Innovation in Compliance with Tom Fox Healthcare Compliance: Fraud, Waste & Abuse, Culture, and Data-Driven Risk Management with Evan Sampson
Innovation occurs across many areas, and compliance professionals need not only to be ready for it but also to embrace it. Join Tom Fox, the Voice of Compliance, as he visits with top innovative minds, thinkers, and creators in the award-winning Innovation in Compliance podcast. In this episode, host Tom Fox welcomes Evan Sampson, a noted health care compliance attorney.
Sampson traces his path from commercial litigation to representing healthcare practices on HIPAA/privacy and reimbursement matters, then moving in-house at a network of plastic surgery centers, where he managed compliance focused on fraud, waste, and abuse, and on evolving out-of-network billing rules leading into the No Surprises Act. Sampson explains how compliance programs can create business value beyond risk mitigation by uncovering inefficiencies and opportunities, such as identifying downcoding in medical billing and using complaint investigations to spot growth areas. He describes how his litigation background helps him anticipate how issues will unfold over time in investigations and litigation, thereby improving his credibility with business leaders. They discuss building a culture of compliance in fast-growing healthcare organizations, tracking regulatory changes across primary and secondary sources, and leveraging AI and data analytics to detect claim outliers and strengthen compliance.
Key highlights:
- Healthcare Compliance Shift
- Fraud, Waste, and Abuse
- Compliance Creates Value
- Building Compliance Culture
- Tracking Regulatory Changes
- AI in Compliance Analytics
Resources:
Evan Sampson on LinkedIn
Innovation in Compliance was recently honored as the Number 4 podcast in Risk Management by 1,000,000 Podcasts.