Latest Oig Podcast Episodes
Assessing the Impact of Financial Woes Facing America’s Healthcare Providers
Monitor Mondays - August 28, 2023 16:00 - 31 minutes ★★★★ - 19 ratingsFirst there was COVID-19, which seemed to have torn a gaping hole in our nation’s patchwork quilt of care facilities. Add to this the rising costs of everything that touches healthcare, and now the growing list of Chapter 11 bankruptcies rippling through nursing homes and other facilities that p...
Physician Advisors: Revenue Drag or Stimulant?
Monitor Mondays - August 21, 2023 17:00 - 28 minutes ★★★★ - 19 ratingsBroadcast segments will also include these instantly recognizable features: Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds. The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors. Risky Business: Healthcare attorney ...
What’s So Smart About Smart Hospitals?
Monitor Mondays - August 14, 2023 20:00 - 31 minutes ★★★★ - 19 ratingsInformation technology has revolutionized many industries, including healthcare. “Smart” hospitals promise vast increases in productivity, and are being designed as integrated IT platforms linking together technology, patients, and providers in a complex web of interaction. But are the promised...
FY 2024 IPPS Final Rule: Looking Under the Hood for Hazards
Monitor Mondays - August 07, 2023 17:00 - 29 minutes ★★★★ - 19 ratingsThe Centers for Medicare & Medicaid Services (CMS) FY2024 Inpatient Prospective Payment System (IPPS) Final Rule, posted on Aug. 1, reveals changes to the MS-DRG, CMS Hospital Acquired Conditions, and CMS Inpatient Quality Reporting Program affecting inpatient revenue cycles, quality reporting, ...
Proposed Expansion of Medicaid RACs Includes Focus on Managed Care Payments
Monitor Mondays - July 31, 2023 17:00 - 31 minutes ★★★★ - 19 ratingsThe Government Accountability Office (GAO) is recommending expansion of the Medicaid Recovery Audit Contractors (RACs) program, to include auditing of payments made to managed care organizations (MCOs), according to a GAO report released in June. Launched in 2011 as a consequence of the Patient...
New Developments for Defeating Statistical Extrapolations Revealed
Monitor Mondays - July 25, 2023 15:00 - 29 minutes ★★★★ - 19 ratingsThere is a buzz swirling within the healthcare auditing community. And thanks to RACmonitor investigative reporter Edward M. Roche, the news is buzzworthy. According to Roche, a legal team has developed two arguments that can be used by healthcare providers in federal court after the Administra...
$9 Billion Refund to 340B Hospitals at Risk
Monitor Mondays - July 17, 2023 17:00 - 31 minutes ★★★★ - 19 ratingsThe Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to remedy Medicare Part B pay cuts made to 340B hospitals by issuing a lump-sum repayment to affected facilities. Last year, the U.S. Supreme Court ruled that those cuts, implemented by CMS from 2018 through most of 2...
Enforcement and Penalties, Guardrails and Risks: Understanding the 21st Century Cures Act
Monitor Mondays - July 10, 2023 17:00 - 30 minutes ★★★★ - 19 ratingsAlthough the 21st Century Cures Act was enacted in 2016, many hospitals today continue to struggle with effective implementation of its provisions and the goal of preserving patient access to medical records. Seven years later, however, meaningful guidance regarding its enforcement is here. One...
A Story (And interview!) from Norm Foster
Happy Funny Amazing - June 27, 2023 12:52 - 27 minutes ★★★★★ - 5 ratingsTickets for The Foster Festival: https://fosterfestival.com/ Information on the Happy Funny Amazing Storytelling Express Workshop: https://happyfunnyamazing.com/workshops#service-1
The Big Worry. The Big Unwind: Medicaid Disenrollment Keeps Rolling Along
Monitor Mondays - June 26, 2023 18:00 - 29 minutes ★★★★ - 19 ratingsAt least 1.3 million Medicaid enrollees have been disenrolled as of June 20, according to the Kaiser Family Foudation (KFF) “Unwinding Tracker.” This estimate could be an under-count, KFF admits, due to state recordkeeping details. Yet the major issue looms on the horizon: what will happen to th...
