Latest / I Am Wiser Podcast with Dr. Laura Purdy / The Pain of Discipline or the Pain of Regret

Transcript

The Pain of Discipline or the Pain of Regret · I Am Wiser Podcast with Dr. Laura Purdy

• 0:00
  SPEAKER_01: Everybody's gotta suffer two types of pain, the pain of discipline and the pain of regret.
• 0:04
  SPEAKER_01: The difference is the pain of discipline weighs ounces, the pain of regret weighs tons, and it's one of those things where if you have the discipline to go slow, learn the business, hire the right advisors at the beginning.
• 0:16
  SPEAKER_01: I mean, it's a little painful.
• 0:17
  SPEAKER_01: You're gonna have to pay more, but regret of a massive investigation and ending up with, you know, hundreds of thousands of dollars of fines and legal fees and reputational damage.
• 0:27
  SPEAKER_01: I mean, that weighs tons.
• 0:29
  SPEAKER_00: Welcome to the I Am Wiser Podcast, where the biggest questions in health care and wellness meet the collective wisdom of industry leaders and innovators.
• 0:38
  SPEAKER_00: I'm Dr.
• 0:39
  SPEAKER_00: Laura Curdy.
• 0:40
  SPEAKER_00: And here we explore the intersections of AI, care delivery, telehealth policy, and more.
• 0:47
  SPEAKER_00: Through the lens of those who are reshaping healthcare.
• 0:51
  SPEAKER_00: This is not just about theory, it's about lived experience and real industry insights.
• 0:57
  SPEAKER_00: Let's dive in and get wiser together.
• 1:00
  SPEAKER_00: Welcome to today's episode of the I Am Wiser Podcast with Dr.
• 1:04
  SPEAKER_00: Laura Purdy, where I explore the real stories behind groundbreaking healthcare innovations and the human impact they have on patients and providers.
• 1:12
  SPEAKER_00: On that note, I'm delighted to welcome Brian Kalau, director of Daikuma's Dental Service Organization's Industry Group, a seasoned commercial litigator, and strategic advisor to healthcare leaders.
• 1:26
  SPEAKER_00: Brian helps DSOs navigate complex legal, operational, and compliance challenges, showing how disciplined decision making can drive sustainable growth while elevating patient care.
• 1:39
  SPEAKER_00: Today, we'll explore his insights on the DSO industry, talk a lot about corporate practice of medicine, the power of discipline, and how thoughtful strategy can transform businesses and the experiences of the patients they serve.
• 1:55
  SPEAKER_00: Hi, Brian.
• 1:55
  SPEAKER_00: Thank you so much for joining us today.
• 1:57
  SPEAKER_00: I'm excited for you to be here and to get to hear more about you, what you're doing, why you're doing it, and the journey that's led you to be where you are today.
• 2:06
  SPEAKER_01: Well, thank you, Laura.
• 2:07
  SPEAKER_01: It's really, really nice to be with you today.
• 2:10
  SPEAKER_00: Awesome.
• 2:10
  SPEAKER_00: So tell us about yourself.
• 2:12
  SPEAKER_00: Who are you?
• 2:12
  SPEAKER_00: Where are you?
• 2:13
  SPEAKER_00: And what are you working on these days?
• 2:16
  SPEAKER_01: Well, I'm in my 30th year in the dental industry, as a matter of fact.
• 2:20
  SPEAKER_01: Um, I started in 1995, and I'm the director of Dicomo, which is a law firm's dental service organization group.
• 2:28
  SPEAKER_01: I think at last count we represent over 750 dental organizations in all 50 states, six Canadian provinces, Mexico, Europe, Japan, and Australia.
• 2:39
  SPEAKER_01: And I also serve as an advisor to 24 dental technology companies.
• 2:44
  SPEAKER_01: And I run the largest dental uh service organization conference in the United States, a Daicoma conference.
• 2:50
  SPEAKER_01: We had about 2,500 people in Denver last August.
• 2:54
  SPEAKER_01: So that's a little bit about myself, and this is 30 years for me.
• 2:58
  SPEAKER_00: Wow.
• 2:58
  SPEAKER_00: And are you a dentist by training?
• 3:01
  SPEAKER_01: I'm an attorney by training.
• 3:02
  SPEAKER_01: You're an attorney by training.
• 3:03
  SPEAKER_01: Yeah, I run what you know what I think is the largest law group uh dedicated to you know dental organizations, probably in the world, definitely in the United States.
• 3:14
  SPEAKER_00: Wow.
• 3:14
  SPEAKER_00: So I you know I'm a physician, I work in healthcare, and I work in 50 state healthcare, and we always talk about corporate practice of medicine, flow of funds, how to set up your corporate structure so that the money's moving in the right direction with uh MSO and we call them PCs.
• 3:32
  SPEAKER_00: Does it work that way in the dental industry as well?
• 3:35
  SPEAKER_01: Yeah, it's actually harder.
• 3:36
  SPEAKER_01: Um I like it if I get a medical assignment.
• 3:38
  SPEAKER_01: I feel I find that the MSOs are easier to set up.
• 3:42
  SPEAKER_01: Sometimes uh some of the MSO people get a little upset.
• 3:45
  SPEAKER_01: They're like, no, you know, we're complicated over here.
• 3:47
  SPEAKER_01: We're doing maybe, but I I don't find it as complicated as dentistry.
• 3:52
  SPEAKER_01: Uh the dental rules, I mean, you know, for example, you know this very well, Laura.
• 3:56
  SPEAKER_01: There's only four states that let dentists, non-dentists, own dental practices.
• 4:00
  SPEAKER_01: In medicine, it's 17, 18.
• 4:02
  SPEAKER_01: Yes.
• 4:02
  SPEAKER_01: There's a lot of states where you can be a corporate corporation that's owned by non-dentists and still own medical practices and things, and it's not, you know, as crazy.
• 4:11
  SPEAKER_01: But in dentistry, there's only four states like that.
• 4:13
  SPEAKER_01: So 46 out of 50 times, you know, you've got to set things up, you know, in a in a very different way to comply with the regulations.
• 4:21
  SPEAKER_01: So that's why I've I find when I do a dental deal, it's much more challenging than a medical deal.
• 4:26
  SPEAKER_00: What are the four?
• 4:27
  SPEAKER_00: What are your four states that don't require a dentist to own?
• 4:31
  SPEAKER_01: Well, let's see.
• 4:31
  SPEAKER_01: Arizona, Utah, um, Wisconsin, South Carolina, and New Mexico with a non-dentist owner license.
