS policies. If the hospital compliance department is not monitoring these resources, it would be prudent for CDI leadership to do so, according to CDI expert Cheryl Ericson, who will be the special guest during the next live edition of the long-running Monitor Mondays Internet broadcast.The venerable weekly Internet broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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 news concerning healthcare legislation.

Monitor Mondays
Why Complications are Complicated

Monitor Mondays

Play Episode Listen Later Mar 10, 2025 31:43


Hospitals routinely measure, analyze, and track adverse patient harm events, collecting information about and reporting on certain types of such events in order to meet the Centers for Medicare & Medicaid Services (CMS) program and state legal requirements.Prior work plans of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) revealed that hospitals reported few harm events to state reporting systems.During the next live edition of Monitor Mondays, Dr. James Kennedy, president of CDIMD, will unwrap the January 2025 OIG proposal (OEI-06-18-00401) to evaluate hospital quality reporting, suggesting how hospitals' clinical documentation integrity (CDI) and coding workflows can address errors of omission or commission.Access the OIG's announcement at https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000907.asp.The venerable weekly Internet broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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: Adam Brenman, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

Monitor Mondays
DEVELOPING STORY: No Public Comment Allowed for HHS Rulemaking

Monitor Mondays

Play Episode Listen Later Mar 3, 2025 32:41


Across America, in sprawling university teaching facilities and in picturesque rural hospitals, administrators are dealing with a powerful tool called statistical extrapolation.When auditors say that they're using statistical “sampling” to review your Medicare claims, what they are often doing is using extrapolation – which could take what might appear to be minor discrepancies in your billing and turn them into major financial obligations.To learn more about extrapolation and what it means for you and your team, the producers of RACmonitor have invited senior healthcare analyst Frank Cohen to be the special guest during the next live edition of Monitor Mondays.The venerable weekly Internet broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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: Cate Brantley, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

Monitor Mondays
Hot Off the Presses: Latest Issues Impacting Medicare Home Health Care, Hospice, and Medicaid Services

Monitor Mondays

Play Episode Listen Later Feb 24, 2025 29:41


During the next edition of Monitor Mondays, special guest Bill Dombi, senior counsel with Arnall, Golden, and Gregory, will offer an update on the hot-button issues affecting home healthcare, hospice, and long-term home care. These issues include the latest developments related to the Medicare Hospice Special Focus Program, the impact of the Medicare home health payment model, Medicare Advantage (MA) claim denials in post-acute care, and increasing threats to Medicaid support.The venerable weekly Internet broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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 news concerning healthcare legislation.

Monitor Mondays
1.2 Billion in Fraudulent Claims for Wound Care Procedures

Monitor Mondays

Play Episode Listen Later Feb 17, 2025 30:37


Evoking the age-old adage of having “skin in the game,” a Phoenix, Arizona couple last month entered a plea of guilty to one of the largest healthcare frauds in U.S. history.The couple pleaded guilty to criminal charges involving the submission of $1.2 billion in fraudulent claims to Medicare, Medicaid, and other insurers for wound care procedures. The husband-and-wife team have agreed to pay more than $600 million in restitution and face over 20 years in prison, according to famed whistleblower attorney Mary Inman, who will return to Monitor Mondays for its next edition.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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: Adam Brenman, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

Monitor Mondays
Major Challenges Facing American Hospitals Explained

Monitor Mondays

Play Episode Listen Later Feb 10, 2025 29:58


Challenges in reimbursement, benchmarking, and quality reporting are being experienced in many American hospitals. Why is this problem arising?Our special guest during the next live edition of Monitor Mondays will have answers. Penny Jefferson, a seasoned healthcare professional who serves as the Director of Clinical Documentation Integrity (CDI) Services at the University of California at Davis Medical Center, will report on why misinterpretation of the admission types appears to be the culprit, impacting compliance, payment, and patient safety indicators (PSIs).The broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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: Cate Brantley, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

Monitor Mondays
Artificial Intelligence and Healthcare: Three Critical Areas You Need to Know About

Monitor Mondays

Play Episode Listen Later Feb 3, 2025 28:24


Artificial intelligence (AI) is becoming as commonplace in healthcare as billing audits.It's ubiquitous.And that is why the producers of Monitor Mondays have invited senior healthcare analyst Frank Cohen to explore the intersection of AI and healthcare. So, during the next live edition of the venerable live weekly Internet broadcast, Cohen will address key concerns for compliance professionals, including Health Insurance Portability and Accountability (HIPAA) requirements, data governance, and responsibility in AI-driven decision-making.The broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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 news concerning healthcare legislation.

