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Health Care Fraud and False Claims – Top Docs Radio

February 29, 2016 by CW

Top Docs Radio

Health Care Fraud and False Claims - Top Docs Radio

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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

Jason Marcus

Nexus Research Group, Social Impact Advisor, Marketing Eye, Mazzone and Associates

February 26, 2016 by CW

Midtown Business Radio

Nexus Research Group, Social Impact Advisor, Marketing Eye, Mazzone and Associates

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Nexus Research Group, Social Impact Advisor, Marketing Eye, Mazzone and Associates

We talked non-profit consulting/optimization with Kelly Burton of Nexus Research Group and Que Frazier of Social Impact Advisor, learned about small business marketing through an innovative outsourced model with Mellissah Smith, of Marketing Eye, and talked mid-market M&A and capital resources with Stuart Sanford.

More info coming soon!

Special Guests:

Kelly Burton, Founder of Nexus Research Group

Quinetha “Que” Frazier, President of Social Impact Advisor

Mellissah Smith, Founder of Marketing Eye

Stuart Sanford, VP at Mazzone & Associates

Dr. Gilles LaMarche, DC, VP of Professional Relations at Life University

Doctor of Chiropractic, Canadian Memorial Chiropractic College
Author, The ART of Responsibility, Insight Publishing 2012
Certified Six Advisors Coach, Six Advisors Coaching Academy
Previous Vice President, Parker College of Chiropractic

Cash Flow For The Medical Practice – Top Docs Radio

February 22, 2016 by CW

Top Docs Radio

Cash Flow For The Medical Practice - Top Docs Radio

00:00 / 00:40:51

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.

Stellar Consulting Solutions and Orange Theory Fitness

February 18, 2016 by CW

Midtown Business Radio

Stellar Consulting Solutions and Orange Theory Fitness

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Stellar Consulting Solutions and Orange Theory Fitness

Today I had the pleasure of talking to Sugra Naqvi and Varun Jhanjee, founders and consultants for the growing boutique technology consulting and staffing firm, Stellar Consulting Solutions, LLC. I also caught up with CEO/Founder of Orangetheory Fitness, Dave Long to talk about their very effective approach to helping their members achieve a higher level of fitness, regardless of their fitness level when they start.

Varun brings seventeen years of experience beginning as an engineer moving rapidly into the technology field working with several major Fortune 500 companies and has been in the Atlanta area for the past fifteen years. I

Sugra makes contacting Stellar Consulting Solutions personal….letting potential clients/clients know she is only a click away from a response through any chosen media…a rarity in today’s depersonalized business world.

Our guests are two upwardly mobile entrepreneurs who saw a growing need in the business community: maintaining traction in the rapidly changing world of IT. Using their combined business acumen, they developed Stellar Consulting Solutions to help businesses alleviate the stress and strain of staying current in the IT world; imperative in today’s market.

SCS, LLC specializes in the IT field offering a resource pool of experts to assist on technology projects, provide experienced consultants, and deliver end-to-end recruiting staffing solutions, and the list is only the beginning of what this company can offer. Concentrating on the H2H factor allows Stellar to bring the right solution with the right talent to its clients. Varun feels the importance of not only providing quality IT answers but takes their expertise into the personal realm allowing companies to blend their needs with Stellar to build the perfect profile.

Sugra shared that Stellar Consulting assists those in the job seeking market to connect with companies looking for people to fill sort-term projects, fill full time positions, or fill contract jobs. Because the resource pool for specialized IT professionals is limited, SCS can offer businesses the freedom to concentrate on business while SCS provides quality staffing to respond to the data driven issues that arise daily.

Sugra and Varun also foster diversity in the workplace, as Stellar is a minority business enterprise (MBE). Authenticity matters to SCS. Our guests shared that SCS can bring the personal and the professional into the IT field of constant change and guarantee quality results.

Stellar Consulting Solutions also addresses specialty areas: ERP Systems Database, Social, Mobile Analytics, Cloud Project/Program Managers, Infrastructure technologies to name a few.

A little over a year ago, a long-time friend of mine began talking about Orangetheory Fitness. I had heard of the fitness concept brand before but as I watched my friend’s physical and personal transformation before my eyes, and heard her rave about her experience with them, I wanted to learn more.

David Long graduated with a degree in Physical Therapy and an MBA from the University of Florida. David has an extensive, successful past as an entrepreneur and visionary. He has had management roles with GNC, Massage Envy VP of Operations, and is Partner and Founder of Orangetheory Fitness.

David has been immersed in personal fitness since he hit the retail scene in 2001 as a Director of Operations with Lifestyle Family Fitness. Reviewing David’s extensive professional background, it is apparent why he again is instrumental in leading the fitness industry to a unique new concept: Orangetheory Fitness.

Orangetheory Fitness combines interval, cardio, and a floor workout into a one hour session. What sets this concept apart is focusing on the individual working out within a community and using a Heart Rate Monitor for each client. Each studio is a “boutique fitness” location. Studios are conveniently located, franchise driven, and staffed with hand-picked experts in a variety of fields. Clients are exposed to a non-intimidating climate, a community, and can quickly blend in, therefore, removing the stigma of being “different” because they are newbies, walked in from a sedentary life style or have no clue about the world of physical fitness.

