This episode of Off the Record is a bit of a departure: A replay of the Norwood webinar August Audit Heat: False Claims Act settlements put spotlight on upcoding.

This was our second largest attended program ever, and the topic so important—recent massive OIG audits in the Medicare Advantage/risk adjustment space resulting in over $550M in financial recoupments—that I wanted to share it with the broadest possible audience.

The presenter/guest, Norwood SVP of Solutions Jason Jobes, refers to a few slides during the show but does a good job explaining them here. You don’t need visuals…but if you want the slides I’ve provided them on our website. You can find them in a link in the show notes.

Listen in as we cover:

• What happened in two big False Claims Act settlements: $541M assessed against The Villages Health, and $14.1M against Complete Health Partners Holdings to resolve allegations of submitting false diagnosis codes/inflated HCCs.

• That’s not all: More OIG audits in the risk adjustment space

• How these recoupments impact healthcare providers—not just MA organizations

• “Mining” for diagnoses vs. appropriate capture

• Blueprint for staying on the right side of compliance

• Audit strategy for proactive defense

View the slides (free with registration): https://www.norwood.com/resource/august-audit-heat-webinar-slides/

View the results and analysis of the live webinar polls: https://www.norwood.com/would-your-organization-stand-up-to-a-targeted-hcc-audit-survey-says-probably-not-we-can-help/

Trey LaCharite has seen it all during his time as physician advisor. The debut of ICD-10. The growth of value-based care and CMS pay for performance initiatives. And the rise of EHRs and the dreaded RACs.

For more than a decade he’s brought that distilled wisdom to the ACDIS national pre-conference, teaching a popular seminar for physician advisors. And now he’s authored a new book from HCPro/AHIMA, The Physician Advisor’s Guide to Clinical Documentation Integrity, third edition.

So yeah, Trey’s seen a lot.

He’s also seen a lot of heavy metal concerts. Which is where I come in.

As Trey was pouring his heart and soul and wisdom into his new book I was pouring myself into a book of my own: Growing Up Metal: The Story Of A Fan Who (Kind Of) Rocked. Now available on Amazon.

This unlikely union of metalheads talk all things physician advisors, CDI, and heavy metal, as well as the trials and travails of writing, on what is a very out of the box episode of Off the Record. Listen in as we cover:

• Trey and his current multi-hat role as physician advisor for the University of Tennessee Medical Center.
• The Physician Advisor's Guide to Clinical Documentation Integrity, Third Edition ... What’s in the book and what’s new? Heavy rewrites from prior editions and a new focus on practicality.
• Trey’s favorite section on sepsis, and how his organization is navigating the minefield of sepsis-2 vs. sepsis-3.
• Trey's process of writing... “pantser” over “plotter,” and how he tackled the book with his own writing and voice (no AI, thank the lord)
• Working with a pair of terrific contributors—Dr. Nicole Fox and Dr. Deepa Velayadikot
• Documentation in the age of AI—is writing notes still important, either to a physician’s thought process or the practice of care? Trey's thought on the state of technology as useful tool vs. potential loss of autonomy.
• What has changed most over the years in the role of the PA: Biggest difference in job responsibilities of a PA circa 2008 and today
• Talking metal: Growing Up Metal questions and general metal banter, concert stories, favorite bands, and more

Order Brian's book Growing Up Metal: https://www.amazon.com/Growing-Up-Metal-Story-Rocked/dp/B0HHJP531W/ref=tmm_pap_swatch_0⁠

Order Trey's book The Physician Advisor's Guide to Clinical Documentation Integrity: https://hcmarketplace.com/subject/clinical-documentation-integrity/physician-advisors-guide-to-cdi-third-edition

CDI, coding, and clinical medicine are involved in a tug-of-war over a complex, life-threatening medical emergency that seems resistant to all forms of consensus. I'm talking about sepsis of course, and on today’s show I got to talk about sepsis with someone as qualified as anyone in the world to do so.

Steven Simpson, MD, is Professor of Medicine at the University of Kansas in the Division of Pulmonary, Critical Care, and Sleep Medicine. He has done research in all areas of severe sepsis, from molecular and cellular mechanisms to translational and quality improvement studies. He is currently chair of the board of directors for the Sepsis Alliance and an author of the 2016, 2021, and 2025 reviews and updates of the Surviving Sepsis Campaign Guidelines.

I’m also joined by James Kennedy, MD, CCS, a familiar name and voice for anyone involved in CDI and coding circles. Listen in as we cover:

• Dr. Simpson’s deep and rich background in sepsis, including early clinical days with septic patients, working with Drs. Bone and Balk who created Sepsis-1, and his role on the Sepsis Alliance.
• Co-authoring the 2026 Surviving Sepsis Guideline that defines sepsis as a “life-threatening acute organ dysfunction to infection”: His stance on sepsis-2 and sepsis-3.
• The politics of definition and diagnosis: Who gets to write these definitions.
• The struggle: Reconciling sepsis-2 with sepsis-3, further complicated by CMS’ use of sepsis-2 in its new sepsis readmission measure. What’s the right answer for this, if there is one?
• Looming sepsis proposal to create codes for “impending sepsis,” the role of AI-technologies (e.g., Sepsis ImmunoScore, TriVerity) in identifying these patients, and what the University of Kansas is doing to identify and intervene on infected patients before they evolve into organ dysfunctions.
• Plans for future work for other sepsis-related concepts, payers and denials, and a pair of songs for the Off the Record Spotify playlist.