Compliance Deconstructed

Whistleblower litigation plays an important role in healthcare compliance, particularly when employees identify suspected fraud, improper billing practices, or conduct that puts patients and public funds at risk.  In this episode of Compliance Deconstructed, Jessica Zeff, Lorie Davis, and Elvan Baker welcome Pittsburgh-based attorney Darth Newman to discuss whistleblower protections, the federal F...

Healthcare fraud can take many forms, and some are much easier to recognize than others.  In this episode of Compliance Deconstructed, Jessica Zeff, Lorie Davis, and Elvan Baker examine the nature of fraud in healthcare, starting with the traditional understanding of fraudulent billing and moving into less obvious situations involving inaccurate claims, inflated services, and misrepresentation.  T...

Healthcare compliance and legal teams often work in the same areas, but knowing when an issue belongs with compliance, when legal counsel should be involved, and when both teams need to work together can create confusion.  In Episode 33 of Compliance Deconstructed, Jessica Zeff, Lorie Davis, Elvan Baker, and special guest Gabby Morella, Managing Partner at Morella & Associates, explore the rel...

Medical billing and coding is one of the most complex operational areas in healthcare, with providers and billing organizations required to navigate hundreds of codes, modifiers, reimbursement rules, payer requirements, and changing regulations.  In Episode 32 of Compliance Deconstructed, Jessica Zeff, Lorie Davis, and special guest Nancy Worthy of Worthy Billing and Consulting discuss the medical...

The Office of Inspector General’s new Medicare Advantage Industry Segment-Specific Compliance Program Guidance (ICPG) provides healthcare organizations with a more focused framework for identifying and managing compliance risks within the Medicare Advantage sector.  In this episode, Jessica Zeff, Elvan Baker, and special guest Brian Burton of Healthicity discuss how the new guidance fits alongside...

California Medicaid, known as Medi-Cal, is one of the largest and most complex Medicaid programs in the United States, serving approximately 15 million members across diverse geographic and socioeconomic communities.  In this Part 2 episode of Compliance Deconstructed, Jessica Zeff, Elvan Baker, Lorie Davis, and special guest Marwan Kanafani continue to explore what makes California Medicaid uniqu...

California's Medicaid program, Medi-Cal, serves more than 14 million residents and continues to shape how managed care, compliance, and healthcare delivery evolve across the country.  In this episode of Compliance Deconstructed, Jessica Zeff, Elvan Baker, and special guest Marwan Kanafani explore how Medi-Cal operates, why California's regulatory environment is so complex, and what healt...

GLP-1 medications continue to reshape healthcare delivery, creating new opportunities for patient care while introducing significant compliance responsibilities for providers, telehealth organizations, pharmacies, and health plans.  In this episode of Compliance Deconstructed, Jessica Zeff is joined by co-hosts Elvan Baker and Lorie Davis to examine the regulatory and operational challenges surrou...

In this episode of Compliance Deconstructed, Jessica Zeff and Elvan Baker sit down with Denise Lord to explore the realities of managing healthcare compliance in a critical access hospital. Denise shares firsthand insights into balancing multiple responsibilities, building effective compliance programs with limited resources, and creating sustainable processes that support both regulatory requirem...

Information security plays a critical role in healthcare compliance, risk management, and organizational resilience. In this episode of Compliance Deconstructed, Jessica Zeff, Lorie Davis, and special guest Joe Wynn, Founder & CEO of Seiso, break down the foundational elements of an effective information security program and explain why protecting sensitive data requires a structured approach...

In this episode of Compliance Deconstructed, Jessica Zeff joins co-hosts Elvan Baker and Lorie Davis to unpack one of the most operationally complex areas of healthcare compliance: Medicaid and the realities of navigating state-specific healthcare programs. The reality is Medicaid is not a single national program with standardized rules, and organizations often underestimate how much variation exi...

Healthcare providers continue to face growing pressure to improve patient outcomes while meeting evolving regulatory expectations, and this episode of Compliance Deconstructed breaks down how the Merit-based Incentive Payment System (MIPS) shapes modern healthcare compliance and quality reporting. Jessica Zeff, Lorie Davis, and Elvan Baker explain how MIPS creates measurable standards for quality...

