Stark Integrity

Latest Episodes:

Unique Trends and Compliance Issues with Value-Based Reimbursement Arrangements: A Discussion with Christine Worthen of Nelson Mullins Mar 21, 2023

Show notes

Send us Fan Mail

There’s been a fascinating shift to value-based reimbursement arrangements from those based on production. In this episode, Captain Integrity Bob Wade discusses trends and issues in that space with Christine Worthen, Partner at Nelson Mullins. Hear why you should consider your strategic planning for the glide path to risk, look at the regulatory addendum and negotiate it, always have providers at the table, opportunities within deferred compensation, and how you can mitigate the risk of takebacks. Learn more at CaptainIntegrity.com

Logos and Slogans to Promote an Effective Compliance Program Mar 14, 2023

Show notes

Send us Fan Mail

Creating a tagline, slogan, or logo could be an effective way to market and promote your compliance program. In this episode, Captain Integrity Bob Wade dives into the marketing of your compliance program. Hear how a logo helps promote the identification of your compliance program, why it should be consistently used, why it doesn’t ensure an effective compliance program on its own, the story of Captain Integrity, and some nostalgia around Schoolhouse Rock! Learn more and check out the white paper at CaptainIntegrity.com

One Purpose Test: Greber vs. Holland; A discussion with Gabe Imperato with Nelson Mullins Mar 08, 2023

Show notes

Send us Fan Mail

Unfortunate statements and emails can trigger a long and expensive journey for an organization. In this episode, Captain Integrity Bob Wade discusses the Greber and Holland cases as they relate to the One Purpose test with Gabe Imperato, longtime friend and Partner at Nelson Mullins. Hear why the U.S. v. Holland case is a significant decision, the court looked for evidence of willful conduct, the decision exposes the shortcomings of the One Purpose Test, when it’s optimal for the government to apply the One Purpose Test, and why educating your organization on these matters is so important. Learn more at CaptainIntegrity.com

Waiving Copays: Legal or Illegal? Feb 28, 2023

Show notes

Send us Fan Mail

Waiving copays and deductibles has to be performed in a specific manner. In this episode, Captain Integrity Bob Wade details the ins and outs of waiving copays. Hear why the routine waiver of copays and deductibles can be illegal, you can waive them in certain instances, what will cause a claim to be overstated, what exactly a copay waiver is, and examples from recent cases. Learn more at CaptainIntegrity.com

DOJ 2022 False Claims Act Settlements and Judgments: Learning Points Feb 22, 2023

Show notes

Send us Fan Mail

There’s an interesting issue with respect to the amount of the collections in 2022. In this episode, Captain Integrity Bob Wade highlights the learning points from the DOJ (Department of Justice) 2022 False Claims Act (FCA) Settlements and Judgments. Hear why the qui tam bar still represents the largest dollar amount of settlements, individual accountability is still occurring, we’re still seeing classic fraud and abuse issues, the most notable cases and issues, and how the 2022 numbers compare to previous years. Learn more at CaptainIntegrity.com

Compliance Effectiveness: It Is about the Culture of the Organization Feb 14, 2023

Show notes

Send us Fan Mail

One of the most effective parts of a compliance program is to have a compliant culture. In this episode, Captain Integrity Bob Wade breaks down how to foster a culture of compliance. Hear why an ethical culture starts at the top, how to understand the culture of an organization, what to do if you believe your organization is making unethical decisions, how to measure the effectiveness of your compliance program, and the infamous examples of Enron and FTX. Learn more at CaptainIntegrity.com

Value-Based Arrangements Key Issues: A Discussion with Kelly Conroy from Pinnacle Healthcare and Ed White from Nelson Mullins Feb 08, 2023

Show notes

Send us Fan Mail

The new rules create new standards that reduce compliance risk. In this episode, Captain Integrity Bob Wade discusses the key issues in value-based arrangements with Kelly Conroy, Principal at Pinnacle Healthcare, and Ed White, Partner at Nelson Mullins. Hear why now is the time to start your value-based care strategy, value-based enterprises can be used as a strategy for providers to leverage their value proposition with payers, it’s time to get a fresh perspective on the healthcare market landscape, where the government will help most, and the “Holy Grail” of arrangements. Learn more at CaptainIntegrity.com

Medical Necessity: A Major Compliance Issue and Risk Jan 24, 2023

Show notes

Send us Fan Mail

Physicians may believe a test or procedure is medically necessary, but payers make the final determination. In this episode, Captain Integrity Bob Wade details medical necessity and the implications for Stark Law compliance. Hear why payers make the medical necessity determination, patients are in control, we can compensate a physician if the patient desires additional services, what the Medicare payment rules say, and examples from the medical field. Learn more at CaptainIntegrity.com

Audit Work Plan Development: The Who, What, and How Jan 17, 2023

Show notes

Send us Fan Mail

How do you audit practically? In this episode, Captain Integrity Bob Wade breaks down the Who, What, and How of audit work plan development under the Stark Law. Hear why you shouldn’t do it alone, how to look at the government resources out there, use some type of numerical weighting to assess risks, why auditing isn’t rocket science, and a sausage analogy from Bob. Learn more at CaptainIntegrity.com

Corporate Practice of Medicine (CPOM) Compliance: A Discussion with Heather Miller from Nelson Mullins Jan 10, 2023

Show notes

Send us Fan Mail

Make sure that management fee is in order. In this episode, Captain Integrity Bob Wade talks Corporate Practice of Medicine (CPOM) compliance with Heather Miller, Healthcare Transactional and Regulatory Lawyer at Nelson Mullins. Hear why you need to substantiate the management fee in your paperwork, stick with a flat management fee, check state laws on leasing, how CPOM ties to the Stark Law, and what varies the most by state. Learn more at CaptainIntegrity.com

Our TOPPODCAST Picks

Follow Us

Stay Connected

Related Podcasts

Links

Stay Connected

Our TOPPODCAST Picks

Follow Us

Stay Connected

Stark Integrity

Related Podcasts

1

2

3

4

5

6