Estafas de Préstamos Estudiantiles y Cómo Evitarlos
Eye on ED - June 21, 2023 15:00 - 21 minutesEstoy segura de que todos nuestros oyentes en alguna manera tienen experiencia con los préstamos estudiantiles. Algunos han sacado un préstamo para pagar sus estudios universitarios, otros quizás han ayudado a sus hijos obtener un préstamo, o conocen a alguien que ha obtenido uno. Y desafortun...
Don't Get Caught by Student Loan Scams!
Eye on ED - June 21, 2023 15:00 - 15 minutesCyber criminals and fraudsters are targeting student loan borrowers with schemes and scams aimed at separating you from your money, stealing your personal information, or both. The impact of falling victim to these scams can be severe—your identity stolen, credit cards and loans taken out in you...
How Suffocating Regulations Are Leading to Smart Hospitals
Monitor Mondays - June 19, 2023 16:00 - 30 minutes ★★★★ - 19 ratings“Hospitals may be the most complex organizations in the world,” writes Edward M. Roche, scholar, United Nations consultant, and RACmonitor investigative reporter. “They are tasked with improving patient outcomes, controlling costs, and meeting sustainable environmental goals.” Roche, who will b...
How Staffing Shortages Increase Audits
Monitor Mondays - June 12, 2023 17:00 - 30 minutes ★★★★ - 19 ratingsHealthcare organizations often face staffing shortages in their revenue cycle, adding to the pressure of ensuring proper claims processing. The Centers for Medicare & Medicaid Services (CMS), U.S. Department of Justice (DOJ), and U.S. Department of Health and Human Services (HHS) Office of Inspe...
Running Afoul of Federal Regulations
Monitor Mondays - June 05, 2023 17:00 - 28 minutes ★★★★ - 19 ratingsThis week, a disgraced Elizabeth Holmes was seen in media clips walking in the company of two unidentified men. Evidently, Holmes, who was convicted of fraud for her blood-testing start up, Theranos, turned herself in at a minimum-security prison in Texas to begin an 11-year prison term. All th...
Smart Strategies to Avoid Denials of SNF Transfers
Monitor Mondays - May 22, 2023 18:00 - 31 minutes ★★★★ - 19 ratingsWhy the confusion and the apparent uptick in denials by Managed Care Organizations (MCOs) for skilled nursing facility (SNF) transfers? Returning to report on this vexing topic during the next live edition of Monitor Mondays will be Ben Kartchner, MD, a physician advisor who will join the broad...
How to Avoid Managed Care Denials for SNF Transfers
Monitor Mondays - May 15, 2023 16:00 - 30 minutes ★★★★ - 19 ratingsMedical necessity denials for skilled nursing facility (SNF) transfers by Managed Care Organizations (MCOs) are increasing at an astonishing rate. The reason seems to be a lack of understanding of the difference between skilled and non-skilled care. During an exclusive two-part series being pro...
Compliance Risk and Revenue Loss: Practicing without Privileges
Monitor Mondays - May 08, 2023 17:00 - 28 minutes ★★★★ - 19 ratingsYour medical staff office just notified you that a physician has been performing procedures without privileges for the past five years. No, it doesn’t happen all the time. But what should you do? Physician and attorney Dr. John K. Hall will walk you through the considerations and help you unde...
Stories from Christel Bartelse and Briane Nasimok
Happy Funny Amazing - May 07, 2023 21:11 - 33 minutes ★★★★★ - 5 ratingsCo-Hosts from the popular Live Storytelling Show, But That's Another Story, Christel Bartelse and Briane Nasimok both reach back into their pasts to tell Joanne Happy Funny and Amazing stories of love and loss. Plus, Joanne has an announcement about the next exciting chapter for Happy Funny Amazi...
Utilization and Billing: Reconciling Conflicts
Monitor Mondays - May 01, 2023 17:00 - 30 minutes ★★★★ - 19 ratingsHospital utilization and billing are notoriously challenging concepts for providers and case management staff because they frequently boil down to two, often conflicting points of view: what can be done per the rules, regulations, and contracts, and what should be done to provide the most effect...
The False Claims Act: Will it Live to See Another Day?
Monitor Mondays - April 24, 2023 17:00 - 28 minutes ★★★★ - 19 ratingsThe beleaguered False Claims Act, which traces its origins to the Civil War, came before the Supreme Court this past Tuesday, when the Court heard oral arguments in a consequential and closely watched case involving one of the Government’s most effective tools for fighting healthcare fraud. Sp...
