Podcasts about healthcare compliance

While many of you might have been enjoying the holiday season, thebeat of healthcare keeps on beating.Much has happened in the world of medical coding and that is whythe producers of Talk Ten Tuesday are dedicating the next liveedition of the popular national Internet broadcast to the topic ofcoding.And that's why Dr. James S. Kennedy, a trained medical professionalwho loves coding, will be the Talk Ten Tuesday special guest.The popular Internet broadcast will also feature these additionalinstantly recognizable panelists, who will report more news duringtheir segments:POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of DavisMedical Center, is the new cohost of Talk Ten Tuesday. Shewill share her point of view (POV) during the broadcast.The Coding Report: Christine Geiger, Assistant Vice Presidentof Acute and Post-Acute Coding Services for First ClassSolutions, will report on the latest coding news.Social Determinants of Health: Tiffany Ferguson, CEO forPhoenix Medical Management, Inc., will report on the news thatis happening at the intersection of medical record auditing andthe SDoH.CDI Report: Cheryl Ericson, Director of Clinical DocumentationIntegrity (CDI) for the vaunted Brundage Group, will have thelatest CDI updates.The Coding Report: Christine Geiger, Assistant Vice Presidentof Acute and Post-Acute Coding Services for First ClassSolutions, will report on the latest coding news.News Desk: Timothy Powell, ICD10monitor nationalcorrespondent, will anchor the Talk Ten Tuesdays News Desk.

While many of you were enjoying the holidays, Kaiser Permanente wasback in the news. This time, another whistleblower case which resulted inan amazing $556 million settlement to resolve allegations that the giantprovider/payer fudged on its Medicare Advantage risk adjustment.Reporting the lead story during the next live edition of Monitor Mondays willbe Liz Soltan, a New York-based senior associate at WhistleblowerPartners. Soltan is a member of the firm's litigation team who representedDr. James Taylor in his landmark False Claims Act (FCA) case againstKaiser Permanente which resolved allegations of Medicare Advantage riskadjustment fraud. Soltan also works on a major Medicare Advantage riskadjustment fraud case against UnitedHealth Group on behalf ofwhistleblower Benjamin Poehling.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, partnerat the law firm of Nelson Mullins, will report the latest news aboutauditors. Risky Business: Healthcare attorney David Glaser, shareholderin the law offices of Fredrikson & Byron, will join the broadcast withhis trademark segment. Legislative Update: Adam Brenman, legislative affairs liaison forZelis, will report on current healthcare legislation.

Fast-evolving challenges, including telehealth transitions and health system acquisitions, are redefining pay transparency/equity expectations. In this episode, we offer healthcare employers actionable insights for harmonizing compensation and boosting workforce morale amid industry-wide change.   

What's new when it comes to artificial intelligence (AI) and coding?Listen to the next edition of the long-running and popular Talk Ten Tuesday and learn from longtime RACmonitor and ICD10monitor contributing author Sharon Easterling.Sharon Easterling will continue her editorial series on artificial intelligence and medical record coding. The potential for AI in health information is both exciting and daunting as you'll learn.The popular Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, is the new cohost of Talk Ten Tuesday. She will share her point of view (POV) during the broadcast.CDI Report: James S. Kennedy, president of CDIMD, will substitute for Cheryl Ericson and will provide an update on clinical documentation integrity (CDI).The Coding Report: Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, will report on the latest coding news.News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.

The Centers for Medicare & Medicaid Services (CMS) will block hospitals from performing certain interventions that are intended to change a child's physical appearance to align an asserted sex identity.Reporting the lead story during the next live edition of Monitor Mondays will be independent physician consultant Dr. Drew Updike.More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday, Jan. 12, with a cadre of the smartest minds in healthcare auditing. You'll hear auditing news you won't find anywhere else – except here the 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: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

Are you wondering what connects the nouns in the headline together?It's a Medicare cognitive screening devise. Look at these words and commit them to memory. Try to repeat back this list of words twice a day, from memory: Apple, Chair, Ocean, Book, and Clock.  During the next live edition of the popular Talk Ten Tuesday live Internet broadcast, Gloryanne Bryant will report on what some medical experts say about an inability to recall these five words.Could it be signs of cognitive changes or impairment within the brain? Or could it mean that the individual has memory and recall issues? Register now to learn more.The broadcast will also feature these instantly recognizable panelists, who will report more news during their segments:News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News DeskThe Coding Report: Jodi Worthington, with First Class Solutions, will substitute for Christine Geiger to report on the latest coding news POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, and guest cohost of Talk Ten Tuesday, will share her point of view (POV) during the broadcast.

Whistleblower attorney Max Volman will return to the next Monitor Monday broadcast to report the latest news about whistleblowers. As we have learned, often “whistleblowers” are not insiders reporting wrongdoing; they tend to be outside the offending organization.Register now to listen to Max Voldman's exclusive report.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, legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.●       Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Anyone who has been working within the scope of hospital case/utilization management for any period of time has heard of the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation.But are you familiar with the CMS Conditions for Coverage?  Sometimes referred to as “conditions of payment,” these requirements must be met in order for federal health plans to pay a healthcare facility for a submitted claim.Welcome to the live edition of Talk Ten Tuesday, Dec. 9, 10 Eastern. That's when Dr. Juliet Ugarte Hopkins, Chief Medical Officer for Phoenix Medical Management, Inc., will explain how failure to meet some aspects of the CoPs doesn't mean there is a failure in Conditions for Coverage (CfC).The broadcast will also feature these instantly recognizable panelists, who will report more news during their segments:Social Determinants of Health: Tiffany Ferguson, CEO for the aforementioned Phoenix Medical Management, Inc., will report on the news that is happening at the intersection of medical record auditing and the SDoH.CDI Report: Cheryl Ericson, Senior Director of Clinical Policy and Education for the vaunted Brundage Group, will have the latest CDI updates.The Coding Report: Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, will report on the latest coding news.News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.MyTalk: Angela Comfort, veteran healthcare subject-matter expert, will co-host the broadcast. Comfort is the Assistant Vice President of Revenue Integrity for Montefiore Health.

