Almost Clinical

Buttaci Leardi & Werner

Welcome to Almost Clinical, the podcast where healthcare, law, and business converge in the most captivating way. Hosted by the dynamic trio from Buttaci Leardi & Werner – Vincent Buttaci, John Leardi, and Paul Werner – this show is your backstage pass to the gritty, multifaceted world of healthcare management. Every episode brings you face-to-face with the realities of running a healthcare practice, navigating legal hurdles, and capitalizing on business opportunities. Forget the clichés and technical jargon – Almost Clinical is all about accessible, engaging conversations that cut through the noise. Here, you’ll get straight-talking insights and no-nonsense discussions perfect for savvy healthcare leaders and business owners with hectic schedules and a thirst for industry knowledge. What makes Almost Clinical essential listening? It’s all about melding perspectives: ~Clinical Insights: Get the scoop on the latest in medical practice, patient care innovations, and what’s really needed to enhance healthcare delivery. ~Legal Realities: Learn about the pitfalls and legal entanglements healthcare practices face, and why compliance can sometimes feel like navigating a minefield. ~Business Opportunities: Find out who’s making waves in the industry, where the money is flowing, and how to seize emerging opportunities. Almost Clinical isn’t just about talking shop; it’s about understanding the nuances and balancing acts that keep a healthcare practice thriving. Our goal is to make you feel like part of the conversation, providing insights that go beyond headlines and Twitter threads. Our conversations are as engaging and enlightening, featuring guests from all corners of the healthcare world. Whether dissecting a new regulation or exploring innovative business models, we aim to shed light on the issues that impact the day-to-day operations of healthcare practices. So, whether you’re a healthcare leader, a business owner, or simply someone interested in how these fields overlap and influence each other, be sure to tune in to Almost Clinical today!

Episodes

  1. JAN 30

    The Most Dangerous Letter a Licensed Professional Can Receive: A Guide to Not Making It Worse

    Most licensing board letters are written to sound harmless when they are, in fact, anything but. In this episode of Almost Clinical, powered by Buttaci, Leardi, & Werner, hosts Vincent Buttaci, John Leardi, and Paul Werner break down what really happens when a professional licensing board comes knocking – and why even the most “innocuous” inquiry can spiral into something far more serious. Drawing on decades of experience defending licensed professionals across New York and New Jersey, the conversation covers: Why licensing board inquiries are never just “requests for information”How minor complaints can quickly expand into full-scale investigationsThe real, long-term consequences of board discipline (including public records and Data Bank reporting)Why trying to “explain it yourself” often makes things worsThe hidden risks in billing disputes, patient complaints, and mandatory reportingHow early decisions — especially written responses — can shape the entire outcomeAlong the way, the hosts share real-world war stories, practical guidance, and a few hard truths about how licensing boards actually operate behind the scenes. If your livelihood depends on a professional license – or you employ people whose livelihoods do – this is a conversation worth hearing before you ever receive that letter. Join Almost Clinical hosts Vincent Buttaci, John Leardi, and Paul Werner as they challenge each other’s views on how to operate, invest, and succeed in healthcare’s rapidly shifting landscape, translate legalese into business sense for healthcare providers, executives, private equity professionals, and strategic stakeholders, and explore the issues shaping the business of medicine today and tomorrow.

