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The Compliance Guy

The Compliance Guy

By: Sean M. Weiss
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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.

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Episodes
  • Season 9 - Episode 413 - #TerryTuesday - Unmasking Insurance Down Coding: How Payers Undermine Providers

    Season 9 - Episode 413 - #TerryTuesday - Unmasking Insurance Down Coding: How Payers Undermine Providers
    Mar 26 2026

    Summary

    This episode features Sean Weiss and Terry Fletcher discussing recent issues with insurance payers, down coding policies, and the impact on healthcare providers. They analyze the implications of AI-driven denials, the importance of proper documentation, and advocate for provider advocacy and education.Key Topics

    • Insurance payer policies and down coding
    • Impact of AI and algorithms on medical billing
    • Importance of accurate documentation and provider advocacy
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    19 mins
  • Season 9 - Episode 412 - #TerryTuesday The Hidden Risks of Documentation Cloning

    Season 9 - Episode 412 - #TerryTuesday The Hidden Risks of Documentation Cloning
    Mar 12 2026

    Summary

    In this episode, Sean Weiss and Terry Fletcher explore the complexities of healthcare compliance, focusing on workflows, documentation, and audits in medical practices. They discuss real-world scenarios involving frequency audits, documentation cloning, and the importance of proactive compliance strategies to avoid regulatory risks.

    Key Topics

    • Impact of workflow failures on compliance
    • Risks of documentation cloning and cut-and-paste
    • Strategies to improve patient follow-up and adherence
    • Understanding medical necessity and billing levels
    • Regulatory scrutiny from Medicare and commercial payers
    • Effective workflows are crucial for compliance and avoiding audits.
    • Cloning of medical records can lead to serious legal and financial risks.
    • Proactive follow-up with patients can prevent unnecessary visits and documentation issues.
    • Understanding and documenting medical necessity is key to justified billing.
    • Regular audits and leadership involvement are essential for a compliant practice.

    Takeaways

    • Effective workflows are crucial for compliance and avoiding audits.
    • Cloning of medical records can lead to serious legal and financial risks.
    • Proactive follow-up with patients can prevent unnecessary visits and documentation issues.
    • Understanding and documenting medical necessity is key to justified billing.
    • Regular audits and leadership involvement are essential for a compliant practice.
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    27 mins
  • Season 9 - Episode 411 - The Hidden Dangers of Medical Documentation Alterations, Metadata and Its Role in Healthcare Fraud Detection

    Season 9 - Episode 411 - The Hidden Dangers of Medical Documentation Alterations, Metadata and Its Role in Healthcare Fraud Detection
    Mar 9 2026

    Summary

    This episode features a lively panel discussion on healthcare documentation, compliance risks, and best practices. The experts share insights on managing documentation delays, metadata analysis, contract oversight, and the impact of AI in healthcare record-keeping.

    key topics

    Risks of documentation modification

    Metadata analysis in audits

    Contract oversight and compliance

    AI in healthcare documentation

    Takeaways

    Altering original medical records can escalate legal issues.

    Metadata analysis is crucial in fraud detection.

    Effective contract management prevents costly mistakes.

    AI in documentation requires careful oversight.
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    55 mins
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