The Compliance Guy

By: Sean M. Weiss
  • Summary

  • Sean is the host of “The Compliance Guy” a live production dedicated to the intersection of regulatory compliance and the business of medicine. The show provides timely, accurate, and easy to digest information to healthcare professionals.

    The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape.

    Sean M. Weiss (AKA – The Compliance Guy) has been an industry respected name for more than 25-years. A physician and health system advocate, Sean engages with clients to ensure a “level-playing-field” and due process when allegations and/or accusations of impropriety are leveled by a payor or government investigation agency.

    When Sean is not engaging in administrative, civil and criminal matters on behalf of more than 30 nationally recognized law firms and clients, he is serving as a third-party compliance officer for a dozen organization across the country ranging in size and specialty to ensure a “Culture of Compliance”!

    Sean is a proud member in good-standing with the National Society of Certified Healthcare Business Consultants (NSCHBC), American Health Lawyers Association (AHLA), National Alliance of Medical Auditing Specialists (NAMAS), and the American Academy of Professional Coders (AAPC). Sean holds (CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC, CMC, CMIS, CMOM) national certifications from the Health Care Compliance Association, The National Alliance of Medical Auditing Specialists, The American Academy of Professional Coders and Practice Management Institute.

    Sean M. Weiss
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Episodes
  • Season 8 - Episode -24 - #TerryTuesday - Metadata "The What, When and Who"
    Jan 7 2025

    Summary

    In this episode of the Compliance Guy program, Sean and Terry discuss the importance of understanding compliance and auditing in the healthcare industry as they enter 2025. They emphasize the significance of metadata and audit trails in electronic medical records, the need for documentation integrity, and the challenges that healthcare providers will face in the coming year. The conversation highlights the necessity for providers to stay informed and proactive in their compliance efforts to avoid potential pitfalls and ensure proper practices.

    Takeaways

    • Understanding your tools is crucial for compliance.
    • Metadata serves as an essential audit trail in healthcare.
    • Documentation integrity is vital for patient safety.
    • Providers must be aware of the compliance landscape in 2025.
    • Healthcare fraud is a growing concern that needs attention.
    • Audit trails can reveal critical information about patient care.
    • It's important to educate clients about compliance risks.
    • Being proactive in compliance can prevent serious issues.
    • The healthcare industry is facing increased scrutiny from regulators.
    • Providers should not underestimate the importance of accurate documentation.
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    29 mins
  • Season 8 - Episode 23 - Monday Roundtable - Payor Policies for Telehealth and The OIG's Year-Long Audit of Incident-To Servics
    Jan 7 2025

    Summary

    In this episode, the panel discusses the complexities and challenges surrounding telehealth services, particularly focusing on the regulations, compliance issues, and the evolving landscape of audio-only services. They explore the implications of recent legislative changes, the importance of understanding payer policies, and the need for careful navigation of telehealth guidelines to ensure compliance and effective patient care. The conversation also highlights the specific considerations for behavioral health services and the role of advanced beneficiary notices in the context of Medicare. In this conversation, the panel discusses the complexities of compliance in telehealth, emphasizing the importance of understanding the nuances between different insurance plans. They highlight the necessity of conducting internal audits to ensure adherence to regulations, especially with the Office of Inspector General's increased focus on audits in 2025. The discussion also covers the critical aspects of incident to services, stressing the need for proper supervision and documentation. The panel concludes with insights on optimizing revenue through better compliance practices.

    Takeaways

    • Telehealth regulations are constantly evolving and require careful navigation.
    • Audio-only services have specific guidelines that must be followed to ensure compliance.
    • Behavioral health services have exceptions that differ from general telehealth policies.
    • Payer policies can vary significantly, necessitating thorough research by providers.
    • Advanced Beneficiary Notices (ABNs) are not applicable for non-covered services.
    • Patients may prefer audio-only visits for convenience, but compliance must be maintained.
    • The abuse of audio-only services has led to stricter regulations and scrutiny.
    • Providers must stay informed about the latest coding and billing practices for telehealth.
    • Transparency in healthcare is often not prioritized by patients; they focus on out-of-pocket costs.
    • The future of telehealth services remains uncertain as new regulations are anticipated. Understanding compliance nuances is crucial for telehealth services.
    • Patients must take accountability for their care and coverage.
    • Regular internal audits are essential for compliance and risk management.
    • The OIG's focus on audits will significantly impact providers in 2025.
    • Incident to services require direct supervision and established relationships.
    • Billing data can reveal compliance issues beyond documentation quality.
    • Providers must be aware of state-specific regulations regarding telehealth.
    • The quality of medical records is deteriorating due to over-reliance on templates.
    • Proper training and understanding of billing practices are vital for staff.
    • Optimizing existing services can lead to increased revenue without adding new services.
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    1 hr and 6 mins
  • Season 8 - Episode 22 - From Military to Medicine - Jose Vela, Jr., ESQ
    Dec 16 2024

    Summary

    In this episode, Sean welcomes back Jose Vela Jr., a retired military officer and former federal prosecutor, to discuss his transition into healthcare law. They explore Jose's military career, his experiences as a prosecutor, and the complexities of healthcare fraud cases. The conversation delves into the impact of indictments on healthcare professionals and the importance of understanding the socio-economic factors affecting healthcare delivery. Jose shares insights on the legal landscape and the need for prosecutors to engage with the communities they serve. In this conversation, Jose Vela Jr. discusses various themes surrounding healthcare fraud, the political landscape affecting the justice department, and the implications of pardons in the current political climate. He emphasizes the importance of accountability in crime, the challenges posed by private equity in healthcare, and the need for a balanced approach to healthcare costs and job creation. The discussion also touches on the future regulatory expectations for 2025 and the impact of political changes on healthcare enforcement.

    Takeaways

    • Understanding the socio-economic factors is crucial in healthcare.
    • Indictments can severely impact a healthcare professional's career.
    • Prosecutors often lack insight into the healthcare environment.
    • Healthcare fraud cases require a nuanced understanding.
    • Indictments should not be published without context.
    • Prosecutors need to engage with the communities they serve.
    • There are many cases that never reach indictment.
    • Transparency from the DOJ is essential for public trust. Healthcare fraud cases are on the rise, particularly in Texas.
    • Prosecutors must adhere to strict guidelines regarding public statements.
    • Most criminal cases are resolved without going to trial.
    • The narrative of weaponization of the justice system is prevalent in politics.
    • Pardons are a controversial but legal aspect of presidential power.
    • Job creation in the U.S. is a pressing issue that needs attention.
    • Regulatory changes in 2025 will depend on new leadership in key departments.
    • Private equity's involvement in healthcare can lead to increased costs for consumers.
    • Healthcare costs are rising, impacting patients and their families.
    • A balanced approach is necessary to ensure quality healthcare while managing costs.
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    1 hr and 24 mins

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