    51 min

  2. 12/17/2025

    Three Partners. Two Decades. One Firm: Then, Now & What’s Next

    Every firm has an origin story. This one starts in a bathroom, involves a risky career move away from a stable Big Law job, and turns into a 20-year healthcare law firm that still works. In this episode of Almost Clinical, healthcare attorneys Vincent Buttaci, John Leardi, and Paul Werner reflect on the founding and evolution of Buttaci, Leardi & Werner, a healthcare law firm built without a roadmap – and kept together by trust, judgment, and a willingness to figure things out in real time. The conversation begins with the “then”: shared office space, dictated letters, loud fax machines, and taking the healthcare legal work that paid the bills. The hosts explain what practicing healthcare law looked like in the mid-2000s and how learning on the fly shaped the firm’s approach to clients, risk, and problem-solving. From there, the discussion moves to the “now.” Buttaci, Leardi & Werner operates as a nationally respected healthcare boutique representing physicians, healthcare organizations, and healthcare investors in regulatory, transactional, and litigation matters. The hosts break down how technology, consolidation, and increasingly sophisticated clients have changed the role of healthcare attorneys from ‘document donkeys’ to true business advisors..  The episode closes with a look ahead. Vincent, John, and Paul discuss where healthcare law and healthcare business are headed next, how artificial intelligence and automation are reshaping legal practice, and why independence, trust, and partnership still matter in a rapidly consolidating healthcare industry. In this episode, we discuss: How Buttaci, Leardi & Werner was founded and why the early years matteredWhat practicing healthcare law looked like 20 years ago versus todayHow trust and disagreement support long-term law firm partnershipsThe shift from survival-mode legal work to intentional practice growthHow technology changed healthcare law, firm operations, and client expectationsWhy mentorship in law still requires learning the hard wayWhat’s next for healthcare providers, healthcare investors, and healthcare attorneysProduced by Buttaci, Leardi & Werner, this episode is less about nostalgia and more about longevity – what holds up over time, what falls apart, and what’s worth carrying forward in healthcare law and business. Join Almost Clinical hosts Vincent Buttaci, John Leardi, and Paul Werner as they challenge each other’s views on how to operate, invest, and succeed in healthcare’s rapidly shifting landscape, translate legalese into business sense for healthcare providers, executives, private equity professionals, and strategic stakeholders, and explore the issues shaping the business of medicine today and tomorrow.

    54 min

  3. 10/22/2025

    EKRA: The Law That Changed How Behavioral Health Does Business

    In the latest episode of Almost Clinical, hosts and healthcare attorneys Vincent Buttaci, John Leardi, and Paul Werner dissect the Eliminating Kickbacks in Recovery Act (EKRA) and what the recent Ninth Circuit decision means for behavioral health providers, labs, and investors. EKRA isn’t just another compliance acronym – it’s the law that upended how behavioral health operators, treatment facilities, and clinical labs market and grow their businesses. What began as Congress’s response to rampant patient-brokering and kickback schemes has evolved into one of the broadest and most unforgiving enforcement tools in healthcare. Vincent, John, and Paul explain how EKRA expanded beyond the Anti-Kickback Statute, why “creative” inducements can now carry criminal risk, and how the Ninth Circuit’s decision made it clear that third-party marketers and investors are not immune. They also dig into real-world scenarios – from “free” flights and charitable donations to commission-based pay – that illustrate just how easy it is to step over the line. Listeners will learn: How EKRA closed the loopholes left by the Anti-Kickback Statute;Why behavioral health became ground zero for kickback enforcement;What the Ninth Circuit’s ruling changes for marketers and investors;Why “intent” won’t protect you when enforcement comes calling;How free housing, charitable donations, and profit sharing can cross the line;What whistleblowers and DOJ pilot programs mean for operators;Practical strategies for staying compliant without killing your business, and so much more.Please note that this episode discusses various forms of addiction and substance abuse facilities/programs. If you or someone you know is struggling with addiction, don’t be afraid to ask for help. Please contact ReachNJ at 844.732.2465 or reachnj.gov. Someone will be there to listen. Produced by Buttaci, Leardi & Werner, the healthcare law boutique helping providers and investors navigate what’s legal, what’s risky, and what’s next. Join Almost Clinical hosts Vincent Buttaci, John Leardi, and Paul Werner as they challenge each other’s views on how to operate, invest, and succeed in healthcare’s rapidly shifting landscape, translate legalese into business sense for healthcare providers, executives, private equity professionals, and strategic stakeholders, and explore the issues shaping the business of medicine today and tomorrow.