Confronting Artificial Intelligence: Healthcare’s Next Major Disruptor
Monitor Mondays - April 17, 2023 16:00 - 30 minutes ★★★★ - 19 ratingsRecent highly publicized advances in artificial intelligence forecast the elimination of at least 30 percent of the healthcare workforce (probably more), including all generalist physicians. The astonishing scalability of information technology suggests that one to three data centers will be abl...
The Ins and Outs of Procedures: Confronting the CMS Inpatient-Only List
Monitor Mondays - April 10, 2023 18:00 - 25 minutes ★★★★ - 19 ratingsThis year, as in past years, the Centers for Medicare & Medicaid Services (CMS) Inpatient-Only List continues to confuse and bewilder so many healthcare professionals. And it’s little wonder: in 2021, CMS removed 500 surgical procedures from the List, only to reinstate most but not all of the pr...
Reintroducing the Three-Midnight Rule: It’s Back, and it’s a Problem
Monitor Mondays - April 03, 2023 17:00 - 27 minutes ★★★★ - 19 ratingsIt’s back: the Three-Midnight Rule. Created with the nation’s 1965 enactment of Medicare, the Rule provided that patients needed to have at least three consecutive midnights of inpatient care in an acute hospital setting before being admitted to skilled nursing facility (SNF). And then came the...
15 Million Enrollees Soon to be Missing: The Unwinding of Medicaid’s Continuous Enrollment
Monitor Mondays - March 27, 2023 16:00 - 32 minutes ★★★★ - 19 ratingsIt’s the biggest healthcare story of the decade: up to 15 million individuals will soon be disenrolled from Medicaid, when the COVID-19 public health emergency (PHE) shuts down. Those who enrolled in Medicaid during the pandemic must re-enroll to keep their Medicaid coverage. Suddenly, your hosp...
Stories from Judy Holm and Paul Mather
Happy Funny Amazing - March 22, 2023 13:35 - 42 minutes ★★★★★ - 5 ratingsWhat do being a model in the 80s and being alone in a pandemic 40 years later have in common? Producer Judy Holm and Television Writer Paul Mather share very different and amazing stories of overcoming adversity, showcasing the unwavering human spirit that drives us to push through the unexpected...
Reverse False Claims: This Could Happen to You
Monitor Mondays - March 20, 2023 19:00 - 30 minutes ★★★★ - 19 ratingsImagine for a moment that the federal government, through one of its contractors, sends you money for services you don’t believe are covered benefits for a particular patient at your facility. But wait. Don’t react just yet. The best course of action might not be what you think, and it’s defin...
The Anatomy of Fraud: Kickbacks and 64,000 False Claims
Monitor Mondays - March 13, 2023 17:00 - 30 minutes ★★★★ - 19 ratingsFamed whistleblower attorney Mary Inman will return to the Monitor Mondays weekly Internet radio broadcast this coming Monday to report on a unique case in which a jury found that Precision Lens and its owner, Paul Ehlen, illegally paid kickbacks to ophthalmic surgeons to induce their use of the...
National Doctors Day Recognizes Physicians as Gatekeepers
Monitor Mondays - March 06, 2023 18:00 - 28 minutes ★★★★ - 19 ratingsWe at Monitor Mondays will begin a monthlong observance of National Doctors’ Day this coming Monday, March 6. Although the 90-year-old recognition of American physicians is March 30, during the next live edition of our weekly Internet radio broadcast we will recognize the contributions of Scott...
FCA Fraud Against U.S. Tops $2.2 Billion
Monitor Mondays - February 27, 2023 17:00 - 30 minutes ★★★★ - 19 ratingsThe U.S. Department of Justice (DOJ) reports that fraud against the U.S. under the federal False Claims Act (FCA) has amounted to $2.2 billion recovered in settlements and judgments for the 2022 fiscal year. As in past years, FCA recoveries in the healthcare and life sciences industries cont...
Related Oig Topics
- Medicaid 3
- Poignant 3
- Fraud 3
- Investigation 3
- Government 2
- Audit 2
- Healthcare 2
- Cms 2
- Regulatory 2
- Medicare 2
- Health 2
- Storytelling 2
- True stories 2
- Funny 2
- Hhs 2
- Crime 2
- Scheme 2
- Scam 2
- Agent 2
- Compliance 2
- Providers 2