The Compliance Guy

Hosted by Sean M. Weiss

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Episodes

435

Latest episode

Aug 2026

Language

EN-US

About the show

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.

Listen to episodes

60 recent

August 27, 2026Episode 43730 min

Season 10 - Episode 437 - #TerryTuesday - Proposed CMS Changes 2027

Summary In this episode, Terry Fletcher and Sean Weiss discuss the latest Medicare final rule, its implications for healthcare providers, and how stakeholders can engage in the comment process to influence policy changes. They explore key topics like telehealth flexibilities, modifiers, and upcoming payment adjustments for 2027. Key Topics Medicare final rule published on July 14th Comment period ending September 14th, 2023 Telehealth flexibilities extended until 2028 Modifiers BB and BC for incident two services Proposed payment reductions for multiple procedures Importance of stakeholder comments in policy shaping Impact of Medicare policies on commercial payers G2211 complexity add-on code changes Future implications for physician billing and RVUs Stakeholders must comment by September 14 to influence policy. Telehealth flexibilities are extended until the end of 2027. Modifiers BB and BC will identify platform ownership and incident two services. Proposed rules include payment reductions for multiple procedures. Engaging with professional societies amplifies advocacy efforts. Takeaways Stakeholders must comment by September 14 to influence policy. Telehealth flexibilities are extended until the end of 2027. Modifiers BB and BC will identify platform ownership and incident two services. Proposed rules include payment reductions for multiple procedures. Engaging with professional societies amplifies advocacy efforts.

August 19, 202626 min

Season 10 - Episode 436 - #TerryTuesday - The Complexities of Lifestyle Medicine

In this episode, Terry Fletcher and Sean discuss the complexities of lifestyle medicine, insurance reimbursement, and the importance of understanding what services are covered. They explore how providers can navigate insurance limitations while advocating for patient care. Key Topics Insurance reimbursement for lifestyle medicine Medical necessity and insurance coverage Billing and coding challenges in healthcare Advocating for patient services outside insurance coverage Impact of diagnosis on service reimbursement Legal considerations in billing non-covered services Strategies to appeal insurance denials The role of preventive and lifestyle services in healthcare Limitations of insurance plans for wellness services Provider-patient communication about costs and coverage

August 19, 2026Episode 43528 min

Season 10 - Episode 435 - #TerryTuesday: Incident Two, Split Shared Visits, and Why Medical Student Documentation Cannot Be Billed

This episode focuses on a compliance issue that keeps tripping up practices: incident to billing, split shared visits, and the limits of what medical students can document. Sean M Weiss and Terry walk through where the rules apply, where they do not, and why using student documentation to support a billable service is not allowed. Terry also shares a real world question from recent presentations that pushed the conversation into medical student use, supervisory rules, and the risk of stretching billing frameworks beyond their intent. The discussion closes with a cautionary look at fraud, waste, and abuse, plus the importance of proper credentialing and supervision. Key topics Incident to vs. split shared visits What counts as a shared service Medical student documentation is not billable What a teaching physician may use Why cut and paste is not allowed Students are for education, not revenue Employment and supervision requirements still matter Telehealth supervision and ancillary services Fraud, waste, and abuse concerns

August 5, 2026Episode 43224 min

Season 10 - Episode 434 - #TerryTuesday - Staying Ahead of Regulatory Updates: A Guide for Healthcare Practices

In this episode of The Compliance Guy, Terry Fletcher and Sean dive into the importance of proactive compliance and staying updated with federal and state healthcare regulations. This discussion is vital for healthcare providers who want to safeguard their practice from compliance risks and ensure they’re informed about the latest industry guidance. Key topics covered: The significance of subscribing to authoritative listservs from agencies like OIG, CMS, OCR, and DOJ How healthcare providers can leverage alerts and newsletters to stay compliant The importance of understanding the definitions of fraud, waste, and abuse Practical tips for managing vast amounts of regulatory information in small practices Common pitfalls, like billing consult codes post-2010 or misinterpreting LCDs The evolution of healthcare information dissemination, from paper newsletters to digital alerts The role of exclusion lists and maintaining awareness of provider sanctions How to tailor subscription strategies to avoid inbox overload but still stay informed The value of free resources such as CMS alerts, Becker's Health, and decision health publications The impact of regulatory updates on claims processing and appeal strategies

