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The Compliance Guy

The Compliance Guy

Hosted by Sean M. Weiss

BusinessInterviews guests

Episodes

429

Latest episode

Jun 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
June 12, 2026Episode 43035 min

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

SummaryIn 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 TopicsHealthcare fraud, waste, and abuseMediRegs features and benefitsRegulatory updates and alertsCustomizable compliance toolsAI and automation in healthcare complianceImportance of accurate guidance documentsHere is a link to the Wolter Kluwer MediRegs Website: https://www.wolterskluwer.com/en/solutions/mediregsChristina Panos, RHIA, ODSSenior 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

SummaryThis 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 TopicsEthical dilemmas in virtual critical careLegal and malpractice considerations in telehealthImpact of COVID-19 on virtual healthcare practices

June 2, 202633 min

Season 9 - Episode 428 - #TerryTuesday - OIG Findings

SummaryThis 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 TopicsMedicare Advantage overpayment risksThe role of OIG alerts in complianceData analytics in fraud detectionBest practices for healthcare audits

May 28, 202631 min

Season 9 - Episode 427 - #TerryTuesday - Navigating Medical Necessity

SummaryIn this episode of The Compliance Guy, Sean Weiss and Terry Fletcher discuss various compliance issues related to audits, medical necessity, and the importance of thorough documentation in healthcare. They engage in a role play to illustrate common pitfalls in audits, emphasizing the need for physicians to conduct appropriate examinations and maintain accurate records. The conversation also touches on the impact of electronic medical records (EMR) and artificial intelligence (AI) on healthcare practices, highlighting the risks of relying on outdated or incorrect information. The episode concludes with a call for healthcare providers to take responsibility for their documentation and patient care.TakeawaysAudits often reveal common sense oversights in healthcare practices.Physicians must understand the difference between hospital-based and private practice standards.Medical necessity is crucial for justifying patient evaluations and management services.Technicalities in documentation should not overshadow clinical responsibilities.Inaccurate or outdated information in EMRs can lead to significant risks in patient care.Providers should not rely on loopholes in guidelines to justify their actions.The importance of a medically appropriate history and examination cannot be overstated.Documentation should reflect current patient status, not historical data.AI and EMR systems can exacerbate existing documentation issues if not managed properly.Healthcare providers must prioritize accuracy and thoroughness in patient evaluations.

May 26, 202648 min

Season 9 - Episode 426 - Sonda Kunzi - Behavioral Health

SummaryJoin Sean Weiss as he discusses behavioral health coding, billing, and the current challenges faced by providers with expert Sonda Kunzi. Explore topics like reimbursement issues, telehealth, and regulatory complexities in behavioral health care.Key TopicsBehavioral health reimbursement challengesTelehealth regulations and complianceImpact of COVID-19 on behavioral health services

May 20, 2026Episode 42522 min

Season 9 - Episode 425 - Daily Dose - Mastering Virtual Supervision Under Medicare: A Practical Guide

SummaryThis episode explores the complexities of virtual supervision under Medicare, emphasizing compliance, operational best practices, and the potential benefits when implemented correctly.Key TakeawaysVirtual supervision is a payment, workflow, and compliance rule, not just a convenience.Real-time audio-video technology is required for virtual direct supervision.Separate telehealth policies from supervision policies to avoid confusion.Organizations must verify service eligibility and supervision compliance before billing.Immediate availability of the supervisor is a critical operational and documentation requirement.Global surgery exclusions and state law overlays are key considerations.Proper training, documentation, and auditing are essential for compliance.When done right, virtual supervision enhances access, efficiency, and workforce flexibility.

May 19, 202626 min

Season 9 - Episode 424 - Hidden Dangers of Healthcare Billing - #TerryTuesday

SummaryIn this episode, Terry Fletcher discusses common compliance pitfalls in healthcare, billing errors, fraud risks, and the importance of accurate documentation and risk management. He emphasizes the need for healthcare providers to stay informed and vigilant against fraud and billing mistakes.Key TopicsHealthcare billing errors and compliance pitfallsFraud risks and detection in healthcareCMS guidelines and billing codesThe impact of AI and data analysis on fraud prevention

May 19, 20261 hr 1 min

Season 9 - Episode 423 - Monday Roundtable - Navigating CMS and LCD Challenges

SummaryThis episode features a comprehensive discussion on healthcare compliance, audits, and payment integrity, with insights from industry experts on recent trends, challenges, and legal considerations in healthcare billing and review processes.Key TopicsPrepayment reviews and quality reviews in healthcareLegal considerations and due process in auditsCMS restructuring and payment modelsSubjectivity and AI in healthcare reviewsALJ hearings and LCD misapplications

May 12, 202620 min

Season 9 - Episode 422 - #TerryTuesday - The Truth About G2211

SummaryIn this episode, Sean Weiss and Terry Fletcher discuss the complexities and pitfalls of billing add-on code G2211 for E&M services, emphasizing the importance of medical necessity, proper documentation, and understanding payer policies.Key TopicsG2211 coding and billingMedical necessity and documentationPediatric billing considerationsPayer policies and reimbursement ratesRisks of improper billing and fraud

May 1, 202646 min

Season 9 - Episode 421 - AI: Separate Fact From Fiction - Frank Cohen

SummaryIn this episode, Sean Weiss and Frank Cohen explore the realities of AI, its limitations, and its implications for healthcare and legal fields. They discuss how AI models work, the importance of human oversight, and the risks of overestimating AI capabilities.Key TopicsHow AI tokenizes words and predicts next tokensThe misconception that AI reasons or learns like humansThe importance of human oversight in AI applicationsRisks of hallucinations and fake citations in AI outputsThe role of bias and subjectivity in AI decision-making

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