Monitor Mondays
Stargate Promises New Advancements in Medicine. Compliance Unclear

Monitor Mondays

Play Episode Listen Later Jan 27, 2025 28:52


Earlier this week, in the wake of the inauguration of President Donald Trump, a major announcement was made that some hope will lead to new advances in healthcare: “Stargate,” a private venture to build in the U.S. hyperscale data centers for artificial intelligence (AI). The strategic goal is to make the United States the world's leader in AI.Larry Ellison, founder of the relational database company Oracle, indicated that much work in this project will be focused on healthcare, including the promise of better medical diagnostics and imaging, personalized medicine, remote monitoring, and telehealth for patients, according to Edward M. Roche, RACmonitor investigative reporter, whose day job is director of scientific intelligence for Barraclough New York LLC.Roche will be reporting this lead story for the next edition of the long-running Monitor Mondays weekly broadcast.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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: Adam Brenman, senior government affairs liaison for Zelis, will report on current healthcare legislation.

Monitor Mondays
Major False Claims Act Settlement Snags New York's Independent Health

Monitor Mondays

Play Episode Listen Later Jan 13, 2025 30:41


New York health insurer Independent Health and its former executive reached a settlement that will amount to up to $100 million with the U.S. Department of Justice (DOJ) and a whistleblower over False Claims Act allegations that they made Medicare members appear sicker than they really were to get more money from the government, a practice known as risk adjustment fraud.Betsy Gaffney, former CEO of now-defunct vendor DxID, agreed to pay $2 million to resolve allegations she helped DxID mine patients' medical records for diagnoses that risk-adjust, nudging doctors to approve them up to a year after the patient visits, all while pocketing up to 20 percent of the additional revenue generated for Independent Health by these unsupported diagnoses.Reporting the lead story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm Whistleblower Partners.More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of the smartest minds in healthcare auditing. You'll hear auditing news you won't find anywhere else – except here and in RACmonitor.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, 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: Cate Brantley, senior government affairs liaison for Zelis, will report on current healthcare legislation.Register now to listen to this exclusive news edition of Monitor Mondays; all this and more will be coming up at 10 a.m. EST on Jan. 13, 2024.

Monitor Mondays
May I have the Envelope: 2024 Healthcare Heroes to be Revealed

Monitor Mondays

Play Episode Listen Later Dec 16, 2024 28:43


“He's making a list, checking it twice…”With a nod to the legendary Tin Pan Alley composer Haven Gillespie, who penned the lyrics to the iconic holiday song, senior healthcare consultant Ronald Hirsch, MD has been making his own list of healthcare professionals all year, paying close attention to their deeds in the field of healthcare.Calling them “Hirsch's Heroes,” an annual tradition that began in 2015, Hirsch will reveal those to whom he has bestowed the esteemed honor during the next live edition of Monitor Mondays.Other broadcast segments will include these instantly recognizable features:• 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.• Field Report: Phyisican and attorney Dr. John K. Hall is expected to file a field report on the recent Anthem Blue Cross Blue Shield proposal relative to its anethesia policy which the giant payer has since abandoned.• Legislative Update: Matthew Albright, chief leglistative affairs analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

Monitor Mondays
Health Insurers in the Spotlight in the Wake of CEO Slaying

Monitor Mondays

Play Episode Listen Later Dec 9, 2024 28:41


Have you ever had your insurance company deny payment for your claim?Have you ever had your insurance company stall or deny a pre-authorization?How long did it take to get the authorization for the medication you've been using to keep yourself alive for the past few years? Was it maddening?During the next edition of Monitor Mondays, physician and attorney Dr. John K. Hall will examine the frustration that modern health insurance has become – especially in the context of the recent fatal shooting of a prominent health insurance chief executive officer (CEO).Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior healthcare legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
National Audit News Roundup

Monitor Mondays

Play Episode Listen Later Dec 2, 2024 28:54


It's raining recovery auditors.More denials. More grief. More lost revenue and more palpable anxiety.The seemingly unending war between payers – private and public – and providers continues unabated. The ubiquitous Two-Midnight Rule and the contentious subject of observation versus inpatient status have become an indelible part of America's healthcare system.And that is why the producers of RACmonitor have dedicated the next live edition of the venerable Monitor Mondays Internet broadcast to be the go-to source for the latest audit and regulatory news: a veritable feast of valuable information for you and your team to use.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Substituting for Dr. Ronald Hirsch will be Dr. Tripti Katari, who will be making her Monday Rounds. Dr. Katari is expected to report on updates on the American Medical Association (AMA), which she serves as Legislative Counsel.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior healthcare legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
How E&M Code Misuse Triggered an FCA Settlement

Monitor Mondays

Play Episode Listen Later Nov 25, 2024 22:23


$23 million: that's the amount that the University of Colorado Health, also known as UCHealth, has agreed to pay to resolve False Claims Act allegations related to its seeking and receiving payment from federal healthcare programs for visits to its emergency departments.The university, headquartered in Aurora, was accused of falsely coding certain Evaluation & Management (E&M) claims submitted to the Medicare and TRICARE programs.Reporting the lede story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm of Whistleblower Partners.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Dr. 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 Mullins, will report the latest news about auditors.• Legislative Update: Matthew Albright, chief legislative analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
New Healthcare Survey Reveals Need for Continuous Financial Risk Monitoring