For years, federal audit contractors have treated statistical extrapolation as the unassailable engine driving massive overpayment demands. The premise sounds reasonable enough: review a small sample of claims, calculate an error rate, and multiply across the entire population to produce a "statistically valid" overpayment figure.In a perfect world, this approach might hold up. But healthcare isn't a perfect world. It's a domain where coding is inherently subjective, documentation varies dramatically by provider, and even seasoned experts routinely disagree on the same chart. In this environment, extrapolation doesn't multiply truth—it amplifies uncertainty. Join us Monday during the long-running Monitor Monday when senior healthcare analyst Frank Cohen returns to the broadcast to debunk long-held beliefs regarding auditing, auditors and extrapolation. 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, legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

The False Claims Act (FCA) suit was initiated by the U.S. government, not a traditional whistleblower. Nonetheless, the recent $45 million settlement with a Florida physician and his wound care group – Vohra Wound Physicians Management LLC – resolved allegations that group knowingly submitted claims to Medicare for medically unnecessary yet lucrative surgical procedures, when routine non-surgical wound management had actually been done.  During the next live edition of the long-running Monitor Monday Internet broadcast, famed whistleblower attorney Mary Inman will report the details of the amazing case, as a not-so-subtle reminder that crime doesn't pay.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 government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

By  Adam Turteltaub Listen up people:  It's all about the people. That's the key message from Gabor Sulyok, Global Head of Commercial and Healthcare Compliance at BioNTech and experienced senior compliance counsel Luciane Mallmann. At its core, ethics and compliance is a human endeavor. While regulations and standards provide the structure, it's the people within an organization who bring these principles to life. A people-centered approach to compliance programs enhances engagement, supports better decision-making, and fosters a culture of integrity. From design to execution, every aspect of the program should reflect a deep understanding of how people learn, behave, and interact. This means rethinking how we educate, maintain awareness, and ensure accountability. Policies must be relatable and actionable. Training should be immersive and role-specific. And accountability should be balanced with support to avoid creating a risk-averse culture. They explain in the podcast that there are three key elements of a people-centered framework: Speak-Up Culture A healthy program starts with psychological safety. Employees must feel empowered to raise concerns without fear of retaliation. Transparency and Accountability Transparency builds trust. Training should include real-life ethical dilemmas and storytelling that resonates with employees. Sharing actual cases from within the company helps humanize compliance and makes it more relatable. Accountability, meanwhile, must be visible and fair. Leaders should model ethical behavior and be the first to complete training, setting the tone from the top. Ethical Decision-Making  Decision-making frameworks should incorporate diverse perspectives and encourage thoughtful deliberation. Employees need tools to navigate ambiguity, and those tools must be grounded in the organization's values. Listen in to learn more about how to put people front and center in your ethics and compliance program.

It's raining RACs.  And many other third party auditors. It seems like every submission of medical records is being scrutinized for omission and commission. Then enter artificial intelligence (AI). The use of AI in auditing, although relatively new, is here to stay.How is your facility faring compared to your peers? More audits? Less auditing? More denied claims? More money being recouped?Now you can see for yourself how you're doing comparing to others. Thanks to the annual benchmark study performed by MDaudit and shared here on Monitor Monday, you will be able to judge for yourself.During the next live edition of the long-running Internet broadcast, Ritesh Ramesh, CEO for MDaudit, will share the findings of his company's annual 2025 Benchmark study.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.

By Adam Turteltaub Ahmed Salim wants you to change how you approach change.  An active consultant to the compliance community and Healthcare Compliance & Regulations Adjunct Professor at DePaul University, he is passionate about following a disciplined approach to change management.  Not surprisingly then, he's the author of a new book from the SCCE & HCCA:  Mastering Compliance Through Change Management. In this podcast he explains that the concepts behind change management are simple.  It contains 8 critical steps: Vision and strategy Building leadership and sponsorship Communications and awareness Training and acceptability building Implementation and reinforcement. Continuous monitoring and improvement Sustaining the change Feedback and adaptation. So what are the keys to success along the way?  First, have a vision and strategy you want.  Second, get leadership and senior management buy in.  Third, effective communication because if people don't know about the change, what's the point.  Fourth, continuous monitoring to ensure that you are making the progress you want, and if you aren't why. To all that I would add two more keys:  listen in to learn more about how to make change management a part of your compliance program.  Then, get your copy of Mastering Compliance Through Change Management.

I'd love to hear from you 'text the show'“If we are not investigated, why do I need to be compliant?”Welcome back to the Treat Your Business podcast! I'm Katie, and in this episode, I'm diving into the world of compliance, why it matters, even if you're not being audited or investigated, and how you can make it a real strength in your clinic. I'm joined by the brilliant Sarah and Sandra from HCPG, who are experts in helping clinic owners like us plug the gaps and build solid, safe businesses without any judgement. If you've ever felt unsure about what you need in place or worried you're missing something crucial, this conversation is for you.Episode Summary

An effective compliance program, as outlined in the U.S. Sentencing Guidelines, incorporates seven key elements to prevent and detect organizational misconduct. First, organizations must establish clear standards and procedures to ensure legal and ethical conduct, supported by comprehensive training and communication to promote awareness. Second, high-level personnel must oversee the program, ensuring accountability, while specific individuals are responsible for its implementation. Finally, regular monitoring, auditing, a system for confidentially reporting violations, consistent enforcement, and periodic risk assessments ensure the program's ongoing effectiveness. Two CITI Program colleagues, Andra M. Popa, JD, LLM, Assistant Director of Healthcare Compliance, and Anne Hawkins-Badge, DHSc, MSPH, Assistant Director of Environmental Health and Safety, discuss their respective regulatory expertise that directly aligns with the U.S. Sentencing Guidelines' seven key elements. In their discussion, they highlight the similarities and skills that may apply to a professional compliance position from their respective backgrounds.  Additional Resources: CITI Program's Healthcare Solution:                https://about.citiprogram.org/solutions/healthcare/ CITI Program's Health and Safety Solution: https://about.citiprogram.org/solutions/health-safety/ CITI Program's Higher Education Training Solution: https://about.citiprogram.org/solutions/higher-education/  

Join Dr. Deepti Pandita, VP of Clinical Informatics and CMIO at UCI Health, as she reveals how academic medical centers can successfully deploy AI-driven solutions while addressing digital disparities. Dr. Pandita will share tactical insights from implementing ambient documentation, streamlined patient messaging, and administrative workflow automation at Orange County's only safety net academic medical center. Learn how her evidence-based approach to digital health equity has reduced hospital stays, improved operational efficiency, and influenced national policy through her co-authored American College of Physicians position paper on AI in healthcare.Dr. Deepti Pandita, VP of Clinical Informatics and CMIO at UCI HealthMegan Antonelli, Founder and CEO, HealthIMPACT Live

Join us for the fifth episode of our Chief Design Officer Series, where we talk to Chief Design Officers from the most forward-thinking companies. This time, we are joined by Sean Carney, former CDO of Philips. At Philips, Sean led a team of 700+ designers and helped generate over $800 million in sales pull-through.Sean shared a powerful case study of how design contributed directly to business transformation and aided a positive change in the world.Watch to learn how to:- Drive real business impact with design- Calculate and communicate ROI on design- Balance creativity with business strategy at the C-level- Build a design team that influences revenue and strategy00:00 — Welcome to the CDO Series: Why Design Belongs in the Boardroom00:49 — Meet Sean Carney: Former Chief Design Officer at Philips02:55 — Sean's Unplanned Path to Becoming a Chief Design Officer04:42 — From Solo Creator to Strategic Leader: The Power of Diverse Teams07:43 — Why Today's User Research Isn't Enough: Designing for the Future10:24 — Philips' Visionary Design Approach13:24 —

Send us a textIn this episode of the Advancing Surgical Care Podcast, ASCA Chief Executive Officer Bill Prentice talks with Robert Saltaformaggio, senior counsel at Liles Parker, a Washington, DC-based law firm that focuses on regulatory healthcare compliance and reimbursement issues. Saltaformaggio is also a certified professional coder who assists ASCs and other healthcare providers with Medicare and Medicaid payer coverage and payment requirements, as well as claims disputes with major payers such as the various Blue Cross Blue Shield entities and UnitedHealthcare. During their discussion, Prentice and Saltaformaggio talk about the current regulatory landscape, the role of AI, the importance of conducting self-audits and more.

