Compliance Deconstructed
Welcome to Compliance Deconstructed, a podcast dedicated to all things Healthcare Compliance.
Hosted by Healthcare Compliance professionals Jessica Zeff, Lorie Davis, and Elvan Baker, each episode thoroughly breaks down the complex inner-workings of compliance in the healthcare industry.
From the 7 Elements that make up Healthcare Compliance to AI's impact on the industry and everything in between, Compliance Deconstructed is your resource for information, strategy, and commentary to elevate your knowledge base.
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Compliance Deconstructed
United Healthcare's Shocking Billing Fraud Exposed: What You Need to Know - Part 1
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 program, emphasizing the powerful influence of informal norms and leadership behavior. Collectively, they highlight why even the strongest policies fall flat when daily actions don’t align with written expectations.
As you dive into this in-depth conversation, you’ll hear a clear explanation of healthcare billing risks, including upcoding, documentation failures, and the downstream impact on patient care and system credibility. The conversation demystifies these billing pitfalls and offers actionable insights on transparency and prevention.
In addition, this episode addresses the unique challenges faced by large, multilayered healthcare organizations trying to maintain consistent oversight. Jessica, Elvan, and Lorie outline practical strategies, including risk identification, training, monitoring, and escalation that help compliance teams stay proactive in vast systems.
This episode is Part 1 of 2 evaluating the United Healthcare case.
Key Takeaways
- Compliance is deeply connected to patient safety and care quality. Failures in one area inevitably affect the others.
- Organizational culture has a greater impact on compliance behavior than written policies alone.
- Billing practices such as upcoding create legal, ethical, and patient-care risks that organizations must actively manage.
- Large healthcare entities face structural challenges that make centralized compliance oversight difficult.
- Strong internal controls, such as audits, documentation, monitoring, and training. are essential for reducing compliance vulnerabilities.
- Individual employees play a critical role in reporting concerns and maintaining ethical standards, even within massive organizations.
Learn more about Healthcare Compliance and discover how Simply Compliance can help your company at simplycomplianceconsulting.com.