Listen Now!

Business Talk 24-7

Top Docs Radio

Month: February 2016

Health Care Fraud and False Claims

Posted on

Podcast: Download

false claims

Scott Grubman, CW Hall, and James Marcus talk healthcare fraud.

Health Care Fraud and False Claims

I hosted 2 False Claims Act legal experts on this week’s MAG edition of Top Docs Radio.  You’re going to want to check out what they have to say, as it could mean the difference between practicing medicine or not, in the end.

Scott Grubman is a partner with the law firm of Chilivis Cochran Larkins & Bever in Atlanta. He represents health care providers of all types and sizes with government investigations and audits, False Claims Act, and other complex litigation and various regulatory and compliance matters.  Prior to joining private practice, Scott served as a trial attorney with the U.S. Department of Justice in Washington, D.C., and as an assistant U.S. attorney in Savannah – where he served on a district health care fraud taskforce.  Scott also serves as an adjunct professor at Georgia State University’s College of Law, where he teaches a course in health care fraud and abuse.

Jason Marcus is among a select group of lawyers who devote their practice to qui tam and related retaliation claims under federal and state False Claims Acts. He has practiced FCA law exclusively since 2008, and he formed the firm of Bracker & Marcus in January of 2015 with partner Julie Bracker, who is dedicated to representing whistleblowers nationwide. Jason is a 2006 graduate of the University of Georgia School of Law, a former clerk to the honorable Magistrate Judge G.R. Smith of the Southern District of Georgia, and a member of Taxpayers Against Fraud Education Fund and the Georgia affiliate of the National Employment Lawyers Association.

Health care is one of the fastest growing and most heavily-regulated industries in the United States.  Given that government payers (Medicare, Medicaid, etc.) finance a significant portion of the system, regulators and law enforcement have dedicated tremendous resources to rooting out and punishing fraud and abuse in health care.  In fiscal year 2015 alone, the federal government recovered nearly $2 billion in settlements and judgments from health care providers under the federal False Claims Act, which does not include recoveries through audits and other administrative avenues.

Moreover, not only are the actions of healthcare providers constantly scrutinized by federal and state auditors

and law enforcement, but also by competitors, commercial insurance companies, private whistle blowers, and the public. Big hospitals and health care entities with “deep pockets” have historically carried the bulk of the liability in government enforcement actions.  But beginning in 2015, the federal government announced a new policy which focuses on holding individuals – particularly individual health care providers – responsible and liable for unlawful conduct. A lot of the laws governing health care fraud and abuse do not require a specific intent to defraud or even actual knowledge of the unlawful nature of the conduct. In fact, one of the major laws governing health care fraud and abuse (the physician self-referral law or “Stark law”) requires no culpable mindset whatsoever.  Accordingly, it is crucial for health care professionals of all types to be aware of the various statutory and regulatory schemes that govern health care billing and to act accordingly.

MORE INFO SOON!

Special Guests:

Scott Grubman

false claims

Jason Marcus

false claims

Cash Flow For The Medical Practice

Posted on

Podcast: Download

cash flow

Mr. Cash Flow

Cash Flow For The Medical Practice

I sat down with David Wiener, aka “Mr. Cash Flow” on this week’s episode.  I connected with David first on LinkedIn a few weeks ago.  After learning more about the various ways he is able to help a medical or dental practice recapture revenue that is currently being lost, I knew I needed to have him on the show.

David spent numerous years as a practice manager for a doctor’s office, so he knows very well the challenges these practices face trying to maximize the revenue they get to keep for the care they provide.  With patient out-of-pocket obligations significantly on the rise, physicians are experiencing a corresponding increase in the number of patient balance bills they must collect upon to be paid for their services.

David provides access to a service that for only $12 per claim (instead of a typical % of the amount to be collected), that dramatically increases the success rate for bills collected to over 80% in the first 30-45 days from date of bill.

We also talked about other ways Cash Flow Strategies, Inc., is able to help their medical and dental practice clients drop more revenue to the bottom line.  One such way is to enroll their staff into a wellness program as provided for by the ACA.  Businesses that do so can save as much as $500 per employee per year on the Federal income tax they must pay for each of them.  Additionally, as employees take advantage of these wellness benefits, they tend toward better levels of health, decreasing the company’s expenditure for health benefits.

David also talked about a company he’s partnered with that can help a business change all the lights within the building to LED lights, saving enormous amounts of money on utility bills.  They offer a plan through which the business can pay for the lights over time, with the payments + new utility bills amounting to less than previous utility bills were, providing savings from the first month.

There are several other ways David is likely able to reduce amounts being spent by the business, such as procurement costs for necessary supplies through a competitive group purchasing organization and others.  It is clear that any medical or dental practice can benefit from taking a few minutes to talk with David to determine just how much additional revenue they can capture—all without having to work longer or harder.

Special Guest:

David Wiener, “Mr. Cash Flow”, of Cash Flow Strategies, Inc.

cash flow

MAG’s MEP 401(k)

Posted on

Podcast: Download

MAG's 401(k)

Kevin Rainwater talks MAG’s 401(k) plan

MAG’s MEP 401(k)

We continue our series with Medical Association of Georgia, hosting Kevin Rainwater of Atlanta Capital Group to learn about MAG’s MEP 401(k) plan.  Kevin Rainwater is a managing partner with Atlanta Capital Group, specializing in retirement planning.

Kevin began his career in the financial services industry more than 16 years ago. He has a passion for helping employees, executives and business owners reach their retirement goals. Kevin provides investment and plan advisory services to companies and individuals throughout the nation.