• 4:39
  SPEAKER_01: So I guess it's four and a half.
• 4:41
  SPEAKER_01: If you get the non-dentist owner license, you can do it in New Mexico.
• 4:44
  SPEAKER_01: So call it four and a half states allow it.
• 4:47
  SPEAKER_00: Oh, that's interesting because those are, I mean, I'm not a lawyer and this is not a substitute for legal advice, right?
• 4:52
  SPEAKER_00: That's you.
• 4:53
  SPEAKER_00: But I think that some of those are corporate practice of medicine states, but they are not corporate practice of do you call it corporate practice of dentistry?
• 5:02
  SPEAKER_00: Is that what you call it?
• 5:03
  SPEAKER_01: Yeah, we call it corporate practice states where corporations can actually own dental practices, and you know, we've got four and a half of them like we just named.
• 5:12
  SPEAKER_00: Yeah, and it has to be a dentist that's licensed in that state in order to own the practice.
• 5:18
  SPEAKER_00: And 46 of them.
• 5:19
  SPEAKER_00: And the other 46.
• 5:21
  SPEAKER_01: You gotta be a licensed dentist.
• 5:22
  SPEAKER_01: In the four and a half that I named, you actually can be a non-dentist and still own the practice.
• 5:28
  SPEAKER_00: Do they do the 51-49% thing where non-dentists can own 49%, or it's like a hundred percent ownership across the board?
• 5:36
  SPEAKER_01: In basically 45 to 46 of the states, like we've been talking about uh a non-dentist can't even own 1%.
• 5:44
  SPEAKER_01: It's gotta be a hundred percent dentist.
• 5:46
  SPEAKER_01: So yeah, this is why.
• 5:47
  SPEAKER_01: That is harder.
• 5:48
  SPEAKER_01: That is harder.
• 5:50
  SPEAKER_00: Yeah.
• 5:51
  SPEAKER_00: Well, why why did you choose to go into something that is so complex in its regulatory environment?
• 5:58
  SPEAKER_00: What what was the appeal for you in that?
• 6:00
  SPEAKER_01: Well, nobody goes to law school to be the dental guy, Laura.
• 6:03
  SPEAKER_01: That's just not how it how it turns out.
• 6:06
  SPEAKER_01: But in my case, I don't I don't know what I thought I was gonna do.
• 6:09
  SPEAKER_01: I started off being like a trial lawyer and going to court, and like after just a couple months of sort of being on the job, a group of 90 orthodontists came in with a complicated problem against, you know, maybe the first generation of DSOs.
• 6:24
  SPEAKER_01: It's about 30 years ago, and no one really was able to help them.
• 6:27
  SPEAKER_01: And the senior partners at my firm, they didn't want to mess with it.
• 6:30
  SPEAKER_01: They had a lot of things going on.
• 6:31
  SPEAKER_01: They're like, we don't got time for dental law.
• 6:33
  SPEAKER_01: You know, what is that?
• 6:34
  SPEAKER_01: Who's like the young guy around here that's brand new that we can force to do this?
• 6:39
  SPEAKER_01: And I I happen to be that person.
• 6:40
  SPEAKER_01: I've been there like three months, and they said, here, figure it out.
• 6:43
  SPEAKER_01: You know, go help these dentists if they pay the bill.
• 6:45
  SPEAKER_01: Like, you know, I'll tell you something.
• 6:47
  SPEAKER_01: Dentistry's been so successful, that's such a silly thing, you know.
• 6:51
  SPEAKER_01: But you know, the perception 30 years ago, or these are these individual dentists, we don't even know if they're gonna pay the bill, you know, go deal with them.
• 6:58
  SPEAKER_01: And I did deal with them.
• 7:00
  SPEAKER_01: And here we are 30 years later, I never stopped dealing with them, as it turns out.
• 7:04
  SPEAKER_00: Well, I mean, I would imagine if it's a a field of law that not a lot of people do, it also means it's a field of law that not a lot of people know, which means there's a lot of, if I can use the term, bad legal advice out there.
• 7:16
  SPEAKER_00: And that can be expensive, it can be dangerous, it can be harmful for people's career if you don't get proper legal advice.
• 7:22
  SPEAKER_00: That's happened to me before.
• 7:24
  SPEAKER_00: And so to be the guy who knows it and can be trusted to do it, that's really impactful for your clients.
• 7:31
  SPEAKER_01: Yeah, and there still is today bad legal advice.
• 7:33
  SPEAKER_01: I'll I'll tell you what happened.
• 7:34
  SPEAKER_01: 30 years ago, dentistry wasn't big business and nobody really cared.
• 7:38
  SPEAKER_01: They were like, we just don't want to do it.
• 7:40
  SPEAKER_01: Get this young kid to go do it, and they grabbed me and I did it.
• 7:43
  SPEAKER_01: But since the explosion of dental service organizations, you know, around 2010 is when they really, really started to explode, and billions and billions of dollars flowed into the space.
• 7:54
  SPEAKER_01: Since 2010, a lot of people have showed up and all of a sudden they're legal dental experts, and you know, they've, you know, not been around very long, and they're just, you know, a lot of them are bluffing and just stumbling their way through it.
• 8:07
  SPEAKER_01: And you get exactly in the situation that you told us, unfortunately, you found yourself in where you got bad advice, and it, you know, it can be very harmful.
• 8:15
  SPEAKER_01: Obviously, you're doing pretty good right now, but some people get really bad advice and it's very hard to recover from.
• 8:22
  SPEAKER_01: They they don't recover from it.
• 8:23
  SPEAKER_01: You know, their organization really suffers.
• 8:26
  SPEAKER_01: I know of a few instances where people have filed bankruptcies where they just, you know, they ended up getting bad advice and they were not able to recover from it, you know.
• 8:35
  SPEAKER_01: And and so really bad things can happen if you don't engage with not, you know, professionals, including lawyers, accountants, and others that really know what they're doing in your space.
• 8:45
  SPEAKER_00: We have a lot of business-to-business clients, and I tell them in their early days of opening their business, I say, do not skimp on the good legal advice.
• 8:55
  SPEAKER_00: Because if you ask your contracts attorney about healthcare regulatory law, or you're asking your neighbors, brothers, friends, buddy who does a little bit of business law about how to do your health care, you can really get yourself into some expensive trouble.
• 9:11
  SPEAKER_00: It's better to find somebody who knows what they're doing, pay the retainer of the hourly fee, and then get it done right the first time.
• 9:17
  SPEAKER_01: It's an old narrative, Laura, and I hate seeing it, right?
