Host Jonathan Porter welcomes Bryan Nowicki, leader of Husch Blackwell’s hospice practice group and host of the Hospice Insights podcast, to discuss the recent wave of hospice fraud enforcement. With hospice fraud dominating headlines in recent months, Bryan shares insights on how massive fraud schemes are impacting the industry and why legitimate providers face collateral damage.

We begin with the fundamentals, examining why hospice has become such a target for fraudsters. Bryan explains what makes the Medicare hospice benefit particularly vulnerable to exploitation and how the structure of hospice care creates opportunities for bad actors.

Next, we discuss shocking examples from recent California investigations, including 15 hospices incorporated on the same day at the same address. Bryan explains how Medicare’s enrollment processes allow this to happen and why a 97% live discharge rate—reported at one hospice under investigation—is a massive red flag for fraud. We also discuss identity theft schemes, where fraudsters allegedly used stolen data from breaches to enroll patients who were never sick and had no knowledge of their enrollment.

We then pivot to the types of False Claims Act theories DOJ typically pursues against legitimate hospice providers—long length of stay, eligibility determinations that don’t meet LCD requirements, and medically unnecessary crisis care or general inpatient care. Bryan clarifies how these investigations differ dramatically from the egregious fraud schemes making headlines.

Bryan discusses the collateral damage these massive fraud schemes inflict on legitimate hospice providers: increased regulatory scrutiny, reputational harm to the entire industry, chilling effects on patient enrollment, unfair competition from fraudsters, and claims processing problems when identities are already being billed.

We close with a sobering reality: whistleblowers and their attorneys are more likely to pursue FCA cases against legitimate hospices with assets rather than shell companies that have moved money offshore. Bryan explains how the prevalence of fraud in the news may paradoxically cause FCA enforcement to focus on the wrong targets.

Jonathan Porter | Full Biography

Jonathan focuses on white collar criminal defense, federal investigations brought under the False Claims Act, and litigation against the government and whistleblowers. He draws on his experience as a former federal prosecutor to guide clients in sensitive and enterprise-threatening litigation. At the Department of Justice, Jonathan earned a reputation as a top white-collar prosecutor and trial lawyer and was a key member of multiple international healthcare fraud takedowns and high-profile financial crime prosecution teams. He also teaches white collar crime as an adjunct professor of law at Mercer University School of Law.

Bryan Nowicki | Full Biography

Bryan has more than 20 years of litigation and regulatory experience, assisting clients on a nationwide basis with complex litigation, compliance, and business matters with a particular focus on hospice, home health agencies, palliative care organizations, hospitals, and skilled nursing homes. Working closely with clients, he develops practical strategies and remediation when they face issues including state and federal investigations, whistleblower complaints, audits, and federal fraud and abuse claims, among other areas.

Host Jonathan Porter welcomes Sean Weiss from DoctorsManagement, LLC to the podcast to discuss the rapidly evolving healthcare compliance landscape. With healthcare representing 83% of False Claims Act settlement and judgment dollars last year, Sean shares insights on how AI, telehealth, and changing enforcement tactics are reshaping compliance risks for providers.

We begin by examining AI documentation and ambient scribes, now ubiquitous in healthcare. Sean discusses the risks of cloning and clinical plagiarism, explaining what makes notes “audit bait” and how providers can maintain documentation integrity. He also shares recent state-level enforcement actions against AI scribe companies.

Next, we turn to telehealth integration. Moving beyond “telefraud” schemes, Sean provides best practices for legitimate providers looking to safely incorporate telehealth into their practices without stepping on compliance landmines.

Our conversation shifts to modifier 25, a favorite target of auditors and enforcers. Drawing on Jonathan’s DOJ experience using outlier data to identify potential targets, Sean explains what makes modifier 25 usage defensible and shares best practices for ensuring documentation supports billing practices.

We close with Sean’s expert prognostication on where healthcare compliance and enforcement are heading over the next five years, and his prediction that False Claims Act recoveries will explode in the near future due to increased technological capabilities by enforcers.

Jonathan Porter | Full Biography

Jonathan focuses on white collar criminal defense, federal investigations brought under the False Claims Act, and litigation against the government and whistleblowers. He draws on his experience as a former federal prosecutor to guide clients in sensitive and enterprise-threatening litigation. At the Department of Justice, Jonathan earned a reputation as a top white-collar prosecutor and trial lawyer and was a key member of multiple international healthcare fraud takedowns and high-profile financial crime prosecution teams. He serves as a vice chair of the American Health Law Association’s Fraud and Abuse Practice Group and teaches white collar crime as an adjunct professor of law at Mercer University School of Law.

