Shows
Compliance DeconstructedMaster Medicaid Audits: Your ECRO & ISCA Survival GuideMedicaid 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 operational success.Throughout this in-depth conversation, your hosts explain that ECRO audits, conducted by External Quality Review Organizations, focus on evaluating the quality of care, member services, and adherence to state and federal Medicaid standards. ISCA audits concentrate o...
2026-01-2048 min
Compliance DeconstructedWhistleblowing: It's Not What You Think It IsIn 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 discussion reframes whistleblowing as a proactive compliance tool rather than an act of disloyalty, especially within highly regulated healthcare environments. The hosts explain how fostering transparency and psychological safety strengthens compliance culture and supports long-term organizational integrity.Jessica, Lorie, and Elvan...
2026-01-0638 min
Compliance DeconstructedUnited Healthcare's Shocking Billing Fraud Exposed: What You Need to Know - Part 2In 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 highlights how prior authorization, though positioned as a cost-control tool, can delay essential care and complicate compliance workflows. The hosts discuss real-world scenarios where automation, incomplete reviews, and non-specialist evaluators contribute to patient risk and provider frustration.Jessica, Lorie, and Elvan will ta...
2025-12-2357 min
Motivation N'atClick It: Compliance as the Seatbelt | Guest - Jessica Zeff🎧 Compliance Skills and SecretsGuest: Jessica ZeffIn this episode of Motivation N’at, Natalie sits down with Jessica Zeff of Simply Compliance to talk about what truly makes a compliance program successful — and why it always comes back to people.Compliance is meant to be preventative, not punitive, but achieving that requires resilience, adaptability, and strong leadership. Jessica shares her perspective on what it takes to be an effective compliance professional in industries that are constantly changing, where no two days look the same.
2025-12-211h 00
Compliance DeconstructedUnited Healthcare's Shocking Billing Fraud Exposed: What You Need to Know - Part 1In 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 make or break an effective compliance program, emphasizing the powerful influence of informal norms and leadership behavior. Collectively, they highlight why even the strongest policies fall flat when daily actions don’t align with written expectations.As you dive in...
2025-12-0942 min
Compliance Conversations by HealthicityWhy Case Management Is Critical to Demonstrating ComplianceIn this episode of Compliance Conversations, healthcare compliance expert Jessica Zeff, the Founder & CEO of Simply Compliance, shares real-world insight into why structured, electronic case management is essential for demonstrating compliance, managing risk, and responding efficiently to audits and investigations. What You’ll Learn What compliance case management actually looks like in practice Why consistency and categorization matter for risk analysis Common mistakes organizations make when handling compliance cases How case management supports audits, investigations, and leadership reporting Why even basic systems are better than none Who Should Listen Compliance...
2025-12-0442 min
Compliance DeconstructedBoard Fiduciary Duties Explained - How to Avoid Costly MistakesCompliance 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 organizational stewardship and how compliance programs empower boards to uphold those duties effectively.Jessica, Lorie, and Elvan explain the three pillars of fiduciary duty: care, loyalty, and obedience, as well as why each is essential for informed and ethical decision-making. Their...
2025-11-2544 min
Compliance DeconstructedProven Strategies to Justify Your Compliance BudgetCompliance 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 true nature of compliance work, from developing policies to managing investigations and why these tasks require specialized resources. Compliance is not a “plug-and-play” role, but a complex, thought-driven function that operates across the entire organization.The discussion also...
2025-11-1145 min
Compliance DeconstructedThe 2026 Medicare Final Rule --- Are You Ready?In this all-new episode of Compliance Deconstructed, Jessica Zeff, Elvan Baker, and Lorie Davis unpack the major changes included in the latest Medicare Final Rule. From medication affordability to patient rights, the discussion centers on how these updates are poised to drive better health outcomes and increase clarity for healthcare providers and patients alike.One major highlight is the new $35 cap on insulin costs for Medicare beneficiaries, offering a more predictable and affordable path for managing diabetes. This episode explores the real-world impact of this change, particularly for individuals who previously had to ration or delay life-saving...
2025-10-2841 min
Compliance DeconstructedHow to Create a Bulletproof Compliance Plan - A Step-by-Step GuideHosts Jessica Zeff, Lorie Davis, and Elvan Baker are back and, in this episode of Compliance Deconstructed, they break down the key elements of building an effective compliance work plan that truly supports organizational success. This is a deep dive that explores how a well-structured plan can shift compliance from a reactive process to a proactive, strategic advantage.A compliance work plan serves as your organization’s annual roadmap, outlining priorities, audits, and goals that guide your compliance function. This detailed conversation explains how to create a dynamic, data-driven plan based on thorough risk assessment, continuous monitoring of...