• 9:20
  SPEAKER_01: You go down to the old country club if you're a dentist or a physician, and that lawyer down there that helped you with your will or helped you when you bought your hat, your your beach house or something suddenly, because you know, that person's fun.
• 9:33
  SPEAKER_01: You like golfing or having a drink with him or her.
• 9:35
  SPEAKER_01: So you try to get them to do a dental or a medical deal.
• 9:38
  SPEAKER_01: And yeah, I mean, God help you, you know, with that type of, you know, situation.
• 9:42
  SPEAKER_01: And invariably, you know, that's one problem.
• 9:44
  SPEAKER_01: You know, the other problem is, you know, you go to somebody and their business is brand new and you say, look, I'm sorry, it's going to be 10 or 15 grand.
• 9:51
  SPEAKER_01: And they're just like, I just don't want to pay that right now.
• 9:55
  SPEAKER_01: And the sad thing that I've seen is when usually it gets to my desk, you know, when that's been really messed up, is now it's a$150,000 problem.
• 10:04
  SPEAKER_01: And it's like, you know, I know you didn't want to pay the$10,000, but you know, you could have paid the$10,000 and you never would have met me.
• 10:10
  SPEAKER_01: But now you're here in front of me with this mess, and I'm sorry, it's gonna be like a hundred grand now to clean this whole thing up.
• 10:17
  SPEAKER_00: Yeah, or go bankrupt or close your business.
• 10:19
  SPEAKER_00: Like if you if you want to survive, that's what you have to do.
• 10:22
  SPEAKER_00: You know what I hear from a lot of people is one of two things.
• 10:26
  SPEAKER_00: Yeah, my buddy's buddy's buddy from the country club, or I have a friend who has a business down the street and they don't do that.
• 10:32
  SPEAKER_00: They don't have a PC MSO or however they talk about corporate practice of industry, they don't do that.
• 10:37
  SPEAKER_00: They just hire their physicians directly and they don't do that at all.
• 10:41
  SPEAKER_00: And the doctor doesn't own 100%.
• 10:42
  SPEAKER_00: And I have a hard time explaining to people that everything's okay until it's not.
• 10:47
  SPEAKER_00: Right?
• 10:47
  SPEAKER_00: And the healthcare regulatory, and I'm sure the dental regulatory environment is very contentious.
• 10:52
  SPEAKER_00: And if they find out, you can get hammered pretty hard.
• 10:56
  SPEAKER_00: Is it is it like that in dental as well?
• 10:58
  SPEAKER_01: It's criminal, okay?
• 10:59
  SPEAKER_01: I mean, I mean to the the illegal corporate practice of dentistry is criminal.
• 11:02
  SPEAKER_01: I mean, I think in almost a couple states it's like a misdemeanor.
• 11:05
  SPEAKER_01: Most of them are felonies, quite frankly, to do that.
• 11:08
  SPEAKER_01: And I I get it, I get it.
• 11:10
  SPEAKER_01: And and you know, it's not number one when you're going to prosecutors that are prosecuting murder and rape and things like that.
• 11:16
  SPEAKER_01: You know, this is not number one on their list.
• 11:18
  SPEAKER_01: But when it's brought to their attention through, you know, um whistleblowers and others, and it's just like indefensible.
• 11:26
  SPEAKER_01: Like they look at it and they say, Well, let's just look at this.
• 11:28
  SPEAKER_01: Oh gosh, you don't have a dentist owning this.
• 11:30
  SPEAKER_01: You've got to, I mean, it's it's cut and dry.
• 11:32
  SPEAKER_01: There, there's really not a defense to that.
• 11:35
  SPEAKER_01: And people that were not really motivated to prosecute this normally would say, Hey, this isn't first on my list.
• 11:40
  SPEAKER_01: But given that this is a complete give me, you know, 100% you're guilty.
• 11:44
  SPEAKER_01: There's no way around this, you know, they do then get interested.
• 11:47
  SPEAKER_01: And like you said, you can go decades even, you know, doing things wrong and nobody'll say anything.
• 11:53
  SPEAKER_01: But in healthcare, particularly dentistry, also medicine, when it becomes a problem, it becomes a problem.
• 11:59
  SPEAKER_01: It doesn't become like a speeding ticket problem.
• 12:02
  SPEAKER_01: All right, you finally caught me.
• 12:03
  SPEAKER_01: Where do I go to pay the fine and go back about my business?
• 12:06
  SPEAKER_01: It doesn't go like that.
• 12:07
  SPEAKER_01: When they finally kind of get you, it's usually quite serious.
• 12:10
  SPEAKER_01: The fines can be very, very large.
• 12:12
  SPEAKER_01: You know, there can be um sometimes, you know, criminal sanctions and other things.
• 12:16
  SPEAKER_01: I mean, it's it's really not something you want to mess around with.
• 12:20
  SPEAKER_00: You'll have state level or even federal pre Supreme Courts coming after you and subpoenaing everything that you've ever had in your business and demanding that you speak with the investigator.
• 12:29
  SPEAKER_00: I mean, it's terrifying.
• 12:30
  SPEAKER_00: It's uh it's terrifying to get a investigation letter or a complaint letter in your mail inbox.
• 12:37
  SPEAKER_00: They come in the most ominous for official business-only purposes, and you open that letter and you're reading it and you're shaking.
• 12:44
  SPEAKER_00: I mean, it's it's terrifying.
• 12:46
  SPEAKER_00: And to not know is not an excuse to say, well, I didn't know.
• 12:52
  SPEAKER_01: You know, the best thing if you're not compliant, if you're compliant, don't worry.
• 12:56
  SPEAKER_01: But if you're not compliant, the best thing you have going for you is it's not first on their list.
• 13:00
  SPEAKER_01: You know, unless it's just millions and millions of dollars, it's the fraud of the century, you know, it's not first on their list.
• 13:07
  SPEAKER_01: But if it becomes on their list, you know, there's a whistleblower or some reason why they have to get interested interested in this, it's pretty easy to catch you.
• 13:14
  SPEAKER_01: And like you said, if it's federal, the justice can come real quick.
• 13:18
  SPEAKER_01: Subpoenas show up, they can lock your doors, they can send investigators or FBI or Justice Department people onto your premises with like warrants and start taking computers and going through things.
• 13:29
  SPEAKER_01: And I've seen people that have gone for a very long time, you know, being non-compliant.
• 13:34
  SPEAKER_01: No one said a word.
• 13:35
  SPEAKER_01: It looks like it's gonna last forever.