HEDIS measures, developed by the National Committee for Quality Assurance, provide a standardized framework for evaluating healthcare quality across health plans and provider organizations. In Episode 24 of Compliance Deconstructed , Jessica Zeff and Lorie Davis break down how the Healthcare Effectiveness Data and Information Set (HEDIS) supports consistent performance measurement and drives impro...

This episode of Compliance Deconstructed is brought to you by Jessica Zeff of Simply Compliance and features Emma Howard of Cozza Law Group. Together, they focus on medical spa compliance and Managed Service Organizations (MSOs). This episode explores how MSOs help medical spa owners navigate complex healthcare regulations and maintain legal compliance. The conversation breaks down the corporate p...

In this episode of Compliance Deconstructed , hosts Jessica Zeff, Elvan Baker, and Lorie Davis challenge the outdated perception of compliance as a rigid, rule-enforcing function and instead position it as a dynamic, strategic driver within healthcare organizations. They explore how modern healthcare compliance professionals contribute to organizational success by blending regulatory expertise wit...

On this episode of Compliance Deconstructed, hosts Jessica Zeff, Lorie Davis, and Elvan Baker explore the critical non-clinical skills every healthcare professional must master to succeed beyond medical training. Listeners will learn why clinical expertise alone is not enough in today’s complex healthcare environment and how gaps in business, regulatory, and operational knowledge can lead to stres...

In this episode of Compliance Deconstructed , hosts Jessica Zeff and Elvan Baker explore why written policies and procedures are foundational to business success, risk mitigation, and regulatory compliance. Throughout this conversation, they break down how documented guidance eliminates confusion, creates operational consistency, and protects organizations from unnecessary legal and financial expo...

In this episode of Compliance Deconstructed , hosts Jessica Zeff, Elvan Baker, and Lorie Davis unpack the true meaning of whistleblowing in healthcare compliance and why speaking up is essential to protecting patients and public funds. They explore how whistleblowing differs from gossip or tattling, emphasizing that good faith reporting is rooted in observed facts, regulatory violations, and unres...

Continuous learning is essential for healthcare compliance professionals navigating constant regulatory updates, operational changes, and emerging risks. In this episode of Compliance Deconstructed , hosts Jessica Zeff, Lorie Davis, and Elvan Baker explore why ongoing professional development is critical to staying effective, confident, and compliant in a rapidly evolving healthcare industry. This...

Medicaid audits play a critical role in ensuring healthcare organizations meet compliance, quality, and contractual requirements, and this episode of Compliance Deconstructed breaks down what providers and health plans need to know. Hosts Jessica Zeff, Lorie Davis, and Elvan Baker explore how ECRO and ISCA audits function within Medicaid programs and why understanding them is essential for operati...

In this episode of Compliance Deconstructed , hosts Jessica Zeff, Lorie Davis, and Elvan Baker unpack why whistleblowing remains a critical pillar of effective healthcare compliance programs. They explore how speaking up about concerns - whether ethical, operational, or regulatory - helps healthcare organizations identify risks early and protect patients, staff, and reputation. This in-depth discu...

In this episode of Compliance Deconstructed , hosts Jessica Zeff, Elvan Baker, and Lorie Davis continue to break down the complexities of the ongoing United Healthcare case through the lens of prior authorization and patient access. They explore how insurance-driven decision-making continues to impact healthcare delivery, compliance expectations, and provider operations. Today’s conversation highl...

In this episode of Compliance Deconstructed , Jessica, Elvan, and Lorie break down the complex relationship between healthcare compliance, patient safety, and organizational integrity. They use a major real-world case study (United Healthcare, to be exact) to show how compliance failures ripple across quality of care, operations, and public trust. The hosts explore how organizational culture can m...

Compliance Deconstructed is back and in this episode, hosts Jessica Zeff, Lorie Davis, and Elvan Baker break down the fundamentals of fiduciary duties and why they matter for every organization. This in-depth conversation explores how strong oversight begins with understanding the core responsibilities every board member holds, showcasing how fiduciary duties serve as the backbone of organizationa...

Compliance Deconstructed is back and, in this episode, Jessica Zeff, Elvan Baker, and Lorie Davis dive into why budgeting is essential for building a strong, sustainable compliance program. They challenge the common misconception that compliance is a low-cost, back-office function and outline why underfunding it puts organizations at risk. Throughout this episode you will gain insight into the tru...