CMS is expanding RADV audits—and it’s not just business as usual. In Episode 7 of Compliance Deconstructed, Jessica Zeff, Lorie Davis, and Elvan Baker discuss what the shift to annual audits, AI-driven targeting, and extrapolated findings means for Medicare Advantage plans and beyond. From provider strain to operational planning, they unpack the risks—and offer practical insight for compliance professionals.

AI deregulation could shift safety and oversight responsibilities from regulators to hospitals—placing Critical Access Hospitals at heightened risk. Without external validation, CAHs may face greater patient safety risks, liability exposure, and operational strain. Compliance leaders must prepare stronger internal governance to protect quality, equity, and financial stability in a deregulated AI environment.

Weakening FDA oversight of AI in healthcare could increase regulatory gaps, patient safety risks, and liability exposure. From unvalidated tools to adaptive AI model drift, the absence of strong oversight would force healthcare organizations to bear full responsibility for validation, monitoring, and accountability. Compliance professionals must strengthen governance now to prepare for this shifting landscape.

AI is changing the fraud landscape—both for better and worse. In this episode of Compliance Deconstructed, Jessica Zeff, Lorie Davis, and Elvan Baker discuss how AI can detect fraud, streamline audits, and even summarize regulations. But they also explore its darker side: enabling sophisticated fraud at scale. Plus, a candid look at prior auth challenges and why eliminating fraud completely may never be possible.

Deregulating AI in healthcare doesn’t eliminate compliance risk—it amplifies it. From data bias and transparency issues to patient safety and legal liability, the absence of clear standards places greater responsibility on internal governance. Compliance professionals must prepare for a future where proactive oversight, not regulation, is the first line of defense.