The Misunderstood Commercial Reasonableness Test Explained and Fire Stations

Send us Fan MailLeaders can either dismiss questions or comments, or they can be curious to understand what is below the surface. In this episode, Captain Integrity Bob Wade explains why mind-blowing curiosity is the leadership habit that prevents compliance failures. Hear how to foster an effective leadership & compliance culture, how mind-blowing curiosity helps prevent compliance failures, how to apply the 5-step C.L.E.A.R. Framework, how to handle the immense pressure in the world of compliance, and what healthcare compliance teams can learn from the Challenger disaster. Learn more at WadeHealthLaw.com 

Send us Fan MailWhat happens when something looks like fraud, but when you look at it closely enough, it’s not? In this episode, Captain Integrity Bob Wade dives into what happened in United States ex rel. Kyer v. Thomas Health System, Inc. as it relates to the Stark Law, the Anti-Kickback Statute (AKS), and the limits of qui tam litigation. Hear why high compensation does not equal fraud, why the correlation between a referral into a hospital and a physician receiving productivity compensation does not create a Stark Law violation, the question you should continue to ask when it comes to fraud, the key quote from the case, and how to know when fraud is just a mirage. Learn more at WadeHealthLaw.com 

Send us Fan MailThis Halloween Special will serve as a survival guide for healthcare leaders. In this special Halloween episode, Captain Integrity Bob Wade shares his original poem, “The Compliance Officer and the Four Frights.” Hear the most frightening things in compliance, how to keep a reliable inventory of physician financial arrangements, the key agreement terms to track, how to make compliance part of the business conversation, and why compliance is not the department of NO. Learn more at WadeHealthLaw.com 

Send us Fan MailSilence. In this episode, Captain Integrity Bob Wade explains why that is the most dangerous sound in healthcare compliance. Hear why silence is data, how non-retaliation is a compliance control requirement, what the board’s job is when it comes to healthcare compliance, the earliest warning system in healthcare compliance, and the top reasons employees go quiet. Learn more at WadeHealthLaw.com 

Send us Fan MailPrevention really helps avoid much bigger problems down the road. In this episode, Captain Integrity Bob Wade explores the False Claims Act (FCA) with an international spin with Nelson Mullins Partner Christina Lehm. Hear why you should follow the government money, how to take internal concerns seriously and act early, how to treat litigation readiness as part of your business strategy, what international companies should be thinking about in terms of the False Claims Act as they enter the US market, and a bit of bar trivia on Oktoberfest. Learn more at WadeHealthLaw.com 

Send us Fan MailA new chapter: Wade Health Law. But, the same compass. In this episode, Captain Integrity Bob Wade introduces his new law firm, Wade Health Law. Hear why he’s starting his own law firm, 4 stories that have shaped his personal life & professional career, the most important lessons he’s learned in life & healthcare law, why change is inevitable, and what to expect in future episodes of Stark Integrity. Learn more at WadeHealthLaw.com 

Send us Fan MailWe’re not talking about conversion factors as they relate to the 2027 Medicare Physician Fee Schedule (MPFS) and proposed rules. In this episode, Captain Integrity Bob Wade focuses primarily on how the 2027 MPFS may impact physician compensation and Fair Market Value (FMV) in the future. Hear why the 2027 MPFS means a lot more with respect to physician compensation, how the Centers for Medicare & Medicaid Services (CMS) is beginning to challenge certain areas, why the 2027 MPFS is increasingly about why providers get paid, the most surprising aspects of the 2027 MPFS, and an analogy for Christmas morning. Learn more at WadeHealthLaw.com 

Send us Fan MailThere are 3 primary tests under the Stark Law: Fair Market Value (FMV), the Volume or Value standard, and Commercial Reasonableness (CR). In this episode, Captain Integrity Bob Wade dives deep into the Commercial Reasonableness standard. Hear why Commercial Reasonableness is fundamentally about a legitimate business purpose, the right questions to ask in terms of Commercial Reasonableness, why physician arrangements should be judged like a fire station, the biggest myth in healthcare compliance, and a David Letterman Top Ten List for Commercial Reasonableness. Learn more at WadeHealthLaw.com 

Send us Fan MailIn the 2027 Physician Fee Schedule, CMS (Centers for Medicare & Medicaid Services) is proposing modifications for procedures and E&M services (Evaluation & Management) performed on the same day. In this episode, Captain Integrity Bob Wade describes what is being proposed as it relates to the Stark Law. Hear what is not going away, why the proposal is a payment methodology proposal, how there’s still time for advocacy to take place, several medical & non-medical examples, and Captain Integrity’s famous air quotes. Learn more at WadeHealthLaw.com 

Send us Fan MailHaving someone who is accountable is essential for AI governance. In this episode, Captain Integrity Bob Wade discusses implementing & monitoring AI responsibly as it relates to the Stark Law with Arvita Tripati, Founder & Principal at Vahana Labs. Hear why buying technology does not outsource the accountability, why you need to ask every vendor when the tool was last validated, why the goal is not zero AI risk, a Netflix analogy around AI governance, and “The Compliance Bot” poem from Captain Integrity. Learn more at WadeHealthLaw.com