    46 min

  4. 09/24/2025

    Physicians as Employees: Autonomy, Exit Strategies, & the New Healthcare Economy

    Almost Clinical returns with a sharp look at what happens when physicians and other licensed healthcare providers trade ownership for employment. Buttaci Leardi & Werner healthcare attorneys and show hosts Vincent Buttaci, John Leardi, and Paul Werner unpack the realities of a profession where nearly 8 out of 10 physicians now work as employees. This episode cuts through the clichés and legalese to explore what really changes when the person who once ran the practice is suddenly answering to hospital administrators, private equity-backed groups, or “helpful” management companies. From exit deals to employment contracts to the not-so-small matter of clinical autonomy, the conversation moves fast, goes deep, and leaves no stone unturned. Whether you’re a physician contemplating an offer, a healthcare provider navigating institutional protocols, or an investor evaluating practice acquisitions, Physicians as Employees: Autonomy, Exit Strategies, and the New Healthcare Economy offers important insights you won’t find in glossy recruitment brochures. Listeners will learn: Why physician employment is now the dominant model and how we got hereThe hidden challenges when seasoned practice owners become employees again How private equity and hospital system acquisitions reshape autonomy, protocols, and practice cultureThe importance of due diligence: what every physician should ask before signing an employment contractHow compensation models like work RVUs, KPIs, and restrictive covenants can make or break a dealWhy knowing yourself – and trusting your instincts – matters more than any data pointBONUS: Get the lowdown on the tried-and-true “buffet principle” for reading contracts (hint: don’t fill up on the front-page perks). Join Almost Clinical hosts Vincent Buttaci, John Leardi, and Paul Werner as they challenge each other’s views on how to operate, invest, and succeed in healthcare’s rapidly shifting landscape, translate legalese into business sense for healthcare providers, executives, private equity professionals, and strategic stakeholders, and explore the issues shaping the business of medicine today and tomorrow.

    45 min
  5. Coding, Compliance, & the Business of Medicine with David Klein

    09/10/2025

    Coding, Compliance, & the Business of Medicine with David Klein

    Behind every patient encounter lies a web of codes, regulations, and billing decisions that shape both care and cash flow. In this episode, healthcare attorneys Vincent Buttaci, John Leardi, and Paul Werner sit down with longtime collaborator and compliance powerhouse David Klein. David is the Founder and President of DK Coding & Compliance, Inc., co-founder of PayDC.com, and one of the sharpest minds in medical coding, compliance, and reimbursement strategy. With over 25 years in the field – and more acronyms after his name than most lawyers can fit on a business card – David has built a career translating the messy language of clinical practice into the precise codes that drive reimbursement and compliance. This conversation pulls no punches. The guys dive into everything from the absurdity of “impossible days,” to the risk of downcoding, to the darkly comic reality that scotch tape once helped fuel a multimillion-dollar billing scheme. For healthcare providers, investors, and anyone who thinks coding is just clerical busywork, this episode is a bracing reminder: coding is law, coding is money, and coding can make or break a deal. Listeners will learn: Why medical coding is both compliance obligation and financial strategyHow “downcoding” can be just as risky as overbillingWhat happens when modifiers get misused – and why payers love to exploit those mistakesThe surprising role coding plays in private equity healthcare transactions and due diligenceHow AI and algorithms are changing both denials and defensesWhy providers must take responsibility for their billing companies’ actionsWhat “impossible days” reveal about audits, oversight, and defense strategyThe common-sense test every provider and investor should apply before trusting a new device, service, or softwareJoin Almost Clinical hosts Vincent Buttaci, John Leardi, and Paul Werner as they challenge each other’s views on how to operate, invest, and succeed in healthcare’s rapidly shifting landscape, translate legalese into business sense for healthcare providers, executives, private equity professionals, and strategic stakeholders, and explore the issues shaping the business of medicine today and tomorrow.

