Chapman Law Group Shareholder and Healthcare Fraud Defense & Government Investigations Attorney Summer McKeivier, a leading expert in healthcare law, joins The Compliance Guy podcast Sean M. Weiss for an in-depth discussion about some of the most pressing issues facing healthcare providers today, including wound care, reimbursements, local coverage determination, the debate over medical necessity and more.
Many healthcare providers are facing increased oversight and compliance challenges from the federal government as the cost of healthcare continues to rise. Organizations like the U.S. Department of Justice (DOJ) are targeting high-cost reimbursements with the intent of rooting out alleged fraud, waste, and abuse cases.
McKeivier, who has extensive experience in healthcare fraud defense and government investigations confirms that several types of healthcare services are being closely monitored as the costs of reimbursements rise. She outlines wound care as the most notable example.
“Wound care is in their crosshairs right now and we all know why,” McKeivier says on the podcast. “Everybody jumped into wound care including people who weren’t (directly) in the medical field because of how much it paid.” This includes sales professionals, facility owners, and other non-clinicians, she adds.
The challenge is that wound care is a necessary treatment that is important for patients who aren’t fully healing, McKeivier says. It’s also a sector within healthcare with quickly advancing science and treatment. “(The market) has to catch up with costs. It’s being driven by this annual sales price, which is being driven by the manufacturers.”
“These services have been proven to work. CMS sees medical necessity as something completely different from a provider,” McKeivier says
Weiss and McKeivier cover what providers need to know to stay compliant and protected on this episode, from the specifics of incident-to billing and wound care investigations to the growing number of healthcare fraud prosecutions. They also examine how Medicare Administrative Contractors and medical directors influence enforcement — often without having the specialized expertise needed to make fair determinations.
A major theme of the conversation is the ongoing confusion around medical necessity and Local Coverage Determinations. McKeivier explains that while LCDs guide billing practices, they do not have the force of law, leaving many providers vulnerable to accusations and overpayment disputes.
“Local Coverage Determination is a guideline. They were created to drive payment policy, rather than clinical decisions,” McKeivier said. She added that CMS’s definition of medical necessity often conflicts with clinical judgment and can focus more on how to reimburse physicians at the lowest possible level.
The impact of non-clinicians is another challenge for providers, even while they are performing a surgery or a procedure. “We know there are people in the operating room with no medical training other than they know about that device, and they are speaking as if they are a provider,” McKeivier said. “The ultimate medical decision making should always be with the provider.”
The episode also takes a closer look at the human side of compliance, including the stress, financial strain, and reputational harm that can follow unjust accusations. These actions are often fueled by inexperienced prosecutors unfamiliar with healthcare law nuances.
Other issues discussed during the podcast include:
For today’s healthcare professionals, the line between regulatory compliance and alleged misconduct can be alarmingly thin. Investigations tied to medical necessity, reimbursement disputes, or billing practices often arise not from bad intent, but from evolving standards and inconsistent interpretations by oversight agencies. Working through these challenges demands more than familiarity with healthcare regulations, it requires attorneys who understand both the legal and clinical realities of modern medicine.
At Chapman Law Group, our nationally recognized healthcare defense team combines decades of experience in federal investigations, healthcare fraud defense, and compliance counseling. We are committed to helping providers, executives, and organizations protect their practices and reputations when faced with complex government scrutiny. Whether you are confronting issues involving wound care audits, Local Coverage Determinations, or overpayment disputes, our attorneys stand ready to advocate for your rights and safeguard your professional future.
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