Monitor Mondays

Play Episode Listen Later Nov 18, 2024 29:39


As we continue to monitor and review the latest healthcare news, we are always pleased when word of a new study comes to our attention – especially when the study is within the purview of MDaudit.During the next live edition of Monitor Mondays, the CEO for MDaudit, Ritesh Ramesh, will report the latest results of a new national study – and how the salient takeaway points could help you and your team as you grapple with the dynamic environment of America's healthcare system.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Dr. 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 Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Simplifying the Two-Midnight Rule: Simple as 1, 2, 3

Monitor Mondays

Play Episode Listen Later Nov 11, 2024 30:19


Long a contentious edict from the Centers for Medicare & Medicaid Services (CMS), the Medicare Two-Midnight Rule can be simplified into three basic elements.For the first time, Monitor Mondays, along with esteemed physician advisor Benjamin Kartchner, will be outlining them, along with all that's needed to undo the gordian knot of denials.During the next live edition of the venerable Internet radio broadcast, Dr. Kartchner will complete his discussion as to how detailed clinical updates, assessments, and rationale for continued hospitalization can preemptively address payer scrutiny and reduce denials while optimizing reimbursement for patient care.Other segments during the weekly broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Denials Going from Bad to Worse

Monitor Mondays

Play Episode Listen Later Nov 4, 2024 28:52


Denials in healthcare are a problem.Recently, though, the problem seems to be getting worse, especially with the misapplication of the Two-Midnight Rule by Medicare Advantage (MA) plans, according to Nick Hut, senior editor for Healthcare Financial Management Association (HFMA).Hut reports that MA plans are classifying hospital stays as outpatient observation visits at a significantly higher rate than traditional Medicare even though the rule is supposed to be applied the same way in both programs.And Hut believes the situation is likely to be getting worse because UnitedHealthcare is targeting provider coding while it seeks to bring down medical spending that has been higher than anticipated in recent fiscal quarters.Hut will be reporting this story during the next live edition of Monitor Mondays. He has more than 12 years reporting healthcare policy news and trends.Other segments during the weekly broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Sex, Lies and Turmoil

Monitor Mondays

Play Episode Listen Later Oct 28, 2024 27:30


A pediatrician under investigation related to accusations that she had engaged in sexual relations with a male patient, having lied about it when applying for another healthcare position, was recently sentenced for making false statements.In another case, a federal contractor agreed to resolve False Claims Act allegations in connection with a government contract related to its storage of unsecured personally identifiable information of Medicare beneficiaries.Recognizing that it's not only a bad idea, but also a crime to lie to a government agency, Monitor Monday's own attorney and physician Dr. John K. Hall will report on how your organization's cybersecurity could put you at risk of false claims liability during the next live edition of the long-running Internet radio broadcast. Specifically, Dr. Hall will review these two recently resolved cases and offer tips to avoid liability.Other segments during the weekly broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
The Two-Midnight Rule: Presumption of Risk

Monitor Mondays

Play Episode Listen Later Oct 21, 2024 26:48


Could you and your care team be at risk when you upgrade a patient from observation to inpatient simply because the patient passed a second midnight in the hospital, based on the Centers for Medicare & Medicaid Services (CMS) contentious Two-Midnight Rule?And what about the expectation? How does expectation enter this equation? And finally, what should be present to change that expectation?During the next live edition of Monitor Mondays, Ben Kartchner, MD, a prominent physician advisor, will thread the needle of this controversial regulation to give his perspective on how the two-midnight expectation can serve as your compass, helping you steer through regulatory challenges, ensure compliance, and prevent unnecessary denials.Other segments during the weekly Internet broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
False Claims Act Violation: Unnecessary Drug Testing Flags Feds

Monitor Mondays

Play Episode Listen Later Oct 14, 2024 26:56


The U.S. Department of Justice (DOJ) has reported that one of America's largest urine drug-testing companies has agreed to pay $27 million to resolve allegations of unnecessary drug testing and illegal remuneration to physicians.The False Claims Act allegations resolved by this settlement were originally brought in three lawsuits filed by whistleblowers under the qui tam provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government – and to share in any recovery. Reporting on this major story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm of Whistleblower Partners, LLC. Other segments during the weekly Internet broadcast will include these instantly recognizable features:•Monday Rounds: Juliet Ugarte Hopkins, MD, will be making her Monday Rounds.•The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. •Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.•Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
340B Drug Rebates: Old Debate Revived, But Shot Down