Let's dive deep into how healthcare organizations can leverage HubSpot to modernize their marketing, sales, and service operations while staying compliant with ever-evolving healthcare regulations, including HIPAA. Join SmartBug HubSpot experts Paul Schmidt and Casey Peddicord as they explore: ✅ Why more healthcare orgs are adopting HubSpot now than ever before ✅ What HubSpot's HIPAA compliance means for storing PHI and building forms ✅ Real-world examples from medical device companies, vein clinics, and more ✅ How healthcare CRMs integrate with EHR/EMR systems like Epic and Athena ✅ What to look for in a HubSpot partner (including compliance credentials) ✅ Implementation timelines, permissioning best practices, and success metrics Whether you're a marketing leader, IT stakeholder, or operations exec in healthcare, this conversation is packed with insights on how to reduce tool sprawl, improve visibility, and scale securely with HubSpot.

Angela Barker joins host Todd Marquardt to talk about healthcare compliance on this edition of Talk Law Radio. Angela provides proactive audits for Pediatric Home Health Agencies that offer Private Duty Nursing and Therapy. The mission of Talk Law Radio is to help you discover your legal issue blind spots by listening to me talk about the law on the radio. The state bar of Texas is the state agency that governs attorney law licenses. The State Bar wants attorneys to inform the public about the law but does not want us to attempt to solve your individual legal problems upon the basis of general information. Instead, contact an attorney like Todd A. Marquardt at Marquardt Law Firm, P.C. to discuss your specific facts and circumstances of your unique situation. Leave a legacy that makes a positive impact on people's lives Chat online at MarquardtLawFirm.com to schedule an appointment to help you create a legally enforceable last will, living trust, or tax protected inheritance plan. Tell a friend what this show is about discovering hidden legal issue blind spots like in business and estates and elder law. Today's hidden legal issue blind spot is "Citizenship." Subscribe to the Talk Law Radio YouTube channel to watch the show in four separate segments. Like & Subscribe! https://www.youtube.com/@talklawradio3421 Listen here! www.TalkLawRadio.com Work with Todd! https://marquardtlawfirm.com/ Join attorney Todd Marquardt every week for exciting law talk on Talk Law Radio! Follow Shannon Salmon-Haas! Instagram: @shannonrobertasanantonio Tik Tok: @shannonrobertasa Facebook: @Shannon Roberta San Antonio See omnystudio.com/listener for privacy information.

SummaryThe conversation delves into the evolving role of artificial intelligence (AI) in healthcare, particularly its implications for compliance, documentation, and evaluation and management services. The speakers discuss the benefits and challenges of AI, emphasizing the need for providers to understand its limitations and the importance of maintaining accurate documentation. They also explore the complexities of billing for evaluation and management services, highlighting the risks associated with improper documentation and the scrutiny from insurance companies.TakeawaysAI is significantly impacting healthcare, especially in diagnostics.Providers must ensure they understand AI's limitations and capabilities.Compliance and documentation are critical when using AI tools.There are many pitfalls in AI that providers need to be aware of.Patients have the right to opt out of AI-assisted documentation.The importance of accurate documentation cannot be overstated.Modifiers like 25 and 59 are often misused in billing.Commercial payers are becoming more aggressive in audits.Public comments can lead to better regulatory outcomes.Documentation manipulation is a serious concern in healthcare.

In this episode of Compliance Conversations, host CJ Wolfsits down with returning guest Sean McKenna, a Partner at Nelson Mullins and former Federal Prosecutor, to explore the critical issues at the intersection of healthcare law and compliance. From the challenges posed by the False Claims Act to the innovative use of data analytics in enforcement, Sean offers firsthand insights drawn from years of legal practice. Whether you're managing a compliance program or navigating regulatory challenges, this episode delivers actionable strategies and expert predictions for the future. What You'll Learn: - How evolving legal standards impact healthcare providers - The role of whistleblower initiatives in driving compliance - Data analytics as a game-changer in regulatory enforcement - Strategies to build and maintain effective compliance programs - Predictions for upcoming changes in healthcare law and regulation

Join us for an eye-opening conversation on Compliance Conversations, where CJ Wolf interviews Nick Sahar, founder of Semantic Health and pioneer in AI for medical coding. In this episode, you'll learn: - How AI enhances coding accuracy and speeds up workflows. - Practical use cases for AI in coding, auditing, and clinical documentation. - What the future holds for AI in healthcare compliance. Don't miss this must-listen discussion about how technology is shaping the future of healthcare compliance and coding.

Summary In this conversation, Sean discusses the critical issue of healthcare fraud, emphasizing the roles of the Department of Justice and the Office of the Inspector General. He outlines various laws and regulations, shares alarming statistics about fraud losses, and highlights emerging challenges in the healthcare landscape. Sean also explores the impact of technology on fraud detection and prevention, provides real-world case studies, and offers actionable recommendations for healthcare providers to combat fraud effectively. Takeaways The DOJ and OIG are crucial in combating healthcare fraud. Healthcare fraud includes various deceptive practices. Fraud costs the U.S. healthcare system billions annually. Whistleblower claims are increasing in healthcare fraud cases. Telehealth has created new vulnerabilities for fraud. AI and technology are essential tools in fraud detection. Regular training and education are vital for healthcare staff. Collaboration among stakeholders is necessary to combat fraud. Regulatory frameworks must adapt to new challenges. A proactive approach is needed to protect healthcare integrity.

Dive into the transformative world of technology-driven healthcare safety with Amanda Penrod, PhD, MBA, CASC, CEO & Founder of RFX Solutions. In this compelling episode, Amanda addresses the urgent challenges facing healthcare compliance and patient safety, sharing how strategic technology partnerships can be game-changers for healthcare organizations. Discover the key barriers to creating a safety-focused culture and explore actionable strategies and innovative tools to streamline compliance and empower staff management. Gain expert insights on what sets true technology partners apart and learn how to navigate the evolving healthcare landscape confidently.This episode is sponsored by RFX Solutions.

Dive into the transformative world of technology-driven healthcare safety with Amanda Penrod, PhD, MBA, CASC, CEO & Founder of RFX Solutions. In this compelling episode, Amanda addresses the urgent challenges facing healthcare compliance and patient safety, sharing how strategic technology partnerships can be game-changers for healthcare organizations. Discover the key barriers to creating a safety-focused culture and explore actionable strategies and innovative tools to streamline compliance and empower staff management. Gain expert insights on what sets true technology partners apart and learn how to navigate the evolving healthcare landscape confidently.This episode is sponsored by RFX Solutions.