2025-10-1448 min
Compliance DeconstructedCompliance Culture: It's More Than Just RulesBuilding a strong compliance culture requires more than just checking boxes. It demands a shift in mindset across the entire organization. In this informative episode of Compliance Deconstructed, hosts Jessica Zeff, Lorie Davis, and Elvan Baker break down the foundational principles that turn compliance from a burden into a powerful driver of trust, integrity, and long-term success.Compliance culture is more than a policy manual; it’s the framework that ensures ethical behavior, consistent practices, and clear accountability. Businesses that prioritize compliance not only avoid costly penalties but also create a workplace built on transparency, strong leadership, an...
2025-09-3043 min
Compliance DeconstructedOne Big Beautiful Bill Act Explained: What You Need to KnowIn this episode of Compliance Deconstructed, hosts Jessica Zeff, Lorie Davis, and Elvan Baker break down the complexities of the “Big Beautiful Bill” and its potential impact on healthcare. The conversation highlights both the bill’s stated goal of simplifying billing and the unintended consequences that could create new challenges for patients and professionals alike.For compliance professionals and healthcare leaders, understanding healthcare policy changes requires more than reading the surface-level intentions. It’s important to critically examine proposed regulations, compare goals with likely outcomes, and identify potential risks such as coverage gaps, workforce shortages, or added administ...
2025-09-1638 min
Compliance DeconstructedNo Hiding Behind the Company: Leaders Face Jail TimeFederal prosecutors aren't just fining companies anymore. They're putting leaders in the crosshairs. In this eye-opening episode of Compliance Deconstructed, hosts Jessica Zeff, Lorie Davis, and Elvan Baker unpack the Hertel & Brown case and why owners (not just businesses) are facing the consequences. Throughout this episode, they reveal how a network of billing scams, data manipulation, and oversight failures resulted in criminal charges for not only executives but also the compliance officer.Healthcare fraud can include overbilling, upcoding, billing for services not rendered, and data tampering, all of which are deliberate strategies rather th...
2025-09-021h 11
Compliance DeconstructedRADV Audit Prep: Compliance Tips You Can't IgnoreIn this episode of Compliance Deconstructed, hosts Jessica Zeff, Lorie Davis, and Elvan Baker take a deep dive into the world of Risk Adjustment Data Validation (RADV) audits. These audits have become an increasingly high-stakes area of focus for healthcare compliance professionals navigating today’s regulatory landscape and this conversation will help you understand them on a deeper level.Throughout this episode, your hosts cover the purpose and impact of RADV audits, including how CMS uses them to ensure billing accuracy and recover overpayments. With annual audits now planned for every Medicare Advantage plan, the pressure on he...
2025-08-1953 min
Compliance DeconstructedThe Good, The Bad, and The Bot: AI’s Role in Healthcare FraudJessica, Lorie, and Elvan (your favorite Compliance professionals) are back with another installment of Compliance Deconstructed and In this insightful episode, they explore the growing role of Artificial Intelligence (AI) in detecting and preventing healthcare fraud. With healthcare systems facing persistent issues of fraud, waste, and abuse, AI offers new tools to identify patterns, flag anomalies, and streamline compliance efforts.The discussion dives into how AI can both help and hinder fraud detection, acting as a powerful tool for compliance or a potential risk when exploited by bad actors. Real-world examples illustrate how AI identifies unusual billing...
2025-08-0541 min
Compliance DeconstructedThe United Healthcare Investigation - What It Means For YOUWe’re back for Episode 5 of Compliance Deconstructed and today, Jessica Zeff, Lorie Davis, and Elvan Baker explore how recent fraud investigations and emergency response funding missteps impact healthcare compliance. They emphasize the importance of understanding fraud, waste, and abuse regulations to reduce risk and protect patient care quality.Throughout this conversation, the ladies discuss the Department of Justice’s investigation into United Healthcare for alleged upcoding practices to inflate reimbursements. This case highlights the critical need for transparency and the potential consequences of manipulating patient data.Even smaller providers are subject to the same leve...