Monitor Mondays

Play Episode Listen Later Oct 7, 2024 27:58


A major drug company's attempt to turn 340B drug pricing program discounts into rebates made big headlines in recent weeks. Maureen Testoni, president and CEO of 340B Health, will review how this potentially major upheaval came about, how 340B stakeholders responded, and how the drugmaker backed off after the federal government threatened it with massive penalties.This debate is by no means over.The idea of imposing rebates in 340B is not a new one, and the concept has come back into prominence recently amid the ongoing implementation of the Inflation Reduction Act, which will have important effects on 340B.Other segments during the weekly Internet broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Folana Houston, assistant general counsel for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Violence in America's Hospitals

Monitor Mondays

Play Episode Listen Later Sep 30, 2024 28:04


As violent crime has trended slightly downward throughout the United States over the last year, a wound to this country's collective psyche that appears reluctant to close is workplace violence in America's hospitals.Reporting the lead story during the next live edition of Monitor Mondays will be special assignment contributor Dennis Jones, senior director of revenue cycle at Jefferson Health.Jones returns to his beat to continue his reporting of this issue. Among those healthcare professionals most at risk for workplace violence are nurses and those who work in emergency rooms. In fact, a 2021 study conducted by the Cleveland Clinic revealed that workplace violence tends to be four times more prevalent in healthcare than in other industries. Jones is expected to have more details on “Violence in America's Hospitals.”Other segments during the weekly Internet broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, senior government analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Whistleblower Report: Oak Street Health Agrees to Pay $60M to Resolve Alleged False Claims Act Liability in Medicare Advantage Patient Recruitment Scheme

Monitor Mondays

Play Episode Listen Later Sep 26, 2024 28:41


Oak Street Health, headquartered in Chicago and a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the False Claims Act by paying kickbacks to third-party insurance agents in exchange for recruiting seniors to Oak Street Health's primary care clinics, according to a news release issued by the U.S. Department of Justice (DOJ). Reporting the lead story during the next live edition of Monitor Mondays will be Max Wollman, a partner in the Washington office of Whistleblower Partners, LLP.The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Joseph Stinson. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. Mr. Stinson is expected to receive $9.9 million, according to the DOJ.Other segments during the weekly Internet broadcast will include these instantly recognizable features:•Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors. •Legislative Update: Adam Brenman, senior government  analyst for Zelis, will report on current healthcare legislation.•Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Exposing Challenges to Getting Paid by Medicare Advantage

Monitor Mondays

Play Episode Listen Later Sep 16, 2024 29:00


You need to get paid properly for surgical procedures on the Centers for Medicare & Medicaid Services (CMS) Inpatient-Only (IPO) List, according to Mary Beth Pace, vice president of care management at Trinity Health, and also the special guest during the next live edition of Monitor Mondays.Pace, in making the statement, was referring to rules and regulations set forth in the Federal Register for Medicare in 2024. She also alleges that some Medicare Advantage (MA) plans are not abiding by some of those rules and regulations. Pace says all MA plans need to abide by the IPO and reimburse correctly.But does your facility have the processes in place to ensure that you are being paid correctly for surgical procedures on the IPO? Be sure to listen in order to find out.Other segments during the weekly Internet broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
How to Ensure Correct Inpatient Status

Monitor Mondays

Play Episode Listen Later Sep 9, 2024 30:12


What's wrong with this picture?With more than 10 years of the Centers for Medicare & Medicaid Services (CMS) Two-midnight Rule now behind us, one would presume that most healthcare professionals should know what determines an inpatient status. But some don't.That is why RACmonitor has invited renowned physician and attorney Dr. John K. Hall to report on the requirements and risks associated with inpatient order documentation during the next edition of Monitor Mondays.Other segments during the weekly Internet broadcast will include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
New Study Reveals America's Big Hang-up with Healthcare

Monitor Mondays

Play Episode Listen Later Aug 26, 2024 28:58


A comprehensive new survey featuring responses from more than 1,500 U.S. patients reveals that they are not only frustrated by poor provider support, but also are experiencing tangible health setbacks – especially when waiting to refill prescriptions and being placed on hold while waiting to speak to a caregiver.Israel Krush, CEO and Co-Founder of Hyro, the healthcare vendor whose company sponsored the survey, is scheduled to be the special guest during the next live edition of the long-running Internet broadcast Monitor Mondays, produced by RACmonitor.Hyro's “Voice of the Patient” survey and accompanying report highlight significant gaps between patient needs and the current support available through healthcare delivery channels.Other segments during the weekly Internet broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Federal Officials Announce Medical Relief in Wake of Hurricane