The Emergence of Innovative Partnerships: As AI becomes increasingly integral across industries, healthcare is at the forefront of adopting these technologies to improve patient outcomes and streamline services. Sean Martin emphasizes the collaboration between StackAware and Embold Health, setting the stage for a discussion on how they leverage HITRUST to enhance healthcare solutions.A Look into StackAware and Embold Health: Walter Haydock, founder and CEO of StackAware, shares the company's mission to support AI-driven enterprises in measuring and managing cybersecurity compliance and privacy risks. Meanwhile, Steve Dufour, Chief Security and Privacy Officer of Embold Health, describes their initiative to assess physician performance, guiding patients toward top-performing providers.Integrating AI Responsibly: A key theme throughout the conversation is the responsible integration of generative AI into healthcare. Steve Dufour details how Embold Health developed a virtual assistant using Azure OpenAI, ensuring users receive informed healthcare recommendations without long-term storage of sensitive data.Assessment Through Rigorous Standards: Haydock and Dufour also highlight the importance of ensuring data privacy and compliance with security standards, from conducting penetration tests to implementing HITRUST assessments. Their approach underscores the need to prioritize security throughout product development, rather than as an afterthought.Navigating Risk and Compliance: The conversation touches on risk management and compliance, with both speakers emphasizing the importance of aligning AI initiatives with business objectives and risk tolerance. A strong risk assessment framework is essential for maintaining trust and security in AI-enabled applications.Conclusion: This in-depth discussion not only outlines a responsible approach to incorporating AI into healthcare but also showcases the power of collaboration in driving innovation. Sean Martin concludes with a call to embrace secure, impactful technologies that enhance healthcare services and improve outcomes.Learn more about HITRUST: https://itspm.ag/itsphitwebNote: This story contains promotional content. Learn more.Guests: Walter Haydock, Founder and CEO, StackAwareOn LinkedIn | https://www.linkedin.com/in/walter-haydock/Steve Dufour, Chief Security & Privacy Officer, Embold HealthOn LinkedIn | https://www.linkedin.com/in/swdufour/ResourcesLearn more and catch more stories from HITRUST: https://www.itspmagazine.com/directory/hitrustView all of our HITRUST Collaborate 2024 coverage: https://www.itspmagazine.com/hitrust-collaborate-2024-information-risk-management-and-compliance-event-coverage-frisco-texasAre you interested in telling your story?https://www.itspmagazine.com/telling-your-story

The Emergence of Innovative Partnerships: As AI becomes increasingly integral across industries, healthcare is at the forefront of adopting these technologies to improve patient outcomes and streamline services. Sean Martin emphasizes the collaboration between StackAware and Embold Health, setting the stage for a discussion on how they leverage HITRUST to enhance healthcare solutions.A Look into StackAware and Embold Health: Walter Haydock, founder and CEO of StackAware, shares the company's mission to support AI-driven enterprises in measuring and managing cybersecurity compliance and privacy risks. Meanwhile, Steve Dufour, Chief Security and Privacy Officer of Embold Health, describes their initiative to assess physician performance, guiding patients toward top-performing providers.Integrating AI Responsibly: A key theme throughout the conversation is the responsible integration of generative AI into healthcare. Steve Dufour details how Embold Health developed a virtual assistant using Azure OpenAI, ensuring users receive informed healthcare recommendations without long-term storage of sensitive data.Assessment Through Rigorous Standards: Haydock and Dufour also highlight the importance of ensuring data privacy and compliance with security standards, from conducting penetration tests to implementing HITRUST assessments. Their approach underscores the need to prioritize security throughout product development, rather than as an afterthought.Navigating Risk and Compliance: The conversation touches on risk management and compliance, with both speakers emphasizing the importance of aligning AI initiatives with business objectives and risk tolerance. A strong risk assessment framework is essential for maintaining trust and security in AI-enabled applications.Conclusion: This in-depth discussion not only outlines a responsible approach to incorporating AI into healthcare but also showcases the power of collaboration in driving innovation. Sean Martin concludes with a call to embrace secure, impactful technologies that enhance healthcare services and improve outcomes.Learn more about HITRUST: https://itspm.ag/itsphitwebNote: This story contains promotional content. Learn more.Guests: Walter Haydock, Founder and CEO, StackAwareOn LinkedIn | https://www.linkedin.com/in/walter-haydock/Steve Dufour, Chief Security & Privacy Officer, Embold HealthOn LinkedIn | https://www.linkedin.com/in/swdufour/ResourcesLearn more and catch more stories from HITRUST: https://www.itspmagazine.com/directory/hitrustView all of our HITRUST Collaborate 2024 coverage: https://www.itspmagazine.com/hitrust-collaborate-2024-information-risk-management-and-compliance-event-coverage-frisco-texasAre you interested in telling your story?https://www.itspmagazine.com/telling-your-story

Summary In this conversation, Sean and his guests discuss various pressing issues in healthcare, focusing on the implications of HIPAA violations, the challenges of patient privacy, and the recent controversies surrounding the Epic EMR system. They delve into the complexities of unauthorized access to patient information, the role of AI in healthcare compliance, and the legal ramifications of the recent overturning of the Chevron deference. The discussion highlights the importance of statistical sampling in overpayment estimations and the evolving landscape of healthcare legislation, particularly in light of the False Claims Act. Takeaways Epic EMR's interoperability issues have led to legal challenges. HIPAA compliance is critical in protecting patient information. Unauthorized access to medical records is a growing concern. AI tools in healthcare require careful human oversight. Zero paid claims must be considered in overpayment estimations. The Chevron deference ruling will impact regulatory interpretations. The False Claims Act's provisions are under legal scrutiny. Veterans' support is crucial, especially in times of need. Healthcare professionals must prioritize patient privacy and compliance. The Epic EMR Controversy Explained The Future of the False Claims Act "Epic has not particularly been a company that plays well in the sandbox." "You can't just think that signing a waiver will protect you." Chapters Introduction and Context Setting 02:54 The Epic EMR Controversy 07:53 HIPAA Violations and Patient Privacy 14:59 Unauthorized Access and Compliance Challenges 20:02 The Impact of AI on Healthcare Compliance 24:56 Statistical Sampling and Overpayment Estimation 30:07 The Future of Healthcare Regulations 36:09 Closing Thoughts and Call to Action

Summary In this conversation, Sean and Nicole Thorn discuss the increasing challenges healthcare providers face regarding compliance, particularly in light of rising audit risks and overpayment demands. They explore the complexities of healthcare law, the role of attorneys in navigating disputes, and the importance of proactive compliance strategies. The discussion also touches on the impact of AI in healthcare and the necessity for providers to adapt to these changes while maintaining a culture of compliance. Takeaways Healthcare providers are facing a significant increase in audit risks. The complexity of healthcare law requires specialized legal expertise. Overpayment demands from payers are becoming more aggressive and frequent. Proactive compliance strategies can mitigate risks and improve outcomes. AI is being increasingly utilized by payers to identify potential issues. Effective communication with payers is crucial for dispute resolution. Providers must be prepared to defend their billing practices against audits. The cost of compliance is rising due to increased regulatory scrutiny. Understanding the nuances of payer agreements is essential for providers. A culture of compliance can help providers navigate the challenging healthcare landscape.