2025-07-2254 min
Compliance DeconstructedIs It Fraud, Waste, or Abuse? Know The DifferenceIn this insightful episode of Compliance Deconstructed, Jessica Zeff, Lorie Davis, and Elvan Baker break down the often-misunderstood concepts of fraud, waste, and abuse in the healthcare industry. With real-world examples and expert commentary, the team explores how these terms differ and why the distinctions matter for healthcare professionals and organizations alike.Throughout this conversation, you’ll gain clarity on what constitutes healthcare fraud, including how intent plays a central role in determining fraudulent behavior. The discussion covers deceptive practices like billing for unprovided services, upcoding, and illegal kickbacks, all of which carry serious compliance implications....
2025-07-0844 min
Compliance DeconstructedHealthcare Compliance Deconstructed: Our Inaugural Episode!In the premiere episode of Compliance Deconstructed, your hosts Jessica Zeff, Lorie Davis, and Elvan Baker dive into the foundational principles that shape effective healthcare compliance programs. Whether you're a newcomer to the compliance world or a seasoned professional with years of experience under your belt, this episode offers a comprehensive, yet accessible overview to help you confidently navigate the regulatory landscape.The conversation is built around the Seven Elements of an effective compliance program - core building blocks that support ethical behavior and regulatory adherence. Each element plays a critical role in establishing a strong compliance...
2025-07-011h 06
Compliance DeconstructedAI & Compliance - Friend or Foe? Navigating the Risks & RewardsIt’s Episode 2 of Compliance Deconstructed and your favorite trio of Compliance professionals are back to take a closer look at how artificial intelligence (AI) is reshaping the landscape of healthcare compliance. With the ability to automate routine tasks, analyze vast data sets, and flag potential issues, AI offers exciting possibilities for improving both efficiency and effectiveness in compliance operations.But alongside these opportunities come critical risks and ethical considerations. From algorithmic transparency to potential bias in sensitive areas like compliance hotlines, the introduction of AI raises important questions around trust, accountability, and the need for ongoing hu...
2025-07-0137 min
Compliance DeconstructedMedicare Final Rule 2026 | AI, Weight Loss Drugs & Prior Authorizations Under ScrutinyIt’s time for Episode 3 of Compliance Deconstructed and today, Jessica Zeff, Lorie Davis, and Elvan Baker break down the recent Medicare final rule updates effective January 1, 2026, focusing on what was left out, positive changes, and how compliance professionals can navigate the evolving regulatory environment. A key focus of discussion are the absence of clear AI guidelines, coverage decisions on anti-obesity medications, and prior authorization requirements continue to create challenges for healthcare organizations.The conversation also highlights some encouraging developments, including the elimination of cost sharing for adult vaccines, caps on insulin costs, and expanded acc...
2025-07-0126 minCompliance DeconstructedIntroducing Compliance Deconstructed!Welcome to Compliance Deconstructed, a podcast brought to you by Simply Compliance. Hosted by Jessica Zeff, Lorie Davis, and Elvan Baker, this podcast is set to break down and deconstruct many of the various complex aspects of Healthcare Compliance. From the 7 Elements to Medicare to AI's role in today's healthcare landscape and everything in between, you've discovered the best resource for elevating your knowledge in the healthcare compliance space.Whether you're new to the industry or a seasoned professional, you'll find useful information to help you better understand what's happening at many levels of healthcare c...
2025-06-1818 min
Psych2Go On the GO10 Strengths of a Highly Sensitive Person (HSP)Drama queens, crybabies, whiners, wet blankets – Highly Sensitive People (HSP) have been labelled all of these things and more, when the truth is, there’s a lot of things most people fail to understand about the concept. HSP was originated by Dr. Elaine N. Aron (1996), and it refers to an inherent, biological predisposition some people have to process and perceive information on a much deeper level. If you’re an HSP, then you think and feel things with greater intensity, in a way that many others can’t understand. Sometimes, HSP are mistaken as empaths. Do you know someone who migh...
2023-08-1508 min
Hear 2 House UHear 2 House U - Drums Radio - April 26th, 2022You & I (Original Mix) - XtetiQsoul, Kabomo - Iklwa Brothers Music
Love is Not for Hire (Black Coffee Remix) - Mani Hoffman, Avi Elman, Danny J - soWHAT
Y Te Welewe (Original DJ Tool Afro Mix) - DJ Clash, DJ Punch - Luz De Ponce Records
Oceans May Be Still (Original Mix) - Matteo Boyero, Lisa Samuel, Alex Dayo - Wahever Records
The Songs Sang By Drums (Original Mix) - Michael King, Afro Wav - Open Bar Music
Colors Of The Rainbow - Michael King, Afro Wav, Takue (SBT) - Blaq Diamond Boyz Music
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2022-04-282h 00