July 29, 2026Episode 43358 min

Season 10 - Episode 433 - Dr. Ron Elfenbein - The Untold Story of a COVID Hero and the Fight for Medical Truth

Summary Dr. Ron Elfenbein shares his extraordinary journey through the COVID pandemic, his pioneering efforts with monoclonal antibodies, and the unjust legal challenges he faced after speaking out. This episode highlights the importance of scientific integrity, whistleblower protection, and the fight against political misuse of medical science. Key Topics Dr. Elfenbein's background and COVID response Development and distribution of monoclonal antibodies Government policies and their impact on COVID treatment Legal challenges and accusations of healthcare fraud The politicization of COVID medicine and science Whistleblower protection and judicial weaponization The importance of scientific integrity in public health Lessons learned from the pandemic response

July 28, 2026Episode 43228 min

Season 10 - Episode 432 - #TerryTuesday - This is The Stuff That Frustrates Us!

Summary In this episode, Terry Fletcher and Sean Weiss discuss the frustrations faced by healthcare staff with compliance issues, telehealth documentation, and billing practices. They explore real-world challenges, legal considerations, and practical advice for staff trying to navigate complex regulations. Key Topics Telehealth documentation and compliance Billing and coding accuracy Staff frustrations and legal risks Out-of-country medical services Documentation sufficiency and audits Always document concerns thoroughly and keep records safe. Understand the difference between fraud, abuse, and waste. Research authoritative sources for compliance guidance. Staff should document all concerns and interactions. Practice transparency and truthful documentation. Takeaways Always document concerns thoroughly and keep records safe. Understand the difference between fraud, abuse, and waste. Research authoritative sources for compliance guidance. Staff should document all concerns and interactions. Practice transparency and truthful documentation.

July 14, 202628 min

Season 10 - Episode 431 - Why Written Policies Are Critical in Healthcare Compliance

Summary In this episode, Terry Fletcher and Sean Weiss discuss the importance of having up-to-date, written compliance policies in healthcare practices, the risks of relying on memory or outdated policies, and how to effectively implement and audit compliance programs to avoid legal and financial pitfalls. Key Topics Importance of written compliance policies Risks of outdated or missing policies Auditing practices and place of service Telehealth policy updates and compliance Medicaid and Medicare policy challenges Legal implications of non-compliance Resources for building compliance programs

June 12, 2026Episode 43035 min

Season 9 - Episode 430 - Christina Panos - Walters Kluwer - All Things Compliance & MediRegs

Summary In this episode, Sean Weiss interviews Christina Panos from Wolters Kluwer to discuss the importance of regulatory compliance in healthcare, the capabilities of MediRegs, and how organizations can stay ahead in fraud, waste, and abuse prevention. Key Topics Healthcare fraud, waste, and abuse MediRegs features and benefits Regulatory updates and alerts Customizable compliance tools AI and automation in healthcare compliance Importance of accurate guidance documents Here is a link to the Wolter Kluwer MediRegs Website: https://www.wolterskluwer.com/en/solutions/mediregs Christina Panos, RHIA, ODS Senior Subject Matter Expert and Sales Engineer, MediRegs

June 9, 2026Episode 42931 min

Season 9 - Episode 429 - #TerryTuesday - The Ethical and Moral Dilemma of Telehealth In Critical Care

Summary This episode explores the ethical, legal, and practical implications of virtual critical care in healthcare, highlighting recent cases and regulatory challenges. Hosts Sean and Terry discuss the boundaries of telehealth, the moral dilemmas faced by providers, and the importance of appropriate, compliant virtual care practices. Key Topics Ethical dilemmas in virtual critical care Legal and malpractice considerations in telehealth Impact of COVID-19 on virtual healthcare practices

June 2, 202633 min

Season 9 - Episode 428 - #TerryTuesday - OIG Findings

Summary This episode features a detailed discussion on recent healthcare compliance issues, focusing on Medicare Advantage overpayments, the importance of proactive audits, and the evolving role of data analytics in fraud detection. Experts Terry Fletcher and Sean Weiss share insights on regulatory updates, best practices, and the need for strategic compliance in healthcare organizations. Key Topics Medicare Advantage overpayment risks The role of OIG alerts in compliance Data analytics in fraud detection Best practices for healthcare audits