Building 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, and shared responsibility, all of which are elements that searchers often seek when exploring how to strengthen compliance and ethics within their organizations.

Today’s discussion highlights the essential role leaders play in shaping compliance, showing how their example sets the tone for the entire company. Your hosts also emphasize why compliance must be everyone’s responsibility - reinforced through training, communication, and empowerment at all levels.

Finally, the episode explores how compliance professionals can strengthen partnerships across departments by acting as allies and problem-solvers. By fostering collaboration, accessibility, and open communication, organizations can transform compliance into a shared value that supports growth and resilience.

Key Takeaways:

• Compliance is more than rules. It’s a cultural framework for ethical and effective business.
• Strong compliance culture starts with leadership setting the right tone.
• Hiring practices should evaluate candidates’ perspectives on compliance.
• Ongoing training and open communication are critical to sustaining compliance.
• Compliance should be viewed as a shared responsibility across all employees.
• Building partnerships turns compliance into a collaborative, growth-focused effort.

Learn more about Healthcare Compliance and discover how Simply Compliance can help your company at simplycomplianceconsulting.com.

In 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 administrative burdens…ensuring your organization remains compliant and patients continue to receive uninterrupted care.

Jessica, Lorie, and Elvan also explore how this bill could affect vulnerable populations, including patients who depend on Medicaid and other essential programs. With proposed changes to eligibility redeterminations, many patients may face instability in maintaining coverage, placing a significant strain on state agencies, health plans, and the individuals themselves.

And if all that weren’t enough, the discussion focuses strongly on how healthcare workforce development could suffer if provisions around student loans and loan forgiveness are limited. These changes may deter new professionals from entering the field, deepening existing shortages and reducing patient access to critical care. This conversation emphasizes the importance of proactive planning, cross-department collaboration, and continuous monitoring of legislative updates to stay ahead of potential disruptions.

Key Takeaways

• The Big Beautiful Bill aims to improve billing transparency but may unintentionally create new administrative hurdles.
  
  
• More frequent Medicaid eligibility reviews could increase the risk of coverage gaps for vulnerable populations.
  
  
• Administrative changes may shift focus away from patient simplification and toward compliance burdens.
  
  
• Proposed changes to student loan programs could deter individuals from entering healthcare professions.
  
  
• Compliance professionals should conduct risk assessments and plan proactively for operational impacts.
  
  
• Staying informed and engaging stakeholders is essential to navigating evolving healthcare regulations.

Learn more about Healthcare Compliance and discover how Simply Compliance can help your company at simplycomplianceconsulting.com.

Federal 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 than simple mistakes. This episode explores how organizations can detect red flags, improve internal controls, and build a culture of accountability to prevent systemic fraud.

A pivotal moment in the discussion highlights the concept of “impossible days,” where clinicians were allegedly billed for more hours than they actually worked…pretty much an unmistakable sign of fraud. The hosts also emphasize the importance of strong EMR audit trail reviews and avoiding shared login credentials, which can mask unauthorized actions.

You’ll also discover the legal consequences for individuals involved in fraudulent schemes, underscoring that corporate shields do not protect against personal liability. Practical tips are offered for building a resilient compliance program that not only meets legal standards but also supports ethical, transparent healthcare operations.

Key Takeaways

• Fraud is often systematic and intentional, not a one-time oversight. Look for patterns, not just isolated errors.
• "Impossible days" are a critical red flag, where billing exceeds physical capability and must be investigated.
• Compliance officers carry personal liability and must be qualified, empowered, and proactive to avoid complicity.
• Weak internal controls and oversight failures are common gateways for fraud to persist undetected.
• Shared EMR credentials and data manipulation present major legal and ethical risks in healthcare organizations.
• Regular audits, employee training, and a culture of compliance are essential to detect, prevent, and report fraud effectively.
  
  

Learn more about Healthcare Compliance and discover how Simply Compliance can help your company at simplycomplianceconsulting.com.