Monitor Mondays

Play Episode Listen Later Aug 19, 2024 27:15


In response to the devastation caused by Hurricane Debby, now Tropical Storm Debby, the Centers for Medicare & Medicaid Services (CMS) has announced additional resources and flexibilities to support the affected states of Florida, Georgia, and South Carolina.Following President Biden's emergency declarations and U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra's Public Health Emergency determination, CMS is working closely with these states to ensure continued access to critical healthcare services.Importantly, CMS is offering state waivers and other support to help healthcare providers in the impacted regions maintain operations and deliver essential care during this challenging time, according to Timothy Powell, an independent senior healthcare consultant, who also serves as the national correspondent for ICD10monitor and will be the special guest for the next edition of Monitor Mondays.Other segments during the weekly Internet broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
There's a New Sheriff in Town: New DOJ Program Intends to Snare Even More FCA Fraudsters

Monitor Mondays

Play Episode Listen Later Aug 12, 2024 28:37


The U.S. Department of Justice (DOJ) has a new whistleblower reward initiative called the DOJ Corporate Whistleblower Awards Pilot Program.The Program, which seeks to fill gaps left by existing whistleblower reward programs, incentivizes whistleblowers to bring tips to the DOJ about types of healthcare fraud not already covered by the False Claims Act (FCA). According to Monitor Mondays special guest Mary Inman, the new Program raises the stakes for the entire healthcare industry, especially among those who typically ignore or disregard internal reports concerning whistleblowers.Other segments during the next edition of the weekly Internet broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

The Electric Wire
Previewing the 2024 Power Breakfast with Justin Chasco

The Electric Wire

Play Episode Listen Later Aug 8, 2024 29:09


Justin Chasco of Fredrikson & Byron joins the podcast to discuss CFC's upcoming Power Breakfast event, which will celebrate the 50th episode of the Electric Wire podcast. Registration and info about the event can be found here: https://www.eventbrite.com/e/2024-power-breakfast-the-best-of-the-electric-wire-tickets-923933468877

Provident's Healthcare Dealcast
Healthcare Regulatory Updates – Navigating Federal and State Regulations for Healthcare Provider Transactions

Provident's Healthcare Dealcast

Play Episode Listen Later Aug 7, 2024 32:59


In today's dynamic healthcare M&A landscape, navigating new antitrust challenges and evolving noncompete regulations have become crucial considerations for shareholders, investors, and providers pursuing transactions. In this episode, Provident's Director, AJ Shekar, is joined by Katherine Douglas, Shareholder of Fredrikson, who brings extensive experience in guiding healthcare stakeholders through regulatory complexities. Together, they delve into effective strategies for navigating recent regulatory changes and explore best practices for staying ahead of changing guidelines.

Monitor Mondays
FY 2025 IPPS: The Clinical Report

Monitor Mondays

Play Episode Listen Later Aug 5, 2024 31:07


The Inpatient Prospective Payment System Final Rule for Acute Care and Long-Term Care hospitals in the 2025 fiscal year (FY) continues to generate interest from providers, payers, hospital administrators, vendors, and consultants. But what are the significant takeaways for stakeholders as they prepare for the government's fiscal year, which begins Tuesday, Oct. 1, 2024?Standing by to report the lead story during the next live edition of the long-running Monitor Mondays broadcast will be subject-matter expert Dr. James Kennedy.Other broadcast segments will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
“Do the Crime, Pay the Fine:” DaVita to Pay$34 million to Resolve Allegations of Illegal Kickbacks

Monitor Mondays

Play Episode Listen Later Jul 29, 2024 27:28


Denver-based DaVita Inc. has agreed to pay slightly more than $34 million to resolve allegations that it violated the False Claims Act (FCA).The U.S. Department of Justice (DOJ) reported in a news release that DaVita paid kickbacks to induce referrals to DaVita Rx, a former subsidiary that provided pharmacy services for dialysis patients, directing the payments to nephrologists and vascular access physicians.During the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman will report the details on this amazing story, focusing on the provisions of the Anti-Kickback Statute that prohibit anyone to induce referrals of patients or items for services covered by Medicare, Medicaid, and other federally funded programs.Other broadcast segments will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Kate Choe, an undergraduate student at Brown University who is also interning at Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
End of the Road for the ALJs?

Monitor Mondays

Play Episode Listen Later Jul 22, 2024 30:07


Could the end be near for the administrative law judges of the Centers for Medicare & Medicaid Service (CMS). What about the Office of Medicare Hearings and Appeals (OMHA)? Could these entities be gone from the audit landscape?Case in point: the Supreme Court (SCOTUS) continues eviscerating executive powers. This time SCOTUS has limited the authority of administrative tribunals and the administrative law judges to adjudicate some cases—this according to a recent SCOTUS decision.While the actual case relates to administrative hearings at the Securities and Exchange Commission (SEC), the limitations likely transcend that agency.During the next live edition of Monitor Monday, physician and attorney, Dr John K Hall, will discuss the potential impacts of the decision and what impact it might have on Office of Medicare Hearings and Appeals (OMHA) and the Centers for Medicare & Medicaid Services (CMS) administrative law judges.Other broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Handle with Care: Taking Steps for Safe Transitions

Monitor Mondays

Play Episode Listen Later Jul 15, 2024 29:12


Have you ever wondered how professional movers carefully pack everything? From expensive china to precious crystal stemware, they seem to have a knack and knowledge for how to prepare.When it comes to healthcare, how safe is the transition from hospital to home if a patient cannot get the services they need at home when they are ready to transition?More and more, we are seeing challenges with home health care agencies not being available for our patients who need home care at discharge, according to Mary Beth Pace, vice president of care management at Trinity Health. During the next live edition of the long-running Monitor Mondays live broadcast, acting as special guest, she will unpack all the important steps for ensuring safe transitions.Other broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
No More Chevron? What Happens Next?

