In a day and age where we’re too often looking in the mirror and focused on our own problems and successes, Tiara Minor is all about empowering others.

As the Director of CDI for University of Miami Health system Tiara makes things happen for her team, because she’s all about sharing her expertise and education, growing her staff, and now the CDI profession itself. She’s giving back on the broader stage as an ACDIS advisory board member, conference speaker, and now biggest achievement—guest on Off the Record.

(I wrote that last one with a straight face, barely).

One of the things that impressed me about Tiara was her observation that most training seems to be geared for CDI leaders. Her focus is on her staff, making sure that they have not just mastered the fundamentals of chart review, but also clinical nuances across service lines.

We get into education, mentorship, and more on today’s episode. Listen in as we cover:

• Tiara’s broad responsibilities and a typical day in the life
• System focus, CDI metrics, and dashboard
• Her nontraditional journey into CDI--ER nurse to pediatrics, a foray into consulting, and return to the hospital setting. And winning over some skeptical coders along the way...
• Mentorship: Growing her staff and how she differentiates mentorship that from management.
• Her role as educator and an example of an interesting clinical query/quality opportunity she presented to the team
• An ACDIS splash—getting elected to the advisory board, winning both an individual award (recognition of professional achievement) and an organizational award (Diversity in CDI), and the speaking circuit.

This year has been something of a reckoning for Medicare Advantage. Senator Grassley’s scathing report of UHG’s risk adjustment practices, and the Kaiser $556 million settlement to resolve False Claims Act allegations of upcoding, opened eyes, and got many in the industry talking.

I wanted to get someone on the show with opinions, unafraid to speak their mind and share their perspective.

I’ve found that person.

Betty Stump is Senior Solution Consultant for Edifecs, a Cotiviti Business. She is in the business of risk adjustment and value-based care on the vendor side, but is never afraid to offer her opinion on the industry, pro and con. And with more than 20 years in the industry across multiple well-known companies, it’s an informed one.

Listen in as we discuss:

• What is working in value-based care/risk adjustment—and where have we gone wrong? Recent conference disillusionment.
• Kaiser DOJ fine and the Grassley report taking aim at UHG’s aggressive risk adjustment strategy: Betty’s thoughts and where does this heightened era of scrutiny put risk adjustment coders. Do we need to elevate the MEAT standard?
• What are organizations missing with risk adjustment?
• Great, practical, low-tech suggestions for RAF capture including using your 2025 end-of-year roster to identify those patients with high-risk conditions and engage in proactive outreach to get patients seen.
• V28 of CMS-HCCs with V24 in the rear-view mirror.
• Truthful tech talk: How leaders can get a seat at the table, how to get a vendor’s ear to modify functionality, and truth and hype in CDI tech
• How should a CDI or coder interact with a machine prompt from a suspecting tool?
• Looking back at a colorful 20-year career in the consulting life, and a thoughtful selection for the Off the Record Spotify playlist by a fellow music enthusiast.

Medicare Advantage is undergoing a reckoning ... and that reckoning is coming from within.

In January Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for their MA Plan enrollees in order to receive higher payments from the government.

The case was instigated by what is known as whistleblowers.

Regular listeners might recall my podcast on this topic back in January 2025 with Mary Inman, a Partner at Whistleblower Partners LLP, and Head of International Whistleblower Practice for the firm. We had a fascinating conversation about the process of whistleblowing and New York insurer Independent Health, which agreed in December 2024 to pay $100M to settle allegations it had upcoded claims to inflate MA payment.

We’ve now more than 5x-ed that fine with Kaiser. Per the Department of Justice the claims resolved by the settlement are allegations only and there has been no determination of liability. But it was a major wakeup call for MA.

Mary is back for today’s show along with her colleague Liz Soltan, a senior associate in the firm’s NYC office. Listen in as we discuss:

• Key terms: What is whistleblowing and the concept of qui-tam?

• Kaiser case origins which began more than 12 years ago, and Mary and Liz’s evolving roles in the case

• The facts on the ground, as alleged by the whistleblowers and the DOJ, specifically the issue of addenda to the medical record

• Unfolding of the case, a behind the scenes look as new whistleblowers joined, and reaching of the settlement

• What can we learn from a medical coding/reimbursement perspective?

• What can healthcare organizations do to ensure their employees don’t blow the whistle and avoid similar fines and headlines?