Compliance Deconstructed

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 unique, how its managed care model o...

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 healthcare organizations need to understand to...

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 surrounding GLP-1 prescribing, includ...

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 requirements and patient care.

This in-depth...

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 that extends beyond technology solu...

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 exists between states when it comes to...

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 care and why healthcare organizatio...

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 improved patient outcomes.

Today’s c...

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 practice of medicine doctrine, explai...

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 with communication, trust-building, and...

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 stress, burnout, and compliance ri...

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 exposure.

Clear, well-written policies fu...

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 unresolved internal concerns, not rumors ...

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 in-depth discussion highlights how p...

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 operational success.

Throughout this in-dep...

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 discussion reframes whistleblowing as a pr...

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 highlights how prior authorization, ...

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 make or break an effective compliance ...

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 organizational stewardship and how compliance pr...