Monitor Mondays

Play Episode Listen Later Jul 8, 2024 29:25


For nearly four decades, a judicial principle known as “Chevron deference” has guided the federal courts as they reviewed litigation associated with federal agencies. Chevron deference allowed legislators to leave statutes somewhat vague, assuming that an agency full of government experts would sort out the details and promulgate effective regulation.But, according to a recent U.S. Supreme Court (SCOTUS) decision, the principle is fundamentally flawed – in fact, fatally flawed. The decision throws it out in its entirety. This has the potential to upend years of U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) regulation.Distinguished physician and attorney Dr. John K. Hall will report on the resultant doom and gloom of potential outcomes, and how it may affect providers and payers, during the next live edition of Monitor Mondays.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Special Alert: DOJ Cracks Down on Nearly 200 Involved in Major Healthcare Fraud Schemes

Monitor Mondays

Play Episode Listen Later Jul 1, 2024 28:55


In a late-breaking press release, the U.S. Department of Justice (DOJ) announced late Thursday that the agency had charged nearly 200 individuals accused with involvement in various healthcare fraud schemes estimated at $2.7 billion. Charges were brought against nurses, physicians, and others in a national sweep, and it was estimated that more than $900 million in false claims were submitted to Medicare for wound care grafts.Reporting on this major developing story during the next edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm of Whistleblower Partners, LLC.Broadcast segments will also include these instantly recognizable features:• Perspective: RACmonitor investigative reporter Edward M. Roche, founder of Barraclough New York, LLC, where he serves as the director of business intelligence, will go behind the proverbial curtain to ascertain if artificial intelligence (AI) is the latest marketing fad or a promising solution to advance healthcare delivery in the U.S.• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
How a Different Type of Whistleblower Created a Lesson Worth Learning

Monitor Mondays

Play Episode Listen Later Jun 24, 2024 28:57


A recent federal court decision in New Jersey demonstrates the viability of a different kind of whistleblower – in this case, a privately defrauded party.The most common type of a whistleblower under the False Claims Act (FCA) tends to be a corporate insider who sees fraud committed against the government by their employer or a company they work with, and generally after many, many attempts at internal reporting, sues the company under the law and is eligible to share in the recovery.During the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner of Whistleblower Partners, LLC, will report on how this uncommon type of whistleblower has created a lesson worth learning for healthcare leaders.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