Welcome to "Beyond Healthcare Compliance with Joanna Lambert, Director Healthcare Consulting & Advisory," where we delve into the dynamic world of healthcare consulting. In this episode, we introduce you to Joanna Lambert, a healthcare consultant and director at EisnerAmper. She shares her professional journey, detailing her extensive background and experience in the healthcare industry. Discover the critical work she does for healthcare organizations, from improving operational efficiency to strategic planning and financial management. Learn about the top three trends currently shaping the healthcare landscape, and gain insights into her favorite areas of focus within the field. Our director also gives valuable advice on what healthcare organizations should prioritize to achieve financial success in today's challenging environment. Additionally, she highlights the comprehensive services that EisnerAmper's healthcare team offers, designed to support, and elevate healthcare organizations. Join us for an engaging and informative discussion that offers a wealth of knowledge and ability for anyone involved in the healthcare sector.

Innovation comes in many forms, and compliance professionals must be ready for and embrace it. Join Tom Fox, the Voice of Compliance, as he visits with top innovative minds, thinkers, and creators in the award-winning Innovation in Compliance podcast. In this episode, Tom welcomes compliance aficionado Maria Villanueva to dive deeply into healthcare compliance.  In this episode, Tom and Maria discuss her diverse career trajectory from accounting to healthcare compliance and delve into the complexities of ethical selling, aggregate spending challenges, and the growing role of AI in the compliance industry. Drawing on her extensive experience, she offers valuable insights on balancing roles in compliance and HR, the impact of data analytics, and the future landscape of healthcare compliance. Key Highlights Passion for Healthcare Challenges in Healthcare Compliance Balancing Compliance and HR Roles The Role of Data Analytics and AI in Compliance Future of Healthcare Compliance Resources Maria Villanueva on  LinkedIn  Tom Fox Instagram Facebook YouTube Twitter LinkedIn

Jennifer Geetter, a partner at McDermott, Will and Emery, shares insights on AI and data governance, compliance issues related to AI and privacy, and how state and federal guidance can impact AI innovation in healthcare.00:00 - Introduction01:02  - Jennifer's background and role as a digital health lawyer04:11  - Types of clients / legal needs in digital health09:37 - COVID's impact on healthcare delivery and digital health trends14:41  - Challenges faced by digital therapeutics and the future of digital health19:21  - AI capabilities, regulatory guardrails, and considerations for healthcare companies24:55  - Specific applications of AI in clinical contexts and physician support28:38  - Balancing AI risks and benefits in healthcare33:53  - AI governance, regulatory landscape, and the importance of public trust Jennifer Geetter: https://www.linkedin.com/in/jennifer-geetter-6107406/Chris Hoyd: https://www.linkedin.com/in/chrishoyd/For the full YouTube video: https://youtu.be/l6-F2Stemv0McDermott Will & Emery Website: https://www.mwe.com/  Product in Healthtech is community for healthtech product leaders, by product leaders. For more information, and to sign up for our free webinars, visit www.productinhealthtech.com.

Join Chanie Gluck as she navigates the complex aftermath of the Change Healthcare cyberattack alongside Landon Tooke, COO and Chief Compliance Officer at Impact Healthcare Solutions. In this insightful episode, they discuss the latest developments and strategies for strengthening cybersecurity in the healthcare sector. Show Notes:  Chanie sets the stage, discussing her experience and the focus of today's episode—the Change Healthcare cyberattack.  Landon, a seasoned healthcare attorney, gives an update on the current situation regarding Change Healthcare, explaining the sequence of events that led to the recent data breaches and the implications for healthcare providers and revenue cycle management (RCM) companies. Detailed breakdown of the cyberattacks by Black Cat, subsequent responses by Change Healthcare, and the emergence of Ransom Hub, a new threat actor claiming possession of sensitive data.  Discussion on how the breach has sparked debates over healthcare data security, antitrust concerns, and the potential reevaluation of large healthcare mergers. [Cybersecurity Focus]: Emphasis on the importance of maintaining cybersecurity vigilance, investing in protective measures, and considering cybersecurity insurance as essential parts of healthcare operations. Conclusion: Chanie and Landon reflect on the broader implications of the cyberattack and stress the need for continuous improvement in cybersecurity strategies within the healthcare industry. --- We're thrilled to announce that "Leaders in Medical Billing" has been recognized by Feedspot as one of the Top 15 Medical Billing and Coding Podcasts on the web, currently ranking in 5th place! Learn more about this honor here https://podcasts.feedspot.com/medical_billing_and_coding_podcasts/

Opening Paragraph This episode of 'The ChatGPT Experiment' features Jennifer, a healthcare consultant specializing in financial data analysis for medical practices. Host Cary Weston engages Jennifer in a conversation about the practical applications of ChatGPT in healthcare, focusing on streamlining administrative tasks and enhancing communication with various healthcare stakeholders. Main Topics Jennifer's role in healthcare and her approach to integrating financial data with clinical outcomes. Specific use cases of ChatGPT in Jennifer's work, including email drafting, marketing, and conference planning. The conversation at the HIMSS conference regarding AI, legal implications, and data security in healthcare. The potential of AI and ChatGPT to alleviate administrative burdens in healthcare settings. Key Insights/Takeaways ChatGPT serves as a valuable partner for organizing thoughts and managing tasks, particularly for those with administrative and managerial responsibilities in healthcare. The importance of accurate data and human oversight in healthcare, especially concerning patient privacy and compliance. ChatGPT's adaptability to different communication styles and needs, facilitating personalized and efficient interaction with various healthcare professionals. Episode Index: Jennifer's Healthcare Background and Financial Data Analysis [00:00:35] Discussion on Healthcare Compliance and Clinical-Business Connection [00:01:31] Using ChatGPT for Efficiency in Emails and Marketing [00:02:33] Examples of ChatGPT Usage in Conference Planning [00:04:03] Adapting Communication for Different Healthcare Audiences [00:07:30] Insights from HIMSS Conference on Healthcare Automation [00:10:17] Data Privacy and Accuracy Concerns in Healthcare [00:14:28] Balancing Human Input and Technological Efficiency [00:15:59] Jennifer's Use of ChatGPT for Organizing and Project Management [00:23:37] Advice for New Users of ChatGPT in Task Management [00:24:57] Closing Remarks and Jennifer's Podcast [00:28:29] About Jennifer McNamara Jennifer is a healthcare consultant with over 20 years of experience in medical practice management. She specializes in helping healthcare organizations understand their financial data and improve communication between business and clinical sides for the benefit of patients. Jennifer is passionate about compliance and enjoys educating others about the healthcare industry. She recently attended the HIMSS conference, contributing her expertise on the integration of technology and healthcare.   Connect with Jennifer: Linkedin: https://www.linkedin.com/in/jennifer-mcnamara-49364586/ Healthcare Inspired Podcast: https://open.spotify.com/show/0w28iXZEdYs701jQSGOB4G?si=gnTZDAJkQW6h1zvKsolS1w   ABOUT THE AUTHOR Cary is a seasoned marketing professional and partner in the Bangor, Maine-based advertising and marketing firm Sutherland Weston. He is a certified “They Ask You Answer” coach – a sales and marketing framework developed by Marcus Sheridan designed to help companies stand out as the voice of authority in their industry and drive measurable sales results. His specialties lie in developing practical and tactical strategies to help businesses overcome sales and marketing challenges.  Cary is available for coaching, consulting, and strategy engagement with businesses and not-for-profit organizations. Connect with Cary: Podcast Website: www.ChatGPTExperiment.com Cary's Agency Website: www.SutherlandWeston.com LinkedIn: https://www.linkedin.com/in/caryweston LINKEDIN NEWSLETTER The Chat GPT Experiment is also a LinkedIn Newsletter and you can find it here: https://www.linkedin.com/newsletters/the-chat-gpt-experiment-7110348839919702016/ MUSIC CREDITS The instrumental music used in this podcast is called “Curious” by Podington Bear”. You can contact the artist here      

