Healthcare professionals receive extensive clinical training, but many enter practice unprepared for the business, regulatory, and compliance realities of modern healthcare. In this episode of Compliance Deconstructed, we explore the education gaps clinicians often face when navigating billing, insurance rules, privacy laws, and operational responsibilities. Understanding these non-clinical skills can reduce burnout, strengthen compliance, and ultimately improve patient care.

AI tools are transforming how organizations draft policies and procedures—but are they creating new compliance risks? In this episode of Compliance Deconstructed, we explore the role of written policies in operational success and regulatory protection, and examine how AI can support policy development without replacing human oversight. Learn how to build documentation that strengthens compliance, efficiency, and long-term resilience.

Whistleblowing is often misunderstood in healthcare compliance. In this episode of Compliance Deconstructed, we break down what whistleblowing truly means, how it differs from workplace complaints or rumors, and why it plays a critical role in protecting patients and public funds. We also explore the False Claims Act, qui tam actions, retaliation protections, and how organizations can build a safe, effective speak-up culture.

In this episode of Compliance Deconstructed, the team explores why continuous learning is essential in healthcare compliance. From certifications to mentorship, peer networking to hands-on experience, professional development is more than a box to check—it’s a strategic advantage. Discover how staying curious, connected, and proactive can help you grow as a compliance leader while strengthening your organization.

ECRO and ISCA audits are among the most important—but least understood—compliance processes in Medicaid. In this episode of Compliance Deconstructed, the team breaks down what these audits are, how they vary by state, and how organizations can prepare. From data integrity to system capability, get practical tips for managing these audits and using them as opportunities for quality improvement.

Whistleblowing in healthcare isn’t always dramatic—it’s often someone speaking up about a concern before it becomes a crisis. In this episode of Compliance Deconstructed, we explore how building a strong speak-up culture helps organizations reduce risk, protect patients, and stay compliant. From documentation issues to patient safety flags, early reporting is a powerful tool when supported by trust and transparency.

Prior authorization is no longer just an administrative process—it’s a growing source of compliance risk. In this post, we explore how access delays, peer review practices, and automation can expose organizations to regulatory scrutiny. Using UnitedHealthcare as a case study, we highlight key lessons for compliance leaders looking to align prior authorization programs with today’s standards for transparency, governance, and patient care.

Compliance failures at one of the largest healthcare organizations in the U.S. reveal what happens when billing integrity, documentation, and company culture fall out of alignment. In this episode of Compliance Deconstructed, Jessica Zeff, Elvan Baker, and Lorie Davis explore the United Healthcare case and what it teaches us about navigating compliance in a high-tech, high-risk world.

Budgeting isn’t just a spreadsheet exercise—it’s a compliance strategy. In Episode 13 of Compliance Deconstructed, Jessica Zeff, Lorie Davis, and Elvan Baker explore how to build a budget that truly supports the demands of modern compliance work. They unpack common budgeting pitfalls, risks of under-resourcing, and why the 2025 Medicare Final Rule makes proactive planning more important than ever.

The CY 2026 Medicare Final Rule introduces major updates impacting costs, coverage, and care coordination. From the $35 insulin cap to free vaccines and enhanced dual-eligible integration, these changes continue CMS’s push for affordability, transparency, and person-centered care. This blog unpacks what providers and plans need to know—and how to prepare for the upcoming contract year.

A strong compliance plan is more than a checklist—it’s a strategic roadmap. In Episode 11 of Compliance Deconstructed, the hosts break down how to build, refine, and implement an effective compliance work plan. From risk assessment to ongoing monitoring, this episode offers clear guidance for transforming compliance from a reactive task into a proactive advantage that supports growth, integrity, and accountability across your organization.

Compliance isn’t just a checklist—it’s a cultural foundation. In Episode 10 of Compliance Deconstructed, the hosts explore how organizations can turn compliance into a strategic advantage. From leadership tone to employee training and cross-team collaboration, this episode offers practical insights on building a culture of integrity, transparency, and shared responsibility across the business.

The proposed “Big Beautiful Bill” promises billing transparency—but could create serious risks for patients, providers, and healthcare systems. In Episode 9 of Compliance Deconstructed, the hosts explore its potential ripple effects: from Medicaid coverage instability to workforce shortages and red tape. Compliance professionals will walk away with critical insights to help prepare their organizations for the real-world impact behind the headlines.

Federal prosecutors aren’t just fining companies anymore — they’re putting leaders in the crosshairs. In this episode, we unpack the Hertel & Brown case and why owners, not just businesses, are facing the consequences

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 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.

Fraud investigations, billing scrutiny, and emergency fund misuse are reshaping healthcare compliance. In this episode, Simply Compliance's own Jessica Zeff and her co-hosts Lorie Davis and Elvan Baker unpack high-profile cases, including the DOJ’s probe into United Healthcare, and share why even small providers must stay vigilant. Learn how proactive audits, strong documentation, and sound emergency protocols can help protect your organization—and your patients—from risk.

The healthcare regulatory landscape is always evolving, and keeping up with changes—especially in Medicare—is crucial for compliance professionals. As of January 1, 2026, new Medicare guidelines are set to take effect, bringing a mix of clarity, continued uncertainty, and opportunities to improve patient care. Understanding the key updates, what was left out, and how to manage these changes proactively can help compliance teams support their organizations more effectively.

The healthcare regulatory landscape is always evolving, and keeping up with changes—especially in Medicare—is crucial for compliance professionals. As of January 1, 2026, new Medicare guidelines are set to take effect, bringing a mix of clarity, continued uncertainty, and opportunities to improve patient care. Understanding the key updates, what was left out, and how to manage these changes proactively can help compliance teams support their organizations more effectively.

Artificial intelligence (AI) is no longer a futuristic concept—it's a present-day reality reshaping industries across the globe, including healthcare compliance. As regulatory requirements grow more complex and data continues to multiply, AI presents a promising solution to the challenges compliance professionals face daily. But along with the promise comes a set of risks and ethical questions that demand thoughtful consideration.