• 13:37
  SPEAKER_01: They're invincible, and then someday they get interested, and all of a sudden, you know, they they've called me.
• 13:42
  SPEAKER_01: Like, there are FBI people here right now.
• 13:44
  SPEAKER_01: They're like taking my phone.
• 13:46
  SPEAKER_01: Like, I gotta stop talking to you.
• 13:47
  SPEAKER_01: They're like gonna take the phone from me right now, you know, literally because they're seizing the iPhone to look at that.
• 13:52
  SPEAKER_01: You know, it's literally that kind of situation sometimes.
• 13:56
  SPEAKER_00: Wow.
• 13:56
  SPEAKER_00: And not everybody who's involved in those situations was necessarily seeking or intending to commit fraud, but just because you're not out there trying to be a criminal doesn't mean that you are operating 100% compliant or that there's gonna be complete forgiveness for your ignorance.
• 14:12
  SPEAKER_01: Well, there won't be.
• 14:14
  SPEAKER_01: Um, it's a well-established um principle of you know United States law that ignorance is not an excuse for the law.
• 14:22
  SPEAKER_01: You know, just because you're ignorant does not excuse you from breaking the law.
• 14:26
  SPEAKER_01: You're obligated, like if you decide, hey, I'm entering the dental business, or I'm gonna enter the veterinarian business, or I'm gonna enter, you know, the optimology business if I'm an eye doctor, you are now charged with understanding those laws.
• 14:39
  SPEAKER_01: And if you don't, you've got to get a lawyer or somebody that does to kind of walk you through what is required.
• 14:44
  SPEAKER_01: But if you tried to say, well, you know, I've never been in the veterinarian business before, and I, you know, sorry, I didn't realize this exists, that's not an excuse.
• 14:52
  SPEAKER_01: I mean, it's not an excuse at all.
• 14:54
  SPEAKER_00: Well, the state regulators, definitely the federal regulators don't care.
• 14:57
  SPEAKER_00: But that's the challenge, right?
• 14:59
  SPEAKER_00: Is that every single state, at least this is the way it is in healthcare, so I assume also dentistry, every single state is regulated at the state level, and they're all going to have minor variations in their specific state regulations.
• 15:13
  SPEAKER_00: And you talk about working with at least 46 states, that's 46 sets of unique laws that you have to understand the intricate nuances and be up to date with how they change, or you're not going to be compliant and you're not going to be given good legal advice.
• 15:30
  SPEAKER_00: That's a lot to keep up with.
• 15:32
  SPEAKER_01: Yeah, for me, it's a lot.
• 15:33
  SPEAKER_01: I mean, the good news is, you know, a lot of dentists don't operate in 46 states.
• 15:37
  SPEAKER_01: They only operate in one or two.
• 15:39
  SPEAKER_01: So we they only got to worry about one or two.
• 15:41
  SPEAKER_01: But if you're talking about my plight and my life, yes, I have to keep track of 40, 50, really 50 of these things and you know, all the nuances so that I can advise my clients all over the country.
• 15:52
  SPEAKER_01: But unless, you know, as a client, you're in all 50 states, the good news is if you're in three or four or five states, we only got to worry about those three or four or five states.
• 16:02
  SPEAKER_00: So do people usually find you or come to you at the beginning of their business?
• 16:07
  SPEAKER_00: Do they seek you out and say, hey, I'm gonna start dental practice, help me do this compliantly?
• 16:12
  SPEAKER_00: Or are you the one that they find maybe after they've got that letter in the mail or that knock on the door?
• 16:18
  SPEAKER_00: Are you the emergency plan?
• 16:21
  SPEAKER_01: It's all across the board, um, Laura.
• 16:23
  SPEAKER_01: It's it's all across the board.
• 16:25
  SPEAKER_01: Um I love it when they call me very early and they say, we haven't even opened our doors yet.
• 16:30
  SPEAKER_01: Can you help us?
• 16:31
  SPEAKER_01: Like I love that because I'm like, perfect.
• 16:33
  SPEAKER_01: We're gonna make sure you don't get in any trouble.
• 16:35
  SPEAKER_01: But honestly, if I'm I'm just gonna give a guess, you know, that's probably like 25% of the time and 75% of the time it's in some.
• 16:43
  SPEAKER_01: Sometimes it's on the other end.
• 16:45
  SPEAKER_01: Like they they call me, you know, the the FBI is here right now locking our doors.
• 16:50
  SPEAKER_01: You know, can you get that that has happened, you know, where I'm like literally like, okay, my very first interaction is I ran down there or got on a plane and met with the FBI and met with everybody and figured out, you know, what the problem was and what the issues were and how we could sort it out.
• 17:04
  SPEAKER_01: Other times it's in the middle.
• 17:06
  SPEAKER_01: It's you know, thank God the FBI is not on the premises, but they've been in business for four or five or ten years and they want my involvement.
• 17:14
  SPEAKER_01: And I look at things and I'm like, wow, you know, we're gonna have to redo or we're gonna have to change, you know, some things around here to get you into compliance.
• 17:22
  SPEAKER_01: And, you know, usually the longer you wait, the more expensive it is, you know, sort of to fix it.
• 17:27
  SPEAKER_01: If you get me at the beginning, it's the cheapest.
• 17:29
  SPEAKER_01: If you get me after a year or two, yeah, a little more expensive, but probably the same.
• 17:34
  SPEAKER_01: If you go 10 years and expand to five or 10 states and are not compliant, you know, we can do it, but that becomes a much more expensive undertaking, but often it's one you got to do.
• 17:44
  SPEAKER_01: And it's just easier to do it at the beginning than do it, you know, with a gun to your head when you have to do it, because the regulators are beating down your door.
• 17:52
  SPEAKER_00: Because the FBI's taking away your cell phone.
• 17:54
  SPEAKER_00: I mean, that's extreme.
• 17:55
  SPEAKER_01: Yeah, that that that has happened.
• 17:56
  SPEAKER_01: Like, I don't have to ever make anything up on these shows when people have me on.
• 18:00
  SPEAKER_01: I literally had that happen, and they were taking that phone away because they said the phone that the person was talking to me on was evidence.
• 18:06
  SPEAKER_01: So like they had to like give that phone up and you know, go get because it was a smartphone, it had to email, you know, they had to hand that phone over and go call me back on another, you know, phone line or something.
• 18:16
  SPEAKER_01: But um, sometimes it's not quite that.
• 18:18
  SPEAKER_01: But you know, they get a letter from the dental board or they get a letter from the attorney general.