“The CAA was the most significant piece of healthcare legislation that we've had since the ACA.” - Sarah Borders Healthcare compliance, especially post-CAA, can be a complex thing for employers to navigate. There's an increased level of scrutiny on employers, with heavy fees for those who don't comply.  This week on Self-Funded with Spencer I'm joined by Sarah Borders, co-founder of Benefits Compliance Solutions. Here are a few key takeaways for consultants: Understanding compliance: Navigating the complex regulations and avoid costly mistakes. Turning compliance into an advantage: Discover how you as a consultant can leverage compliance as a prospecting tool, saving clients from lawsuits, penalties, and headaches. Embracing the benefits of regulation: Understand the purpose of the CAA and how it exposes bad practices, ultimately improving healthcare for everyone. Join us this week on Self-Funded with Spencer to learn how to not get sued. Chapters: 0:00 - Meet Sarah Borders 6:37 - Sarah's Journey To Compliance Expertise 14:05 - The Shift Towards Data-Driven Compliance 17:33 - Remote Work As An Entrepreneur 27:01 - Effective Communication = Effective Information 34:57 - Legal Repercussions Of Cobra Compliance 41:34 - Group Health Plan Compliance 46:20 - Yearly Attestation 54:04 - The Impact Of Regulations On Transparency 1:01:21 - Empowering Clients and Consultants 1:04:38 - The Impact Of CAA On Group Health Plans Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/ Key Words:  #insurance #compliance #industrytrends #ACA #caa #levelfundedplans #Cobra #CobraCompliance #grouphealthplan #ConsolidatedAppropriationsAct #attestation #regulations #consulting #futureofcompliance #healthcarecompliance #selffunded #selffunding #podcast Insurance, Compliance, Industry Trends, ACA, CAA, Cobra, Cobra Compliance, Group Health Plan, Consolidated Appropriations Act, Attestation, Regulations, Consulting, Future Of Compliance, Healthcare Compliance, Self Funded, Self Funding, Podcast --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

“The CAA was the most significant piece of healthcare legislation that we've had since the ACA.” - Sarah Borders Healthcare compliance, especially post-CAA, can be a complex thing for employers to navigate. There's an increased level of scrutiny on employers, with heavy fees for those who don't comply.  This week on Self-Funded with Spencer I'm joined by Sarah Borders, co-founder of Benefits Compliance Solutions. Here are a few key takeaways for consultants: Understanding compliance: Navigating the complex regulations and avoid costly mistakes. Turning compliance into an advantage: Discover how you as a consultant can leverage compliance as a prospecting tool, saving clients from lawsuits, penalties, and headaches. Embracing the benefits of regulation: Understand the purpose of the CAA and how it exposes bad practices, ultimately improving healthcare for everyone. Join us this week on Self-Funded with Spencer to learn how to not get sued. Chapters: 0:00 - Meet Sarah Borders 6:37 - Sarah's Journey To Compliance Expertise 14:05 - The Shift Towards Data-Driven Compliance 17:33 - Remote Work As An Entrepreneur 27:01 - Effective Communication = Effective Information 34:57 - Legal Repercussions Of Cobra Compliance 41:34 - Group Health Plan Compliance 46:20 - Yearly Attestation 54:04 - The Impact Of Regulations On Transparency 1:01:21 - Empowering Clients and Consultants 1:04:38 - The Impact Of CAA On Group Health Plans Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/ Key Words:  #insurance #compliance #industrytrends #ACA #caa #levelfundedplans #Cobra #CobraCompliance #grouphealthplan #ConsolidatedAppropriationsAct #attestation #regulations #consulting #futureofcompliance #healthcarecompliance #selffunded #selffunding #podcast Insurance, Compliance, Industry Trends, ACA, CAA, Cobra, Cobra Compliance, Group Health Plan, Consolidated Appropriations Act, Attestation, Regulations, Consulting, Future Of Compliance, Healthcare Compliance, Self Funded, Self Funding, Podcast --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

The Rethinking Compliance series with MedTrainer is officially available, unlocking a wealth of insights into healthcare compliance and innovative solutions to navigate the ever-evolving landscape. In this episode, Saul Marquez presents the main takeaways of the five engaging episodes from the series with MedTrainer that spotlight key compliance aspects and how technology transforms this critical healthcare landscape. Episode one features Steve Gallion, emphasizing the pivotal role of technology in cultivating a culture of compliance. Saul underscores Steve's journey from founding a medical waste company to revolutionizing healthcare compliance with MedTrainer's advanced platform. Dr. Hira Rashid takes the stage in episode two, shedding light on policy and compliance in healthcare. She delves into federal training, data collection, and regulatory adherence, offering valuable insights on staying ahead in an ever-evolving healthcare environment. Brent Althoff joins the conversation in episode three, unveiling the intricacies of healthcare credentialing and its profound impact on compliance and revenue cycles.  Episode four explores the symbiotic relationship between technology, compliance, and operations, featuring Kevin Stineman's two decades of expertise. The series concludes with Brian Williams in the fifth episode, exploring the three dimensions of compliance—people, process, and infrastructure.  Tune in and learn more about reshaping compliance,  enriching understanding, and gaining tools to navigate the dynamic realm of healthcare Resources: Learn more about MedTrainer on their LinkedIn and on their website here.  Listen to the entire Rethinking Compliance series here. Episode 1: Steve Gaillon - Understanding the Intersection of Technology and Compliance here. Episode 2: Dr. Hira Rashid - The Impact of Health Policy on Your Compliance Strategy here. Episode 3: Brent Althoff - Protecting the Revenue Cycle With Credentialing here. Episode 4: Kevin Stineman - Technology in Healthcare: Stop Trying To Do it All Right Now here. Episode 5: Brian Williams - Compliance Isn't Just the Policy here.