The Nonlinear Library
AF - Jailbreak steering generalization by Sarah Ball

The Nonlinear Library

Play Episode Listen Later Jun 20, 2024 4:05


Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Jailbreak steering generalization, published by Sarah Ball on June 20, 2024 on The AI Alignment Forum. This work was performed as part of SPAR We use activation steering (Turner et al., 2023; Rimsky et al., 2023) to investigate whether different types of jailbreaks operate via similar internal mechanisms. We find preliminary evidence that they may. Our analysis includes a wide range of jailbreaks such as harmful prompts developed in Wei et al. 2024, the universal jailbreak in Zou et al. (2023b), and the payload split jailbreak in Kang et al. (2023). For all our experiments we use the Vicuna 13B v1.5 model. In a first step, we produce jailbreak vectors for each jailbreak type by contrasting the internal activations of jailbreak and non-jailbreak versions of the same request (Rimsky et al., 2023; Zou et al., 2023a). Interestingly, we find that steering with mean-difference jailbreak vectors from one cluster of jailbreaks helps to prevent jailbreaks from different clusters. This holds true for a wide range of jailbreak types. The jailbreak vectors themselves also cluster according to semantic categories such as persona modulation, fictional settings and style manipulation. In a second step, we look at the evolution of a harmfulness-related direction over the context (found via contrasting harmful and harmless prompts) and find that when jailbreaks are included, this feature is suppressed at the end of the instruction in harmful prompts. This provides some evidence for the fact that jailbreaks suppress the model's perception of request harmfulness. Effective jailbreaks usually decrease the amount of the harmfulness feature present more. However, we also observe one jailbreak ("wikipedia with title"[1]), which is an effective jailbreak although it does not suppress the harmfulness feature as much as the other effective jailbreak types. Furthermore, the jailbreak steering vector based on this jailbreak is overall less successful in reducing the attack success rate of other types. This observation indicates that harmfulness suppression might not be the only mechanism at play as suggested by Wei et al. (2024) and Zou et al. (2023a). References Turner, A., Thiergart, L., Udell, D., Leech, G., Mini, U., and MacDiarmid, M. Activation addition: Steering language models without optimization. arXiv preprint arXiv:2308.10248, 2023. Kang, D., Li, X., Stoica, I., Guestrin, C., Zaharia, M., and Hashimoto, T. Exploiting programmatic behavior of LLMs: Dual-use through standard security attacks. arXiv preprint arXiv:2302.05733, 2023. Rimsky, N., Gabrieli, N., Schulz, J., Tong, M., Hubinger, E., and Turner, A. M. Steering Llama 2 via contrastive activation addition. arXiv preprint arXiv:2312.06681, 2023. Wei, A., Haghtalab, N., and Steinhardt, J. Jailbroken: How does LLM safety training fail? Advances in Neural Information Processing Systems, 36, 2024. Zou, A., Phan, L., Chen, S., Campbell, J., Guo, P., Ren, R., Pan, A., Yin, X., Mazeika, M., Dombrowski, A.-K., et al. Representation engineering: A top-down approach to AI transparency. arXiv preprint arXiv:2310.01405, 2023a. Zou, A., Wang, Z., Kolter, J. Z., and Fredrikson, M. Universal and transferable adversarial attacks on aligned language models. arXiv preprint arXiv:2307.15043, 2023b. 1. ^ This jailbreak type asks the model to write a Wikipedia article titled as . Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org.

The Nonlinear Library
LW - Jailbreak steering generalization by Sarah Ball

The Nonlinear Library

Play Episode Listen Later Jun 20, 2024 4:05


Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Jailbreak steering generalization, published by Sarah Ball on June 20, 2024 on LessWrong. This work was performed as part of SPAR We use activation steering (Turner et al., 2023; Rimsky et al., 2023) to investigate whether different types of jailbreaks operate via similar internal mechanisms. We find preliminary evidence that they may. Our analysis includes a wide range of jailbreaks such as harmful prompts developed in Wei et al. 2024, the universal jailbreak in Zou et al. (2023b), and the payload split jailbreak in Kang et al. (2023). For all our experiments we use the Vicuna 13B v1.5 model. In a first step, we produce jailbreak vectors for each jailbreak type by contrasting the internal activations of jailbreak and non-jailbreak versions of the same request (Rimsky et al., 2023; Zou et al., 2023a). Interestingly, we find that steering with mean-difference jailbreak vectors from one cluster of jailbreaks helps to prevent jailbreaks from different clusters. This holds true for a wide range of jailbreak types. The jailbreak vectors themselves also cluster according to semantic categories such as persona modulation, fictional settings and style manipulation. In a second step, we look at the evolution of a harmfulness-related direction over the context (found via contrasting harmful and harmless prompts) and find that when jailbreaks are included, this feature is suppressed at the end of the instruction in harmful prompts. This provides some evidence for the fact that jailbreaks suppress the model's perception of request harmfulness. Effective jailbreaks usually decrease the amount of the harmfulness feature present more. However, we also observe one jailbreak ("wikipedia with title"[1]), which is an effective jailbreak although it does not suppress the harmfulness feature as much as the other effective jailbreak types. Furthermore, the jailbreak steering vector based on this jailbreak is overall less successful in reducing the attack success rate of other types. This observation indicates that harmfulness suppression might not be the only mechanism at play as suggested by Wei et al. (2024) and Zou et al. (2023a). References Turner, A., Thiergart, L., Udell, D., Leech, G., Mini, U., and MacDiarmid, M. Activation addition: Steering language models without optimization. arXiv preprint arXiv:2308.10248, 2023. Kang, D., Li, X., Stoica, I., Guestrin, C., Zaharia, M., and Hashimoto, T. Exploiting programmatic behavior of LLMs: Dual-use through standard security attacks. arXiv preprint arXiv:2302.05733, 2023. Rimsky, N., Gabrieli, N., Schulz, J., Tong, M., Hubinger, E., and Turner, A. M. Steering Llama 2 via contrastive activation addition. arXiv preprint arXiv:2312.06681, 2023. Wei, A., Haghtalab, N., and Steinhardt, J. Jailbroken: How does LLM safety training fail? Advances in Neural Information Processing Systems, 36, 2024. Zou, A., Phan, L., Chen, S., Campbell, J., Guo, P., Ren, R., Pan, A., Yin, X., Mazeika, M., Dombrowski, A.-K., et al. Representation engineering: A top-down approach to AI transparency. arXiv preprint arXiv:2310.01405, 2023a. Zou, A., Wang, Z., Kolter, J. Z., and Fredrikson, M. Universal and transferable adversarial attacks on aligned language models. arXiv preprint arXiv:2307.15043, 2023b. 1. ^ This jailbreak type asks the model to write a Wikipedia article titled as . Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org

