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Monitor Mondays

RACmonitor
Medicare
False Claims Act
Medicaid
Medicare Advantage
CMS
Artificial Intelligence
Telehealth
340B Drug Pricing Program
Healthcare Fraud
Healthcare Compliance
No Surprises Act
Racmonitor
Medicare Advantage Plans
Healthcare Audits
Affordable Care Act
Health Care Compliance
Centers For Medicare and Medicaid Services
Department Of Justice
Home Health Care
Prior Authorization

Join Chuck Buck every Monday when he welcomes RACmonitor contributing editors and special guests for the latest regulatory audit news and information from CMS, OIG and OMHA. And gain valuable context and perspective that can only be found when you’re listening to the long-running and popular Monitor Mondays. Register to attend live here: racmonitor.medlearn.com/racmonitor/podcasts/

PublishesWeeklyEpisodes421Founded9 years ago
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Latest Episodes

The San Diego chapter of the Association of Clinical Documentation Integrity Specialists (ACDIS) is meeting this week in San Diego, attracting a host of well-known CDI subject-matter experts, including James S. Kennedy, MD. and our very own Penny Jef... more

You’re invited to take a journey with us as we spend time walking in the shoes of professional case managers, during National Case Management Week.

Join us during the next live edition of the venerated Monitor Monday weekly Internet broadcast. You’l... more

Federal officials announced that a Fortune 500 healthcare devices and medical supplies company has agreed to pay just shy of $385 million to resolve allegations involving issues with its production of baby formula.

During the next live edition of th... more

Government agencies routinely publicize allegations and settlements. But convictions are different – and far more consequential. When a court reaches such a judgment, the warning is no longer theoretical.

Understanding how and why entities or indivi... more

As expected, Monitor Monday continues to focus squarely on healthcare auditing and compliance.

During the next live edition of the venerable Internet broadcast, Monitor Monday will examine a range of compliance and auditing concerns associated with ... more

Artificial intelligence (AI) is dramatically reshaping healthcare by accelerating data analysis, auditing, and documentation. But while it appears to reduce provider burden, AI also strengthens medical necessity support.

What about compliance – and ... more

There has been a noticeable recent surge of activity among data-mining companies or individuals who analyze publicly available government data for potential signals of fraud, rather than the insiders who have traditionally served as relators under th... more

Program Update: CMS-2451-F has been published in the Federal Register. The proposed rule is effective Oct. 13, 2026. The recently posted rule prohibits federal and state Medicaid and CHIP program dollars from being spent on gender-affirming care for ... more

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Recent Guests

James S. Kennedy
Physician and clinical documentation integrity specialist
Episode: Compliance: The Underpinnings of ACDIS
Ronald Hirsch
Vice president of R1 RCM
R1 RCM
Episode: Compliance: The Underpinnings of ACDIS
Knicole Emanuel
Healthcare attorney and partner at Poyner and Spruill
Poyner and Spruill
Episode: Compliance: The Underpinnings of ACDIS
David Glaser
Healthcare attorney and shareholder at Fredrikson & Byron
Fredrikson & Byron
Episode: Compliance: The Underpinnings of ACDIS
Matthew Albright
Chief Legislative Affairs Analyst for Zelis
Zelis
Episode: Compliance: The Underpinnings of ACDIS
Nicole Emanuel
Healthcare attorney and partner at Poyner and Spruill
Poyner and Spruill
Episode: National Case Management Week: The Inside Story of What’s Driving Outcomes
Cate Brantley
Senior legislative affairs liaison for Zelis
Zelis
Episode: National Case Management Week: The Inside Story of What’s Driving Outcomes
Patty Nunez
Immediate past chair of the Commission with more than three decades in case management
Episode: National Case Management Week: The Inside Story of What’s Driving Outcomes
Arianna Peters
Hospitalist, internist and care management medical director
Mayo Clinic
Episode: National Case Management Week: The Inside Story of What’s Driving Outcomes

Host

Chuck Buck
Host of Monitor Mondays, RAC Monitor

Talking Points

Recent interactions between the hosts and their guests.

Compliance: The Underpinnings of ACDIS
Q: What's the big news about an OIG audit of Medicare Advantage diagnosis codes from UnitedHealthcare?
James S. Kennedy explains that the OIG examined UnitedHealthcare of Texas diagnoses submitted for CMS HCC reimbursement, and highlights the insurer's response that physician-documented diagnoses should be coded.
DOJ Announces $385 Million Settlement to Resolve False Claims Allegations over Abbott Laboratories Baby Formula
Q: Why is that a false claim?
Because the government contends that shipments to federal and state programs did not meet regulatory and contractual standards, resulting in improper claims for payment, even if Abbott did not admit liability.
The One Note Samba: DOJ Data Sharing
Q: What does the DOJ-CMS data-sharing development enable, and why is it consequential?
It embeds DOJ analytics inside CMS data ecosystems, enabling cross-agency data joins and AI-driven anomaly detection across multiple datasets, which increases the ability to identify fraudulent patterns before payments are issued.
Latest Privacy Issue: AI-Powered Wearables
Q: What should providers do to get RACs to follow the rules on AI wearables and related audits?
The guest suggests a combination of lobbying and litigation to push back on agency actions, with the aim of having a federal judge require more precise and protocol-driven explanations in denials and decisions.
The Latest Compliance Trap: Medicare Cost Reports
Q: What is the significance of Worksheet S-12 in the Medicare cost report?
Worksheet S-12 is a signal that Medicare will increasingly rely on negotiated market rates and MA reimbursements to inform future fee-for-service payments, representing a fundamental shift in how inpatient reimbursement could be determined.

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Frequently Asked Questions About Monitor Mondays

What is Monitor Mondays about and what kind of topics does it cover?

A Monday-focused deep dive into healthcare regulation, billing integrity, and audit activity across Medicare, Medicaid, and related programs. Episodes blend legal, clinical, and policy perspectives to unpack CMS rules, OIG and DOJ actions, and rapid shifts in coding, enrollment, and appeals. A recurring strength is the practical guidance provided by a panel of healthcare attorneys, physician advisors, policy analysts, and investigative reporters, often anchored by live formats, sponsor updates, and real-world case discussions that translate complex regulations into actionable steps for providers, payers, and hospital leadership. The show stands out for its hands-on approach to audits, AI-driven compliance considerations, and timely coverage... more

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Which podcasts are similar to Monitor Mondays?

These podcasts share a similar audience with Monitor Mondays:

1. Talk Ten Tuesdays
2. The ACDIS Podcast
3. An Arm and a Leg
4. The Chalene Show | Pop Culture, Women's Health, & Fitness
5. Becker’s Healthcare Podcast

How many episodes of Monitor Mondays are there?

Monitor Mondays launched 9 years ago and published 421 episodes to date. You can find more information about this podcast including rankings, audience demographics and engagement in our podcast database.

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What guests have appeared on Monitor Mondays?

Recent guests on Monitor Mondays include:

1. James S. Kennedy
2. Ronald Hirsch
3. Knicole Emanuel
4. David Glaser
5. Matthew Albright
6. Nicole Emanuel
7. Cate Brantley
8. Patty Nunez

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