Personal is a key word at Orangetheory Fitness. Someone can go from zero experience in working out or be a seasoned fitness buff. No one is competing with anyone else: an important component to individuals hesitant to even walk into a fitness location.

Orangetheory Fitness empowers members to have more control over their effort level by having clients wear a Heart Rate Monitor (HRM) to track progress while working out. We have all heard “Get that heart rate up!”, but Orangetheroy Fitness makes tracking the heart rate an active component. Clients work toward a target zone that stimulates metabolism, increases energy, promotes extra calorie burn for up to 36 hours post-workout.

Clients WANT to return to the Orangetheory Fitness studio; the dread, lack of visible results, and overly aggressive tactics are gone. Simply stated: it works.

You can hear Dave Long’s Orangetheory Fitness interview on its own below:

Special Guests:

Sugra Naqvi, Vice President of Sales, Stellar Consulting Solutions

BS, Sociology, Georgia State University
BS Nutrition Sciences, Kaplan University
Active Wellness/Lifestyle Coach
Fluent, Urdu/Hindi

Varun Jhanjee, SVP, Stellar Consulting Services

BS, Electronics, University of Pune
Former Senior Programmer Analyst, Microtek International
Previous Development Lead, CAD Images, Government of India
Fluent, Hindi, Punjabi, English

Dave Long, CEO/Founder, Orangetheory Fitness

BS, Health Science/Physical Therapy, University of Florida
MBA, Management, University of Florida
Developer and Owner, European Wax Centers
Former Regional Developer–NY, Massage Envy

MAG’s MEP 401(k) – Top Docs Radio

February 12, 2016 by CW

Top Docs Radio

MAG's MEP 401(k) - Top Docs Radio

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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

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

Chiropractic

February 9, 2016 by CW

Midtown Business Radio

Chiropractic

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Chiropractic

On this week’s episode we featured 2 Life University alumni from the world’s largest school for doctors of chiropractic. Dr. Matt Germain and Alyce Smith from Back to Balance Wellness Centers joined us in the studio to talk about integrity and chiropractic care.

Matt explained how the holistic nature of chiropractic care appealed to him and drew him into become a DC. In speaking with him it’s clear he takes what he does as a provider of health care very seriously. And he understands his role is a facet of what is often a multi-specialty approach to regain or maintain wellness.

We talked about how it is important to him to take time to really get to know the full health picture of a patient and what their individual goals are for evaluating progress. Matt expressed how he understands that in some instances, another type of care provider might be the best alternative for them or in others, be adjunctive to his treatment.

Alyse and Matt shared their views that regular chiropractic care, delivered by a clinically-driven DC, can help optimize one’s health through routine follow-up and occasional treatment to maintain maximal health and function of the body. One way this is achieved is by addressing proper alignment of the skeletal structure, particularly the spine and others that lie along neural pathways, as misalignment can cause impingement of nerves, affecting muscle or organ function.

Both my wife and I have been patients of Dr. Germain, having experienced both chiropractic care and their professional massage therapy services as well. I can say Matt certainly lives what he described in our interview, having taken much time to interview me about what I was experiencing and taking care to explain what his recommendations were for care.

Dr. Gilles LaMarche, DC, VP of Professional Relations at Life University

Doctor of Chiropractic, Canadian Memorial Chiropractic College
Author, The ART of Responsibility, Insight Publishing 2012
Certified Six Advisors Coach, Six Advisors Coaching Academy
Previous Vice President, Parker College of Chiropractic

Matt Germain, DC, of Back to Balance Wellness Centers

Alyse Smith, DC, of Back to Balance Wellness Centers

Dr. Scott Beach – Top Docs Radio

February 9, 2016 by CW

Top Docs Radio

Dr. Scott Beach - Top Docs Radio

00:00 / 00:23:18

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

EPiC Measures

February 5, 2016 by CW

Midtown Business Radio

EPiC Measures

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Isha Edwards talks branding and marketing.

EPiC Measures

On this week’s episode I featured Isha Edwards, Founder of EPiC Measures, having met her recently at the Small Business Expo in Atlanta in December. Isha Edwards is a brand-marketing consultant and the owner of EPiC Measures, LLC. Eleven years of marketing and communications experience, coupled with more than two decades of business management acumen, enables Isha to make a C.A.S.E.* for individuals and organizations that major on being distinctly different. Aligning marketing tactics with marketing strategy enables Isha to measure twice and cut once.

Isha has a global perspective on economic development. In her consulting role, she works to maintain the

integrity, productivity and profitability of individuals and organizations. Her client base spans 12 industries and her reach includes the U.S., Europe, South Africa and the Caribbean.

When not managing client assignments, Isha volunteers with Youth Entrepreneurs of Georgia and Georgia DECA. Learn more about Isha here: www.ishaedwards.com

Special Guest:

Isha Edwards, EPiC Measures

Branding & Integrated Marketing and Marketing Strategy Certifications, University of Southern California Marshall School of Business
BS, Business Management, University of Illinois–Chicago
Teacher’s Certificate, Business, Clark Atlanta University
Business Plan Advisor, Youth Entrepreneurs of Georgia
Marketing Advisory Committee Member, DECA Inc.

Georgia Physicians Leadership Academy – Top Docs Radio

February 1, 2016 by CW

Top Docs Radio

Georgia Physicians Leadership Academy - Top Docs Radio

00:00 / 00:28:01

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!