• 18:23
  SPEAKER_01: And, you know, the good news is it's not serious enough that anybody's broken down their door with a warrant, but now they've got to respond.
• 18:29
  SPEAKER_01: You know, they've demanded information.
• 18:31
  SPEAKER_01: You know, it's come to our attention that you're not following the law.
• 18:34
  SPEAKER_01: Please provide all these documents.
• 18:36
  SPEAKER_01: And then they call me and they're like, What do we do now?
• 18:38
  SPEAKER_01: And I'm like, Well, we're gonna have to get them the documents, and and now that I've seen your documents, they're not gonna like what we get to them.
• 18:46
  SPEAKER_01: I'm gonna have to call, you know, after we send the documents, maybe I ought to like enter into negotiations for how we're gonna clean all this up.
• 18:53
  SPEAKER_01: And you know, sometimes that happens.
• 18:55
  SPEAKER_01: I'll call the attorney general investigator and say, hey, we're complying with your subpoena.
• 18:59
  SPEAKER_01: We're turning it over, but you're not gonna like it.
• 19:01
  SPEAKER_01: I mean, I'm telling you that right now, but we're gonna fix it.
• 19:03
  SPEAKER_01: And, you know, can we, you know, enter into some discussions where we fix it?
• 19:07
  SPEAKER_01: And like you said, they never just say, oh, sure thing, no problem, just fix it.
• 19:11
  SPEAKER_01: I mean, there's always a fine or a penalty, but usually they'll work with us, you know, to get it corrected if that's what we're trying to do.
• 19:18
  SPEAKER_00: Well, the point, right, this is what I tell people who've never been regulated.
• 19:22
  SPEAKER_00: I have been regulated at the state level.
• 19:23
  SPEAKER_00: And it was a very honestly, it was a very uh nuanced line about modalities of technology required for establishment of doctor-patient relationship.
• 19:33
  SPEAKER_00: Thank God it wasn't corporate practice in medicine.
• 19:35
  SPEAKER_00: But here's the thing when you're in the process of getting regulated, what I've learned is that the majority of the time, they're not out to just get you.
• 19:42
  SPEAKER_00: They're out to make sure that the right thing, or at least the the point of regulators is to make sure that the right thing is being done by the patients, that the medical environment, the dental environment is in such a way that the people are protected.
• 19:56
  SPEAKER_00: And they're not just trying to play gotcha.
• 19:58
  SPEAKER_00: They're trying to make sure that you're willing to do it right.
• 20:02
  SPEAKER_00: And so typically, yeah, you may still get some kind of sanction or punishment, but it doesn't have to be career killing, it doesn't have to be practice killing, especially if you answer, if you answer truthfully, fully, honestly, and just participate and cooperate in their investigation, that gets you really, really far.
• 20:21
  SPEAKER_01: I actually prefer the gotchas because the gotchas are just a money grab.
• 20:25
  SPEAKER_01: There are some states in these challenging economic times that it literally is a gotcha.
• 20:30
  SPEAKER_01: And I actually prefer it because I know they just want their money.
• 20:32
  SPEAKER_01: And I'll tell the practice, yeah, this isn't career killing.
• 20:35
  SPEAKER_01: Nobody worry, you're gonna have to write a check.
• 20:37
  SPEAKER_01: But let me call them up.
• 20:38
  SPEAKER_01: And I call them up and say, all right, how much is it gonna cost?
• 20:41
  SPEAKER_01: And they'll tell us what it is, and we write the check, and usually they just go away like that's it.
• 20:45
  SPEAKER_01: You know, you have to fix it, but they take their money and they go away.
• 20:48
  SPEAKER_01: The ones that are the toughest is where there's a deterrent where they're saying, No, you know, we're out here to protect the public, and we feel like what you're doing is wrong.
• 20:57
  SPEAKER_01: And not only can we not just let you off, we have to send a message to the rest of the public to all your other colleagues in your community that if they do the same thing you do, we're gonna come after them too.
• 21:08
  SPEAKER_01: And we feel like only a fairly steep penalty here will convince everybody else not to do this.
• 21:14
  SPEAKER_01: So those are the toughest ones where they're really it's not a gotcha.
• 21:17
  SPEAKER_01: They're really, you know, trying to make a statement to the public or something.
• 21:21
  SPEAKER_01: But but but I agree with you.
• 21:22
  SPEAKER_01: It should not be career killing.
• 21:24
  SPEAKER_01: It doesn't have to be, you know, something that permanently scars your career, but it's it's obviously something that's got to be dealt with, something that's gotta be dealt with right away and decisively when it happens.
• 21:35
  SPEAKER_00: Yeah.
• 21:36
  SPEAKER_00: I'm sure we have different experiences with this because you are the lawyer and usually I'm a consultant or I'm a PC owner, you know, with an MSO on the other side.
• 21:45
  SPEAKER_00: But I actually reject a fair number of c of potential clients after a discovery call because they have absolutely no desire at all whatsoever to set their business up compliantly, and they'll even argue with me to the The point of me saying, look, I didn't make the rules.
• 22:02
  SPEAKER_00: I'm just here to make sure that we follow them, and we gotta follow corporate practice of medicine.
• 22:07
  SPEAKER_00: I don't care what the guy at the country club and your neighbor's brother's mother says, this is what we have to do.
• 22:12
  SPEAKER_00: Do you find that you have potential clients who are also very disinterested in being compliant and try to argue with you?
• 22:18
  SPEAKER_00: Or by the time they get to you, do they are they bought in enough that they're willing to listen?
• 22:24
  SPEAKER_01: It depends where they are, right?
• 22:25
  SPEAKER_01: If the FBI has seized their premises, yeah, they're they're pretty motivated to fix it and they kind of get it.
• 22:31
  SPEAKER_01: But if it's, you know, very early on, I remember a consultation.
• 22:34
  SPEAKER_01: I I'll have to be vague here because of like confidentiality things, but I I was consulting with a group um and I sat with them.
• 22:41
  SPEAKER_01: It's very well known.
• 22:42
  SPEAKER_01: I mean, in dentistry, it was it ended up being a very well-known group, but I sat with them and they asked me what I thought.
• 22:47
  SPEAKER_01: And I said, this is completely non-compliant, we're gonna have to redo all this stuff.
• 22:51
  SPEAKER_01: And you know, and and they were well underway with their business.
• 22:54
  SPEAKER_01: It wasn't like a new thing, they were already in 10 or 12 states, so I don't remember Laura what it was, but it wasn't insignificant.