    1h 4m
  6. Behind the Term Sheet with Anthony DeSena: Real Talk on Transactions, Trust & Timing

    08/14/2025

    Behind the Term Sheet with Anthony DeSena: Real Talk on Transactions, Trust & Timing

    In this milestone episode, Almost Clinical hosts Vincent, John, & Paul welcome the show’s first-ever guest: Anthony DeSena, CEO of Pax Health, a fast-scaling behavioral health platform. A former physical therapist turned operator, Anthony brings rare perspective as both a seller and buyer in private equity-backed healthcare transactions. Together, they explore the rapidly evolving landscape of healthcare investment – from founding and scaling a physical therapy group to over 100 clinics, through M&A integration, private equity exits, and the launch of Pax Health.  With transparency, humor, and insight, Anthony shares what makes a transaction successful, the pitfalls providers overlook, and why alignment – not just capital – is critical for long-term growth in the sector. Highlights include: Behind the scenes of Anthony’s first private equity-backed growth story, including lessons learned during complex integrations and managing scaleHelping operators understand transaction readiness, value creation, and when not to sellWhy trust, storytelling, and goal alignment were critical to closing three simultaneous deals and an investment in under 90 daysThe elements of an investable practiceThe hidden risks buyers watch for – and why full transparency always winsWhat buyers really want from sellers post-closing – and why the “what’s next” conversation mattersHow investors navigate structural limitations – and why clinical ownership still plays a vital role.What practice leaders should do now to be attractive to acquirers, including real advice on data rooms and diligence.BONUS: Stay until the end to learn the ‘ruthless’ guiding principle that Anthony abides by – even when the stakes are high. Join Almost Clinical hosts Vincent Buttaci, John Leardi, and Paul Werner as they challenge each other’s views on how to operate, invest, and succeed in healthcare’s rapidly shifting landscape, translate legalese into business sense for healthcare providers, executives, private equity professionals, and strategic stakeholders, and explore the issues shaping the business of medicine today and tomorrow.

    47 min

  7. 07/24/2025

    From Audit to Accusation: A Smarter Way to Manage False Claims Risk

    We’re officially into episode two of Almost Clinical, and we’re already going to jump fearlessly into the deep end, confronting one of the healthcare industry’s biggest regulatory threats: the False Claims Act. Through the FCA lens, what might begin as a routine audit can quickly escalate into a high-stakes fraud investigation. For providers, executives, and investors, the financial and reputational consequences can be staggering – even when there’s no intent to deceive. In From Audit to Accusation: A Smarter Way to Manage False Claims Risk, hosts Vincent Buttaci, John Leardi, and Paul Werner draw from two decades of experience defending clients in payer audits, civil FCA litigation, and federal criminal prosecutions. They unpack how fraud investigations unfold, how regulators interpret “intent,” and why even an honest coding mistake can land your organization in the government’s crosshairs. Highlights include: Why fraud in healthcare is fundamentally different from other industriesHow insurers and the DOJ infer “intent” from billing patternsThe myth of “simple mistakes” and why they offer little legal protectionThe “should have known” standard and its sweeping implicationsWhy medical necessity documentation is often the deciding factor in FCA defenseHow private equity ownership affects liability exposureStrategic pitfalls for investors and executives during diligence and deal executionThe financial incentive behind fraud allegations—and who profitsInsights from DOJ proffer meetings, qui tam cases, and real-world auditsWhy the fallout from an FCA case often extends far beyond a single lawsuitWhether you're a seasoned operator or evaluating your first deal in the healthcare space, Almost Clinical’s deep dive into one of healthcare’s most feared legal mechanisms is essential listening for anyone looking to mitigate risk in a landscape where compliance missteps are weaponized – and often monetized. Join Almost Clinical hosts Vincent Buttaci, John Leardi, and Paul Werner as they challenge each other’s views on how to operate, invest, and succeed in healthcare’s rapidly shifting landscape, translate legalese into business sense for healthcare providers, executives, private equity professionals, and strategic stakeholders, and explore the issues shaping the business of medicine today and tomorrow.