He relies on his extensive knowledge of qualified plan design and investment offerings to provide business owners and participants with the most competitive retirement plan option available.

MAG member practices can save time and money and retain employees by participating in a MAG-sponsored 401(k) retirement plan that’s available through the Atlanta Capital Group and Transamerica.

The MAG 401(k) Plan is treated like one large plan from a government Form 5500 reporting standpoint. The result is a 401(k) plan with competitive investments, outstanding service, and someone else doing a majority of the plan maintenance leg work. With more than 7,800 members, MAG offers a large, unified plan.

When you utilize the MAG 401(k) Plan, you have all of the advantages and flexibility of a stand-alone plan, while avoiding the expenses and administrative headaches associated with sponsoring a stand-alone plan.

Member benefits include cost savings on the investments; No individual Form 5500 reporting; Minimal plan maintenance; Flexible plan features, including safe harbor; Roth and profit sharing; Customizable 401(k) plan design options involving eligibility, matches, and vesting schedules; No audit at member level.

By participating in the MAG 401(k) Plan, virtually all of the administrative tasks can be offloaded from the practice to Transamerica, ACG, and MAG.

Special Guest:

Kevin Rainwater, Partner, Atlanta Capital Group  linkedin_small1  twitter_logo_small-e1403698475314

MAG's 401(k)

  • BS, Marketing, University of Alabama
  • Previous Regional Sales Director, First Mercantile
  • Former Director, National Accounts, The Standard

 

Dr. Scott Beach

Posted on

Podcast: Download

Heart & Vascular Care

Dr. Scott Beach talks vascular disease.

Dr. Scott Beach

On this week’s show I sat down with interventional cardiologist, Dr. Scott Beach, of Heart & Vascular Care, with offices in Johns Creek, Cumming, and Canton, GA.  I’ve known Dr. Beach for several years through the practice I was working for (Hyperbaric Physicians of Georgia).  Our physicians have worked with him on numerous patients’ cases, both sending him folks who needed to have their blood flow to their lower extremities evaluated, as well as providing specialized wound care for patients he and his colleagues occasionally see in their practice.

Dr. Beach share how he enjoys the fact that his relationship with his patients and their loved ones tends to extend over years rather than being short and limited to a procedure or two.  We talked about vascular disease and some things both patients and doctors need to think about to get problems identified and treated early.

Scott explained how often, symptoms of developing vascular disease are mild and gradually reduce the patient’s tolerance to activity.  In many instances, the patient and their family merely chalk the changes up to “getting older”.  That’s dangerous, because it means the blockage of blood flow that’s causing the symptoms continues to grow until a major event occurs such as a heart attack, stroke, or possibly a limb amputation.

We discussed the fact that there are simple, non-invasive studies that can reveal early vascular disease when it’s easier and more-likely-successful to treat with more options to choose from.  Additionally, we talked about the fact that having pulses that can be felt on a patient’s foot is NOT an accurate means of determining whether a patient has vascular disease that needs attention in many patients.

Additionally, when patients have a wound on their foot or leg that is healing slowly or not at all, it is very important to know whether blockage of blood flow is contributing to the inability to heal.  Too often, these patients go for amputation that could have been readily prevented with one of those non-invasive or minimally-invasive studies he described.  For patients with a wound that’s not healing, it is important for them to have a multiple-specialty team of doctors who help with different facets of the non-healing wound.  Scott and his colleagues certainly subscribe to this approach and get their patients with limb threatening wounds access to all available experts who can help save their foot/leg.

The value in this multi-specialty approach cannot be overstated when you consider that in diabetics (one of the largest groups who experience vascular disease), the 5 year mortality rate for patients undergoing a below-the-knee amputation is just under 50%.  Most patients and many doctors are not fully aware of this risk.

Special Guest:

Dr. Scott Beach, MD, Heart & Vascular Care  facebook_logo_small3  linkedin_small1

Heart & Vascular Care

 

Georgia Physicians Leadership Academy

Posted on

Podcast: Download

Georgia Physicians Leadership Academy

Dr. Bill Clark talks Georgia Physicians Leadership Academy

Georgia Physicians Leadership Academy

Dr. Jim Barber talks GPLA

Georgia Physicians Leadership Academy

Wednesday 1/27 was Physicians at the Capitol Day for members of Medical Association of Georgia.  I caught up with two MAG members who traveled to the capitol to engage with legislators, Dr. Jim Barber, orthopedic surgeon, and Dr. Bill Clark, opthamologist.  We talked about the Georgia Physicians Leadership Academy, an educational offering offered by MAG to nominated candidates each year.

More information soon!

 

Representative Sharon Cooper

Posted on

Podcast: Download

Sharon Cooper

Georgia State Representative, Dist. 43, Sharon Cooper

Representative Sharon Cooper

I hosted MAG CEO/Executive Director, Donald Palmisano, Jr., and Georgia State Representative, Sharon Cooper.  We talked about 2016 legislative priorities affecting healthcare in the state.  More information soon!

Special Guests:

Sharon Cooper, Rep. Dist 43, Georgia State House of Representatives (R) 

facebook_logo_small3

Representative Sharon Cooper

  • MA Education
  • MSN, Nursing
  • Authored 2 books on psychiatric nursing
  • Chair, Georgia Health and Human Services Committee

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia  twitter_logo_small  linkedin_small1  facebook_logo_small3

Medical Association of Georgia

  • JD Law, Loyola School of Law
  • Board of Directors, Physician Advocacy Institute
  • Medical Payment Subcommitte Member, State Board of Workers’ Compensation
  • Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
  • Former Director, Government Relations/General Counsel/Director, GAMPAC