Sean Weiss | Full Biography

Sean is Partner & VP of Strategic Litigation Support and Regulatory Affairs at DoctorsManagement, LLC. He has devoted more than 30 years to advising and advocating for healthcare providers, hospital networks, and integrated health systems, helping organizations strengthen financial performance while reducing regulatory exposure. His command of state and federal governmental processes, underscored by his appointment by the U.S. Department of Health and Human Services to the Board of Scientific Counselors for the National Committee on Vital and Health Statistics at the Centers for Disease Control and Prevention, has made him a trusted advisor to organizations facing complex reimbursement, compliance, and enforcement challenges. At DoctorsManagement, Sean leads the firm’s strategic litigation support, regulatory affairs, and audit functions. He is frequently retained by prominent national law firms, the Department of Justice, United States Attorney’s General, and Public Defenders in high stakes matters involving the False Claims Act, healthcare fraud enforcement, and other significant government investigations. In addition, he serves as an independent Compliance Officer for numerous nationally recognized organizations, helping leadership teams build practical, durable, and defensible compliance programs.

Host Jonathan Porter welcomes Husch Blackwell partner Tim Ribelin to the podcast to discuss False Claims Act enforcement trends in managed care. Fresh off presenting at the American Conference Institute’s managed care conference, Tim shares insights on why 2025 was a watershed year for FCA enforcement.

We begin by examining the dramatic spike in FCA enforcement, with record settlements that largely came from healthcare cases. Tim explains why DOJ is building more cases using data analytics, signaling a shift from reactive whistleblower complaints to proactive government investigations.

Next, we dive into Medicare Advantage risk adjustment, still the top enforcement priority in the managed care world. Tim walks through common FCA theories, including “one way” or “add-only” chart reviews, aggressive documentation templates, and poorly supervised vendor coding programs.

Our conversation shifts to Anti-Kickback Statute scrutiny of broker practices, highlighting a recent case where DOJ alleged brokers steered beneficiaries to plans paying the highest commissions. We then tackle the complex issue of AKS causation and the current circuit split over whether plaintiffs must prove kickbacks were the but-for cause of claims.

Tim discusses how AI and analytics are creating new evidentiary risks, examining cases where return-on-investment tracking became evidence of intent to reduce referrals. He provides practical guidance on framing performance metrics to emphasize permitted goals.

We close by examining parent and successor liability and how DOJ’s increased use of data analytics is changing the detection landscape. Tim outlines concrete steps organizations should take now, from outlier testing to vendor governance to treating data integrity as a core compliance function.

Jonathan Porter | Full Biography

Jonathan focuses on white collar criminal defense, federal investigations brought under the False Claims Act, and litigation against the government and whistleblowers. He draws on his experience as a former federal prosecutor to guide clients in sensitive and enterprise-threatening litigation. At the Department of Justice, Jonathan earned a reputation as a top white-collar prosecutor and trial lawyer and was a key member of multiple international healthcare fraud takedowns and high-profile financial crime prosecution teams. He serves as a vice chair of the American Health Law Association’s Fraud and Abuse Practice Group and teaches white collar crime as an adjunct professor of law at Mercer University School of Law.

Tim Ribelin | Full Biography

Tim is a commercial litigator who represents business clients in high-stakes, high-dollar cases. He has a special focus on litigating disputes for clients in the healthcare industry. Tim’s litigation practice involves complex business disputes and commercial litigation, ranging from membership/shareholder/partner disputes in closely held companies, business separations, franchisor-franchisee disputes, breach of contract, False Claims Act litigation, healthcare law, insurance disputes related to the payment and processing of healthcare claims, landlord-tenant disputes, business torts, wrongful death actions against companies, and other complex cases. Tim’s prior background and substantial experience in the healthcare space help him advise and guide clients’ litigation matters through a complex regulatory environment. With a knack for problem-solving and a persistent work ethic, Tim thrives on digging deep into the facts of a dispute, assessing the risks, strategies, and other considerations to align the litigation strategy with the clients’ goals. Tim uses this information to determine the most effective path to victory. Clients value his strategic approach, responsiveness, and all-in mindset, often remarking on how thoroughly invested he is in driving their cases forward to a successful resolution.