Shows
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 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 min
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 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 06Compliance 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