Christian Okeke Christian Okeke is Information Technology Coordinator at Healing Hands Healthcare with years of experience spanning healthcare, government, and other industries. At Healing Hands, Christian oversees IT strategy and HIPAA compliance. He focuses on understanding business needs, communicating effectively across teams, and implementing technologies to drive productivity. Christian is passionate about continuous learning and...

Eden Brownell, director of behavioral science at MPulse Mobile, joins Melina Palmer on The Brainy Business podcast to discuss the application of behavioral science in healthcare delivery. The conversation, which was conducted live at Greenbook's IIEX North America conference, delves into the use of behavioral interventions to drive behavior change in healthcare. Brownell shares two case studies that highlight the power of storytelling, social influence, and understanding user experience to improve patient engagement and outcomes.  From using videos to simulate the consequences of non-compliance to leveraging loss aversion, the episode demonstrates the effectiveness of behavioral design in healthcare. Brownell emphasizes the importance of addressing real barriers to behavior change and tailoring interventions to the specific needs and motivations of the target audience. Everyone interested in implementing evidence-based behavioral strategies to improve engagement and behavior change will find this episode insightful and practical (it's not just for the healthcare industry). Delve into the cutting-edge fusion of behavioral science and healthcare, and its role in optimizing patient results. Learn about the intriguing complexities of healthcare compliance and the psychology behind procrastination and time discounting. Be intrigued by real-world examples of how behavioral science can massively up the ante when it comes to adherence of medical tests. Discover the transformative power of personalized interventions in enhancing health outcomes with the aid of technology. Understand the synergy between behavioral science and healthcare as a pivotal solution to overcoming prevalent health barriers. Show Notes: 00:00:00 - Introduction, Melina Palmer introduces the podcast episode and welcomes Eden Brownell, the Director of Behavioral Science at MPulse Mobile. This episode is a replay of the live podcast interview conducted at Greenbook's IIEX North America conference. 00:03:24 - Getting to Know Eden Brownell, Eden shares her background and how she got into the field of behavioral science, drawing on her love for understanding human behavior and psychology. 00:06:35 - The Intersection of Theater and Behavioral Science, Eden discusses how her background in theater research has influenced her love for research and understanding human behavior. 00:08:57 - The Challenges of Healthcare Compliance, Melina and Eden explore the issue of compliance in healthcare and how behavioral science can help address it. They discuss the concept of present bias and its impact on healthcare decisions. 00:12:07 - Overcoming the Say-Do Gap, The conversation dives into the say-do gap and the challenges of committing to future actions. Eden shares a case study on healthcare compliance and how behavioral science can be applied to improve outcomes. 00:15:26 - Overcoming Engagement Challenges, Eden discusses the challenges of getting people to engage with colon test kits and the importance of getting their attention. They conducted an A/B test using behavioral science messaging to create a sense of ownership (leveraging loss aversion) and found a significant increase in engagement. 00:17:33 - The Endowment Effect and Psychological Barriers, The endowment effect is discussed as a psychological factor that increases the value of something once it is owned. The guest explains how reframing the message to create a sense of ownership can overcome psychological barriers and increase the likelihood of engagement. 00:19:15 - Increasing Engagement with Colon Test Kits, The results of the A/B test showed a 10-15% increase in engagement when using behavioral science messaging and the endowment effect. Eden discusses the importance of addressing barriers and lowering the perceived effort for members to complete the test. 00:20:44 - Next Steps: Completing the Colon Test Kits, The next step is to focus on increasing completion rates for those who have opted in to receive the test kit. Eden discusses using AI and natural language processing to identify barriers and provide resources to overcome them. 00:26:22 - Using AI to Overcome Barriers, AI is used to identify common barriers mentioned by members and provide targeted responses. Eden emphasizes the importance of allowing barriers to be uncovered and addressing them in real time to increase engagement. 00:30:13 - Encouraging Behavior Change, Eden discusses the importance of using nudges and partitions to encourage people to opt in for important activities such as cancer screenings. She emphasizes the need to make the process simple and streamlined while highlighting the value of health care and preventing cancer. 00:31:29 - Successful Storytelling with Video, Eden shares a passion project that involved using video to promote diabetic eye screening. By utilizing loss aversion and creating an emotional impact, the video successfully increased the click rates for scheduling eye exams by over 200%. 00:35:01 - Using Emotion and Storytelling, Eden discusses the power of emotion and storytelling in driving behavior change. By creating videos that evoke strong emotions and resonate with the audience, it becomes easier to connect people to their future selves and encourage them to take action. 00:39:10 - Leveraging Self-Determination Theory, Eden talks about the impact of self-determination theory and social proof in healthcare. By providing real-life experiences and engaging content, such as videos of moms sharing their concerns and experiences, it becomes easier to spark engagement and provide valuable information to individuals. 00:42:19 - Simplifying the Experience, Eden emphasizes the importance of simplifying the experience for individuals. By reducing complexity and perceived effort, it becomes easier to encourage behavior change and make the overall experience more enjoyable and engaging. Examples include incorporating moments of sunshine and removing unnecessary friction. 00:45:50 - Boosting Engagement and Motivation, The discussion focuses on using social aspects and storytelling to drive engagement and motivation in healthcare. By sharing stories and creating content that can be shared with friends and family, healthcare providers can have a bigger impact on the health and well-being of their members. 00:46:51 - Presenting Health Plans to Prioritize Health, Health plans are often focused on making money, but there is an opportunity to push them to prioritize the healthcare of their members. By testing ideas like sharing messages and content that can be easily shared on social media, health plans can have a broader impact on the health of their members and their extended group. 00:47:33 - Messaging and Social Proof, The conversation highlights the importance of messaging and social proof in healthcare. Simply stating statistics like "one in four women will get breast cancer" may not have the desired impact because people often think they won't be the one affected. Finding ways to effectively communicate and simplify these statistics using images and videos is crucial. 00:48:14 - Simplifying Healthcare Information, The discussion emphasizes the need to simplify healthcare information, especially considering low literacy levels and health literacy levels. Using images, videos, and infographics can help bridge the literacy gap and make healthcare information more understandable and accessible. 00:49:16 - Conclusion, Melina's top insights from the conversation. What stuck with you while listening to the episode? What are you going to try? Come share it with Melina on social media -- you'll find her as @thebrainybiz everywhere and as Melina Palmer on LinkedIn. Thanks for listening. Don't forget to subscribe on Apple Podcasts or Android. If you like what you heard, please leave a review on iTunes and share what you liked about the show.  I hope you love everything recommended via The Brainy Business! Everything was independently reviewed and selected by me, Melina Palmer. So you know, as an Amazon Associate I earn from qualifying purchases. That means if you decide to shop from the links on this page (via Amazon or others), The Brainy Business may collect a share of sales or other compensation. Let's connect: Melina@TheBrainyBusiness.com The Brainy Business® on Facebook The Brainy Business on Twitter The Brainy Business on Instagram The Brainy Business on LinkedIn Melina on LinkedIn The Brainy Business on Youtube Learn and Support The Brainy Business: Check out and get your copies of Melina's Books.  Get the Books Mentioned on (or related to) this Episode: Engaged, by Amy Bucher Friction, by Roger Dooley Behavioral Science in the Wild, by Dilip Soman and Nina Mazar What Your Customer Wants and Can't Tell You, by Melina Palmer Designing for Behavior Change, by Stephen Wendel Connect with Eden:  Follow Eden on LinkedIn MPulse Mobile Top Recommended Next Episode: Engaged, with Amy Bucher (ep 164) Already Heard That One? Try These:  Loss Aversion (ep 316) Influence Is Your Superpower, with Zoe Chance (ep 308) You Have More Influence Than You Think, with Vanessa Bohns (ep 197) The Life-Saving Skill of Story, with Michelle Auerbach (ep 288) Behavioral Storytelling, with David Paull (ep 289) Non-Obvious Thinking, with Rohit Bhargava (ep 297) Priming (ep 252) Framing (ep 296) Endowment Effect (ep 139) NUDGES and Choice Architecture (ep 35) Social Proof (ep 87) Partitioning (ep 254) Using Semiotics in Retail, with Rachel Lawes (ep 191) Behavior Change at WW and Beyond (ep 98) Behavioral Science Testing In Real Businesses (ep 94) Behavioral Science in the Wild, with Dilip Soman (ep 241) Designing for Behavior Change with Stephen Wendel (ep 116) Other Important Links:  Brainy Bites - Melina's LinkedIn Newsletter