Monitor Mondays
The Human Touch at the Intersection of Artificial Intelligence and Denied Claims

Monitor Mondays

Play Episode Listen Later Jun 17, 2024 28:50


Artificial intelligence (AI) is fast becoming a fixture in healthcare revenue cycle management (RCM), where finance leaders are desperate for ways to relieve understaffed departments struggling under unprecedented volumes of third-party audit demands and rising denial rates without sacrificing accuracy or precision.During the next live edition of Monitor Mondays, the CEO for MDaudit, Ritesh Ramesh, will report on why keeping humans in the loop is the best strategy for preventing negative outcomes.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Juliet Ugarte Hopkins, MD, substituting for Dr. Ronald Hirsch, will be making her Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
OIG On the Prowl: Semi-Annual Report to Congress

Monitor Mondays

Play Episode Listen Later Jun 10, 2024 31:15


They're looking for fraudsters, going on the prowl for bad actors, as revealed in the latest semi-annual report to Congress compiled by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). In this latest report, the government watchdog identified more than $2.76 billion in expected recoveries and receivables.Providing analysis and context for the OIG report released June 3 during the next edition of Monitor Mondays will be James S. Kennedy, MD, a subject matter expert who will review highlights and offer suggestions for remaining compliant.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Jail Time, or Hefty Fine?

Monitor Mondays

Play Episode Listen Later Jun 3, 2024 28:40


Most healthcare investigations by the U.S. Department of Justice (DOJ) result in settlements. Many times, the complete details of the settlements in underlying government cases are not fully disclosed. But sometimes, a provider ends up at trial. And when that happens, it often offers insights into what it takes to get hit with hefty fines – and possible prison time, if you lose the case.During the next live edition of Monitor Mondays, physician and attorney Dr. John K. Hall will review two recent convictions against individual physicians, and offer suggestion for avoiding big payouts and incarceration.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
New Medical Technologies: Are They Audit-Proof?

Monitor Mondays

Play Episode Listen Later May 20, 2024 27:01


A deep dive into microbiology can reveal an up-close look at the cells that make up organs of the human body – and corresponding cancer treatments that leave no trace of damage.The science of medicine appears to be moving at the speed of light lately. But will new healthcare technologies be audit-proof? Monitoring these escalating changes and their impact on America's delivery of healthcare services during the next live edition of Monitor Mondays will be RACmonitor investigative reporter Edward M. Roche.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Clarrisa Barnes, MD, President and CEO for the American College of Physician Advisors, is substituting for Ronald Hirsch to report on her Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
Healthcare Whistleblower Roundup: Recent Settlements Reach Nearly $10 Million

Monitor Mondays

Play Episode Listen Later May 13, 2024 28:21


Two recent settlements to resolve allegations of violating the False Claims Act – both involving the virulent COVID-19 – are the latest in a series of actions that will be reported on during the next edition of Monitor Mondays by famed whistleblower Mary Inman, who also notes that her company, Whistleblower Partners, LLP, is poised to announce another major case pending the unsealing of court documents expected this week.Among the two cases, one involves the U.S. and California versus ReNew Health Group, LLC and two of the firm's executives. The settlement alleges that the company knowingly submitted false Medicare Part A claims for nursing home residents. The other settlement involves Atlanta-based Insight Global LLC, which allegedly failed to implement adequate cybersecurity measures to protect personal health information of individuals involved in contact tracing efforts.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Folana Houston, assistant general counsel for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
The AI Arms Race in Healthcare Auditing: Handicapping Winners and Losers

Monitor Mondays

Play Episode Listen Later May 6, 2024 29:07


The arms race is heating up.On one side there are healthcare providers, and on the opposing side, an army operated by the auditors. Who will be the winners and losers?Are you safe? And how do you protect your facility from claim denials and takebacks, especially when auditors are using artificial intelligence (AI)?RACmonitor investigative reporter Edward M. Roche will return to Monitor Mondays this coming Monday to report on the escalating AI arms race. Roche, who just completed an exclusive three-part series for RACmonitor on AI auditing, will also report on essential steps you and your colleagues can deploy in defense of such audits.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Monitor Mondays
The Value of Peer-to-Peer Discussion

Monitor Mondays

Play Episode Listen Later Apr 29, 2024 28:09


Do you have peer-to-peer (P2P) discussions?Are they useful? Are they valuable? And how do you know?Our own physician and attorney, Dr. John K. Hall, will offer his unique take on the value of P2P interactions and how you should measure it during his appearance as Guest Panelist on the next upcoming edition of Monitor Mondays.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, 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 Mullins, will report the latest news about auditors.• Legislative Update: Matthew Albright, a senior government affairs liaisons for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.