    56 min

  8. 05/30/2025

    Intro to the Guys & the Whys

    Almost Clinical is THE podcast where healthcare, law, and business converge - and a passion project of the legal minds behind Buttaci, Leardi & Werner. In this debut episode, Vincent, John, and Paul introduce themselves - not just as lawyers, but as business operators and healthcare translators - and the inspiration behind the entire show's concept. Our inaugural episode sets the stage for the type of informed, conversational, and occasionally irreverent discussion you can expect from our intrepid hosts. You’ll learn why Almost Clinical exists, the unique value of our dialogue-driven format, and how evolving regulatory, business, and clinical realities require layered, strategic thinking.  And you’ll get a candid look behind the curtain into how top legal minds advise clients – from solo practitioners to national health systems to institutional investors. This first episode also previews major themes - from private equity integration to regulatory crackdowns to the evolution of the provider's role as entrepreneur – that you can expect to hear in future discussions.  Highlights of this conversation: Why the legal, business, and clinical sides of healthcare can't be siloed anymore.The firm's conversational approach as a model for client service and decision-making.Real-world examples from transactions and disputes - what goes wrong, and how to fix it.The importance of aligning legal advice with client objectives and risk tolerance.Translation challenges between healthcare language and legal/business frameworks.Evolving roles of providers as entrepreneurs, executives, and dealmakers.Insights into trends like telehealth, PE consolidation, and the new face of litigation.A preview of future episodes covering PBMs, False Claims Act reforms, and leadership evolution in clinical careers.With their distinct personalities and shared passion for real-world problem-solving, the hosts lay the foundation for a thought-provoking, high-caliber series you'll definitely want to follow! Join Almost Clinical hosts Vincent Buttaci, John Leardi, and Paul Werner as they challenge each other’s views on how to operate, invest, and succeed in healthcare’s rapidly shifting landscape, translate legalese into business sense for healthcare providers, executives, private equity professionals, and strategic stakeholders, and explore the issues shaping the business of medicine today and tomorrow.

    49 min
  • 8 Episodes

4.7
out of 5
13 Ratings

About

Welcome to Almost Clinical, the podcast where healthcare, law, and business converge in the most captivating way. Hosted by the dynamic trio from Buttaci Leardi & Werner – Vincent Buttaci, John Leardi, and Paul Werner – this show is your backstage pass to the gritty, multifaceted world of healthcare management. Every episode brings you face-to-face with the realities of running a healthcare practice, navigating legal hurdles, and capitalizing on business opportunities. Forget the clichés and technical jargon – Almost Clinical is all about accessible, engaging conversations that cut through the noise. Here, you’ll get straight-talking insights and no-nonsense discussions perfect for savvy healthcare leaders and business owners with hectic schedules and a thirst for industry knowledge. What makes Almost Clinical essential listening? It’s all about melding perspectives: ~Clinical Insights: Get the scoop on the latest in medical practice, patient care innovations, and what’s really needed to enhance healthcare delivery. ~Legal Realities: Learn about the pitfalls and legal entanglements healthcare practices face, and why compliance can sometimes feel like navigating a minefield. ~Business Opportunities: Find out who’s making waves in the industry, where the money is flowing, and how to seize emerging opportunities. Almost Clinical isn’t just about talking shop; it’s about understanding the nuances and balancing acts that keep a healthcare practice thriving. Our goal is to make you feel like part of the conversation, providing insights that go beyond headlines and Twitter threads. Our conversations are as engaging and enlightening, featuring guests from all corners of the healthcare world. Whether dissecting a new regulation or exploring innovative business models, we aim to shed light on the issues that impact the day-to-day operations of healthcare practices. So, whether you’re a healthcare leader, a business owner, or simply someone interested in how these fields overlap and influence each other, be sure to tune in to Almost Clinical today!

Information

  • Creator
    Buttaci Leardi & Werner
  • Years Active
    2025 - 2026
  • Episodes
    8
  • Rating
    Clean
  • Copyright
    © 2026 Almost Clinical
  • Show Website
    Almost Clinical