• 23:00
  SPEAKER_01: It was like, you know, this is gonna be 100 grand or 75 grand.
• 23:03
  SPEAKER_01: I mean, it wasn't like, hey, five, ten grand, we got this fit.
• 23:06
  SPEAKER_01: It was, you know, because you're in all these states and we're gonna have to redo all these documents and all these different things, it's gonna be like we'll have to do 50 sets of documents.
• 23:15
  SPEAKER_01: You know, it was not an insignificant sort of thing.
• 23:18
  SPEAKER_01: And they literally laughed me out of the room.
• 23:20
  SPEAKER_01: They they were like, there's no way we're paying that.
• 23:22
  SPEAKER_01: You know, you you're just coming in here and you think we're gonna write you a check for this.
• 23:26
  SPEAKER_01: Absolutely not.
• 23:27
  SPEAKER_01: Like it actually got, and I just said, guys, I'll leave.
• 23:29
  SPEAKER_01: I mean, look, you don't need I'm not here to argue.
• 23:31
  SPEAKER_01: Uh you asked me, I told you.
• 23:32
  SPEAKER_01: If you're not interested, you know, have a nice day.
• 23:35
  SPEAKER_01: And literally, it almost ended like it was a little more polite than that, but it was almost like, you know, have a nice day.
• 23:41
  SPEAKER_01: I can't make you do anything.
• 23:42
  SPEAKER_01: I just gave you my honest opinion.
• 23:44
  SPEAKER_01: About six months later, massive class action lawsuit.
• 23:47
  SPEAKER_01: Then an attorney general investigation.
• 23:49
  SPEAKER_01: And they didn't call me.
• 23:50
  SPEAKER_01: I think they were probably too embarrassed.
• 23:52
  SPEAKER_01: You know, they said, Yeah, you wish they were, but I would have been fine if they did.
• 23:55
  SPEAKER_01: I would have come helped them any way I could, but they didn't.
• 23:57
  SPEAKER_01: I think maybe, you know, I don't know why, but maybe it just, you know, they didn't want to give me the satisfaction or they just felt embarrassed or whatever it was.
• 24:05
  SPEAKER_01: I didn't get the call, but it was public.
• 24:07
  SPEAKER_01: The reason I knew about it is the lawsuit was public.
• 24:09
  SPEAKER_01: All you know, the the news picked it up in the dental industry, all the dental publications were carrying it.
• 24:15
  SPEAKER_01: And I know for a fact, just because I kind of sort of looked at it out of the corner of my eye for the next couple of years, and I knew people that were part of that organization that weren't decision makers but were part of it and later sort of told me stuff.
• 24:28
  SPEAKER_01: You know, they settled for a massive fine and penalty.
• 24:31
  SPEAKER_01: And, you know, so in addition to paying every penny, if not more, of what I quoted them to have to fix their business and correct it all, they also paid a massive fine to the government on top of it, and then were shown up in all the you know, all the dental publications as being somebody that violated the law.
• 24:47
  SPEAKER_01: And then when they settled, they embarrassed them again and said, you know, XYZ organization paid a record fine of this amount and they put it everywhere for everybody to see.
• 24:57
  SPEAKER_01: And to me, that's uh, you know, so to answer your question, yes, that happens to me a lot where people don't want to change and I can't make them do it, but that's the most um high profile example that I remember.
• 25:09
  SPEAKER_01: They literally laughed me out of their headquarters, and it wasn't but six, seven months later that this massive thing hit.
• 25:16
  SPEAKER_00: That's crazy.
• 25:17
  SPEAKER_00: And what happens is when you are licensed or you're practicing in multiple states and something happens in one state, then you have to report it to all the other states.
• 25:24
  SPEAKER_00: And then if if dentistry works like healthcare, each individual state has the freedom to decide what they're going to do.
• 25:32
  SPEAKER_00: And they don't have to do what the other states did.
• 25:35
  SPEAKER_00: They can do more, they can do less.
• 25:37
  SPEAKER_00: Does it work on the other way?
• 25:38
  SPEAKER_01: Well, yeah, what I say, I mean that's true.
• 25:40
  SPEAKER_01: What I say sometimes is the best you're gonna get is what happened in the other state, is the best you're gonna get.
• 25:45
  SPEAKER_01: Like you're not gonna get better.
• 25:47
  SPEAKER_01: Like it's not like, oh, they sanctioned me and they're gonna say, sure thing, no problem.
• 25:50
  SPEAKER_01: Like, no, no, no, no.
• 25:52
  SPEAKER_01: The best you're gonna get is they're gonna be lazy.
• 25:54
  SPEAKER_01: They're gonna say, you know, California suspended you for a week, so we're gonna suspend you, you know, here in Texas for a week.
• 26:01
  SPEAKER_01: Yeah.
• 26:01
  SPEAKER_01: That's like the best you're gonna get.
• 26:02
  SPEAKER_01: That's lazy.
• 26:03
  SPEAKER_01: So, you know, we're just gonna, you know, defer to we'll do what they did.
• 26:07
  SPEAKER_01: Uh you know, you probably almost want lazy.
• 26:10
  SPEAKER_01: What you don't want them is to examine it and say, you know, California's just too busy.
• 26:14
  SPEAKER_01: I can't believe they gave you a week.
• 26:16
  SPEAKER_01: Who the heck thought of that?
• 26:17
  SPEAKER_01: We think it should be six months over here or something.
• 26:20
  SPEAKER_01: I mean, that's that's what you don't want to have happen.
• 26:22
  SPEAKER_01: And you're absolutely right.
• 26:24
  SPEAKER_01: The way I say it is the best you're gonna get is the same as you got in the other state.
• 26:28
  SPEAKER_01: The worst is could be could be a lot worse.
• 26:31
  SPEAKER_00: And it can take a lot of time and it can cost a lot of money to fight it at every single level.
• 26:36
  SPEAKER_00: Sometimes the best you can do is sign your name, write the check, report it, and move on.
• 26:42
  SPEAKER_01: No, I mean, sometimes you yes, uh, you know, and and I like I said, I've seen that happen where somebody else will look at it if it's multiple states and it'll be like, you know, I don't know, Colorado or something, and they'll say, look, I'm I'm glad California only gave you seven days, but we know they're too busy.
• 26:58
  SPEAKER_01: We're not as busy in Colorado.
• 27:00
  SPEAKER_01: We dove into this whole thing and analyzed it, and seven days ain't enough.
• 27:04
  SPEAKER_01: You know, you're gonna be two months or something, or three months.