In this eye-opening episode of Corruption, Crime and Compliance, Michael Volkov takes a deep dive into the world of healthcare compliance and fraud. He explores the history, the transformation, and the unique challenges of healthcare compliance. He also sheds light on the alarming rate of fraud in the healthcare industry and the efforts to combat it.You'll hear him discuss:Compliance in healthcare traces back to the 1990s. Its rise is largely due to aggressive federal enforcement programs and increasing regulation.Four significant trends in healthcare compliance include: Rising consumer demand, escalating prices, and increasing regulation during the era of HMO controversies.The DOJ's use of criminal tools and prosecutions to combat healthcare fraud and circumvent government regulations.The growing importance of the False Claims Act as an enforcement tool.The establishment of a robust regulatory enforcement regime through the Center for Medicare Services and the HHS-OIG.As the healthcare industry comes increasingly under federal government regulation and control, the risks of healthcare fraud are escalating. Despite the development of proactive compliance programs, the industry struggles to keep pace with the level of fraud, waste, and abuse.Beyond the traditional elements of compliance programs, the healthcare industry faces unique challenges. These include managing interactions with physicians, ensuring data privacy, avoiding the employment of ineligible persons, and navigating the complexities of billing, coding, and overpayments.The False Claims Act poses a significant risk for healthcare providers, with nearly 99% of all cases each year immediately settled. The Act has been applied beyond billing and reimbursement issues to include false representations incorporated into a product or a drug.The DOJ regularly conducts nationwide crackdowns on healthcare fraud, arresting numerous defendants involved in healthcare fraud and opioid abuse schemes. A growing area of concern is telemedicine fraud, which has seen a surge with the rise of remote work during the pandemic.KEY QUOTES:“Healthcare is becoming increasingly under federal government regulation and control. And as this occurs, the federal health care risks of fraud are going to be increasing significantly. Private insurance companies are also experiencing continuous growth of fraud and the healthcare industry is really developing proactive compliance programs, but they struggle to keep up with the level of fraud, waste and abuse that they sort of have to pursue.” - Michael Volkov“…one of the most significant risk areas is physician interactions.” - Michael Vokov“Nearly 99% of all False Claims Act cases each year where the government decides to intervene are immediately settled.” - Michael VolkovResourcesMichael Volkov on LinkedIn | TwitterThe Volkov Law Group

What do you get when two attorneys and a compliance expert sit down for a chat? This episode of Compliance Conversations! Tune in to our conversation with Sean McKenna, a partner in Spencer Fane LLP's Dallas office, and Keith Dugger, a shareholder in Hall Render's Dallas office. Sean and Keith bring unique perspectives to our discussion filled with insights and tips for healthcare compliance professionals.

Suganya Karuppana, MD, MHCD, CPE, CHC, CHPQ, Chief Medical Officer at Valle del Sol, talks about the shortage of mental health professionals in Arizona and what's being done about it. We discuss the continued integration of behavioral health and primary care. Dr. Karuppana shares some tips for physicians considering the integration process. Dr. Karuppana is a Board-Certified Family Physician with 20 years of experience in healthcare. She attended Cornell University for her Bachelor of Science degree in Human Biology, Health, and Society and Albany Medical College for her Doctor of Medicine. She completed a Family Medicine Residency and Faculty Development Fellowship at Harbor-UCLA Medical Center in Los Angeles, and a Master of Science degree in the science of health care delivery from Arizona State University. She is a Certified Physician Executive, Certified Professional in Healthcare Quality, and Certified in Healthcare Compliance. Hosted and produced by John McElligott. Arizona Physician magazine and podcast are brought to you by Maricopa County Medical Society. This episode is sponsored by Bahbah Sobers Wealth Management and FirstNet, built with AT&T.

Marketing operations is different in every industry. That's no less true for healthcare, a space notorious for stringent conditions on compliance. Of course, that adds a very important layer to consider when developing a robust strategy. Good thing there are people like Mark Clark, Senior Manager Marketing Operations at Indivior, who get the value of cross-collaboration and breaking down barriers within a company. Mark has been in the sales field, marketing, and marketing operations his whole career. But he's also worked in compliance-heavy industries that whole time, making him uniquely qualified to bring all parties to the table to mitigate risk in profound ways. Join us as we discuss: Developing a “big picture” mindset for the whole company The intersection of risk management, revenue, and operations Managing the evolving field of marketing operations

“The Godfather” of corporate governance and compliance joined Sean to discuss the False Claims Act, Regulatory Compliance Matters and what healthcare professionals should be aware of to avoid unwanted legal entanglements. As the Deputy Chief Counsel, Office of the General Counsel, United States Department of Health and Human Services, Dallas, Texas, Gabriel advised and represented various agencies of the Department of Health and Human Services, including the Center for Medicare and Medicaid Services, the Public Health Service, the Social Security Administration, and the Office of the Inspector General. Gabriel's personal practice includes representing individuals and organizations accused of healthcare fraud and assisting and advising healthcare organizations on corporate governance and compliance matters. Gabriel is board certified as a specialist in Health Law by the Florida Bar. Gabriel is a graduate of DePaul University College of Law and the University of Massachusetts. He is also certified in Health Care Compliance (CHC) by the Society of Corporate Compliance and Ethics and the Health Care Compliance Association (SCCE/HCCA). This national accreditation reflects a professional level of competence and experience in compliance processes sufficient to assist healthcare business organizations to understand and address legal obligations and to promote organizational governance and integrity through the operation of effective compliance programs. Gabriel's specific practice areas include Federal Government Strategies, Healthcare Compliance & Operations, Healthcare Government Investigations & Litigation, Healthcare Qui Tam Investigations & Litigation, State & Local Government Relations, and HIPAA & Health Information Privacy & Security.