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 mattered
• What practicing healthcare law looked like 20 years ago versus today
• How trust and disagreement support long-term law firm partnerships
• The shift from survival-mode legal work to intentional practice growth
• How technology changed healthcare law, firm operations, and client expectations
• Why mentorship in law still requires learning the hard way
• What’s next for healthcare providers, healthcare investors, and healthcare attorneys

Produced 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.

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.

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 here
• The hidden challenges when seasoned practice owners become employees again
• How private equity and hospital system acquisitions reshape autonomy, protocols, and practice culture
• The importance of due diligence: what every physician should ask before signing an employment contract
• How compensation models like work RVUs, KPIs, and restrictive covenants can make or break a deal
• Why knowing yourself – and trusting your instincts – matters more than any data point

BONUS: 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.

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 strategy
• How “downcoding” can be just as risky as overbilling
• What happens when modifiers get misused – and why payers love to exploit those mistakes
• The surprising role coding plays in private equity healthcare transactions and due diligence
• How AI and algorithms are changing both denials and defenses
• Why providers must take responsibility for their billing companies’ actions
• What “impossible days” reveal about audits, oversight, and defense strategy
• The common-sense test every provider and investor should apply before trusting a new device, service, or software

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.

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 scale
• Helping operators understand transaction readiness, value creation, and when not to sell
• Why trust, storytelling, and goal alignment were critical to closing three simultaneous deals and an investment in under 90 days
• The elements of an investable practice
• The hidden risks buyers watch for – and why full transparency always wins
• What buyers really want from sellers post-closing – and why the “what’s next” conversation matters
• How 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.

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 industries
• How insurers and the DOJ infer “intent” from billing patterns
• The myth of “simple mistakes” and why they offer little legal protection
• The “should have known” standard and its sweeping implications
• Why medical necessity documentation is often the deciding factor in FCA defense
• How private equity ownership affects liability exposure
• Strategic pitfalls for investors and executives during diligence and deal execution
• The financial incentive behind fraud allegations—and who profits
• Insights from DOJ proffer meetings, qui tam cases, and real-world audits
• Why the fallout from an FCA case often extends far beyond a single lawsuit

Whether 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.

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.