• 27:07
  SPEAKER_01: Is that so?
• 27:07
  SPEAKER_01: Yeah, I mean, if it's the odds are stacked against you once the complaint starts.
• 27:13
  SPEAKER_01: I have, in my 30 years, had people that were wrongly accused that we went all the way to trial and got them acquitted.
• 27:19
  SPEAKER_01: You know, I have done that.
• 27:20
  SPEAKER_01: It's cost probably seven figures and legal fees and everything, but they have gotten off with their name intact.
• 27:27
  SPEAKER_01: But I would honestly say when a complaint is filed, probably 75, 80% of the time, you know, you have to settle.
• 27:37
  SPEAKER_01: Probably 50% of the time, you know, you're guilty.
• 27:40
  SPEAKER_01: You know, it's it's like not only you have to settle, but guilty.
• 27:42
  SPEAKER_01: Yeah, we gotta do it.
• 27:44
  SPEAKER_01: The other time, you know, arguably you're not guilty.
• 27:46
  SPEAKER_01: I mean, arguably you're not, but you know, they're there's like let's say they say, hey, give me a hundred grand and I'll let you off the hook.
• 27:53
  SPEAKER_01: And I'm saying, hey, it's gonna be a million dollars to take this trial and do all this.
• 27:57
  SPEAKER_01: You really just end up saying, you know, we're we may not be guilty here, but the hundred grand or the fifty grand is way cheaper than and it puts an end to it today, and we all go about our business, then you know, being distracted for the next two years and paying all this money.
• 28:11
  SPEAKER_01: So, and then that always breaks my heart when somebody that's not guilty does end up having to settle and write a check.
• 28:17
  SPEAKER_01: But that's why, if you know, you're compliant, very seldom do I see somebody that's completely regulatory compliant that gets just wrongly accused and it becomes a mess.
• 28:27
  SPEAKER_01: It's always somebody that maybe took some shortcuts, didn't do everything correctly in the beginning, even if they maybe fixed it later, but it it was hanging out there.
• 28:38
  SPEAKER_01: You know, they get, you know, somebody, you know, regulator or an attorney general or somebody gets the wrong impression.
• 28:45
  SPEAKER_01: And once they get the wrong impression and they start going down that road, you know, often it is cheaper to write the check than to sit there and fight it for two years or three years, whatever it is.
• 28:55
  SPEAKER_00: It's crazy that that's how long it takes.
• 28:57
  SPEAKER_00: But that, I mean, the the judicial process takes a very long time.
• 29:01
  SPEAKER_00: And if you're trying to run a business or run a practice or be a professional and you have this going on in the background, it can consume your life.
• 29:08
  SPEAKER_00: So yeah, so settling a lot of times is the the better way out.
• 29:11
  SPEAKER_01: I mean, they could tell you, like, hey, give us a hundred grand rather.
• 29:14
  SPEAKER_01: We've looked at it and we think it's a hundred grand problem.
• 29:17
  SPEAKER_01: Give us a hundred grand.
• 29:18
  SPEAKER_01: And maybe you look at it and you're like, you know, dude, we didn't do anything wrong here, or maybe it's 10 grand or something.
• 29:24
  SPEAKER_01: But what they're gonna say is, but if you can test us, we're gonna subpoena all your witnesses.
• 29:28
  SPEAKER_01: So we're gonna come in, we're gonna talk to all your employees, everybody's gonna talk to us, and God knows what else we're gonna find.
• 29:34
  SPEAKER_01: Once we start talking to them, we might find other things that weren't even the subject of this inquiry.
• 29:39
  SPEAKER_01: And then once we, you know, talk to everybody, then we're gonna turn around and file additional charges.
• 29:46
  SPEAKER_01: And then, you know, we're gonna have an expert, and you got to get an expert, and then we got to call witnesses.
• 29:51
  SPEAKER_01: And, you know, by the time you're done with this, it's you know, if they asked for a hundred, this this could cost a half a million or a million dollars, and it's gonna take up the time of your employees that you're gonna have to maybe close your office for certain days when you're messing with this stuff, and it just it just ends up being easier just to write the check and move on.
• 30:09
  SPEAKER_00: And to use an attorney like you who's an expert in this and knows what they're doing and has done it before and understands the nuances of the environment that you're working in.
• 30:19
  SPEAKER_01: Well, that's important too.
• 30:20
  SPEAKER_01: I mean, I I'm not here to promote myself, but that's very important.
• 30:23
  SPEAKER_01: I I've I had somebody recently, maybe a year ago or something, it was a very complicated uh healthcare uh issue under the anti-kickback law, and they hired a DWI attorney to represent him.
• 30:36
  SPEAKER_01: At the time they called me, I walked in and I was like, they said, Hey, let's meet with this.
• 30:40
  SPEAKER_01: You know, I want you to meet with our existing attorney.
• 30:43
  SPEAKER_01: And they kind of knew that he was over his head a little.
• 30:46
  SPEAKER_01: That's why they did.
• 30:46
  SPEAKER_01: But, you know, I sat down in the meeting and he just was acted like somebody that, you know, got transported from another planet and just like we were talking about apples and he's talking about oranges.
• 30:58
  SPEAKER_01: It was just like, did I walk into the right meeting?
• 31:00
  SPEAKER_01: You know, is this some other meeting?
• 31:01
  SPEAKER_01: And then I looked and he was a DWI attorney that just had no business handling a healthcare fraud matter.
• 31:08
  SPEAKER_01: And I literally told the client, look, you know, we gotta just stop talking to him altogether, and then I can, you know, probably fix this for you, but it's gonna take some time and money to do it.
• 31:18
  SPEAKER_00: I mean, especially when you're talking about anti-kickback, that is some high level, that's like one of the top three or top five federal thou shalt not statutes that if you break that one.
• 31:29
  SPEAKER_00: I mean, people go to prison for a long time for for kickbacks.
• 31:33
  SPEAKER_00: So that's a really big deal.
• 31:34
  SPEAKER_00: Trevor Burrus, Jr.
• 31:34
  SPEAKER_00: And there's a perception, at least in in the healthcare space, there's a perception that it only applies to people who take insurance.
• 31:41
  SPEAKER_00: But there are some states, I don't know if it's the same way in dental, but there are some states that have written on top of that their own like anti-kickback and anti-stark laws that apply for any type of payment, even like cash pay, direct pay, no insurance, concierge level stuff.
• 31:57
  SPEAKER_00: Some states have that regulation.
• 31:59
  SPEAKER_01: Laura, you've got some good advice.
