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

·31 min·3 clips

Healthcare attorney David Glazer argues that gutting CMS regional offices risks leaving providers with nowhere to turn for help.

The episode begins with host Chuck Buck introducing the show's focus on CMS actions and a claims denial crisis. Dr. Bonnie Olney substitutes for Ronald Hirsch in Monday Rounds, presenting a case study of an elderly Medicare patient with poor documentation that fails to justify inpatient care, highlighting compliance issues under 2023 E&M rules. Healthcare attorney Nicole Emanuel delivers the RAC Report, explaining how standard Medicare audits are evolving into False Claims Act investigations, with penalties up to $27,018 per claim and treble damages, exacerbated by AI-driven audit tools that lack context. After a sponsor ad for Drug Code Pro, healthcare attorney David Glazer gives the Risky Business Report, arguing that CMS regional office closures and random government firings are dangerous, noting Medicare's efficiency compared to private insurance and warning of reduced oversight. Another sponsor ad promotes a webcast on wound care audits. Adam Brenneman provides the Legislative Update, detailing HHS restructuring under Secretary Robert F. Kennedy Jr. that cut 10,000 jobs, including 3,500 at FDA and 2,400 at CDC, with concerns about public health impacts. Senior healthcare analyst Frank Cohen reports the lead story on 'pay-and-chase' tactics, citing a $23 million acupuncture fraud case by Junyi Liu and a 40% increase in post-payment reviews, advising providers on internal monitoring and documentation. In a final discussion, Glazer and Cohen touch on regional office consolidation and extrapolation challenges in appeals. The episode concludes with acknowledgments and a promo for Talk Ten Tuesday.

As heard by us

A candid healthcare policy discussion on claims denials, CMS enforcement, and the fallout from regional-office closures.

Monitor Monday centers on a healthcare payment fight with immediate practical stakes: CMS is pursuing claims it sees as error-prone, while senior healthcare analyst Frank Cohen leads a segment on the denial crisis.

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Why you'd press play

Need to see how CMS scrutiny over error-prone claims can spill into a provider's day-to-day reality?

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