• 32:00
  SPEAKER_01: I know you got some bad advice.
• 32:02
  SPEAKER_01: You told me you got some bad advice, and I'm sorry about that, but you got some good advice.
• 32:06
  SPEAKER_01: I mean, some of the stuff you're saying, you're spot on.
• 32:08
  SPEAKER_01: It's very I mean, for a non-lawyer, it's very nuanced.
• 32:11
  SPEAKER_01: You got some good advice, you know, at least somebody you talked to knew what they were doing, because you got some good advice.
• 32:16
  SPEAKER_01: But that's exactly right.
• 32:18
  SPEAKER_01: Generally, the federal statutes only apply if you participate in government programs.
• 32:23
  SPEAKER_01: And a lot of people say, well, we don't take Medicaid or Medicare, so we're out of here, right?
• 32:27
  SPEAKER_01: And it's not so fast because if you're in a state where there's a state counterpart to the federal anti-kickback or the federal Stark law, it could apply to anybody, whether you take, you know, participate in government programs or not, and you know, you can get in trouble, even if you're all cash pay or concierge or whatever, you know, whatever it is.
• 32:47
  SPEAKER_01: So yeah, you you really have to have somebody that knows what they're doing.
• 32:51
  SPEAKER_00: You could be doing botox for cash in California or Texas, New York is another big one.
• 32:56
  SPEAKER_00: They really care.
• 32:57
  SPEAKER_00: They really care about the direction that money flows and what entity, which is owned by who, because that that probably is relevant to dentistry as well.
• 33:05
  SPEAKER_00: You guys do botox also.
• 33:06
  SPEAKER_00: They they really, really do care, and they really, really do uh crack down.
• 33:12
  SPEAKER_01: And places like Florida are very tough because you know they they have a huge uh everybody knows this, a huge retirement community population, and the legislature has taken particular care to be careful with the senior population because you know sometimes they can get roped into arrangements and you know they don't know, you know, necessarily.
• 33:30
  SPEAKER_01: So the leg I mean there's very strict penalties in Florida.
• 33:33
  SPEAKER_01: I mean, not you know, California's a bad one too, but Florida in particular, because all the retirement communities there are very, very strict regulations.
• 33:41
  SPEAKER_00: That's a lot.
• 33:42
  SPEAKER_00: My goodness.
• 33:43
  SPEAKER_00: Well, you know, we've kind of come to the end of our time today, and I really appreciate, listen, as you can tell, I talk a lot about corporate practice of medicine, just corporate structure, flow of funds, and how to be compliant.
• 33:54
  SPEAKER_00: And I'm happy to have this conversation with you.
• 33:56
  SPEAKER_00: I hope that people who are listening to this, if they're considering starting a dental or a healthcare business, have a mind to how to do it right the first time so that they don't feel the pain of doing it wrong and having to do it right the second time.
• 34:11
  SPEAKER_01: Yeah, I mean, that's we were talking about quotes before this, and I have a quote about you know, everybody's gotta suffer two types of pain, the pain of discipline and the pain of regret.
• 34:20
  SPEAKER_01: The difference is the pain of discipline weighs ounces, the pain of regret weighs tons.
• 34:25
  SPEAKER_01: And it's one of those things where if you have the discipline to go slow, learn the business, hire the right advisors at the beginning.
• 34:32
  SPEAKER_01: I mean, it's a little painful.
• 34:33
  SPEAKER_01: You're gonna have to pay more.
• 34:34
  SPEAKER_01: It's gonna take a little more time than if you just sprint, you know, through it.
• 34:38
  SPEAKER_01: But the regret of a massive investigation and ending up with, you know, hundreds of thousands of dollars of fines and legal fees and reputational damage, I mean, that weighs tons versus whatever you're gonna have to pay, you know, on the front end to get it done right.
• 34:53
  SPEAKER_01: I mean, that's that's my thinking on it.
• 34:56
  SPEAKER_00: It sure does.
• 34:57
  SPEAKER_00: I agree completely.
• 34:59
  SPEAKER_00: Well, thank you for taking the time to chat with me today all about the regulatory environment of healthcare service organizations in the United States.
• 35:08
  SPEAKER_00: Uh let me let me ask you, I know you said you're not here for self-promotion, but if there's somebody who's listened to this and they think, okay, I need to find a good regulatory attorney to help me with my practice, where can someone find you if they are looking for an expert in these things?
• 35:22
  SPEAKER_01: Yeah, if you go to dykoma dso.com, d y K E-M-A-D-S-O.com, all my information is there.
• 35:32
  SPEAKER_01: My whole team's on there, and you can get in touch with me real easy through an email there and uh be happy to help.
• 35:38
  SPEAKER_01: I mean, it is what I do.
• 35:39
  SPEAKER_01: And I and I don't judge a last thing I'll say, Laura, I don't judge anybody.
• 35:42
  SPEAKER_01: I mean, we've been spending time telling everybody, hey, you gotta follow this.
• 35:45
  SPEAKER_01: I don't care how you know difficult the situation is.
• 35:48
  SPEAKER_01: Uh, you're not gonna hear any lectures or anything from me.
• 35:51
  SPEAKER_01: I'm just gonna come in and try to help.
• 35:53
  SPEAKER_01: You know, so happy to talk to anybody if it's in the beginning, in the middle, or literally the FBI's on the premises.
• 36:00
  SPEAKER_01: Either way, happy to talk to anybody.
• 36:02
  SPEAKER_00: That's awesome.
• 36:03
  SPEAKER_00: Thank you so much, Brian.
• 36:04
  SPEAKER_00: I wish you all the best.
• 36:05
  SPEAKER_00: I appreciate the time you've given me today, and take care.
• 36:09
  SPEAKER_01: Thanks, Laura.
• 36:10
  SPEAKER_01: Thanks.
• 36:11
  SPEAKER_00: Thank you for tuning in to the I Am Wiser Podcast, where each episode brings us closer to a wiser, more human approach to healthcare.
• 36:20
  SPEAKER_00: If today's conversation inspired you or sparked new ideas, share it with someone who's ready to rethink healthcare.
• 36:27
  SPEAKER_00: And if you have a story or innovation that could light the way for others, reach out.
• 36:32
  SPEAKER_00: We'd love to hear from you.
• 36:34
  SPEAKER_00: This space is yours too.
• 36:36
  SPEAKER_00: Don't forget to follow, rate, and review us on your favorite platform.
• 36:40
  SPEAKER_00: Until next time, stay curious, stay courageous, and stay wiser.