Health Law Simplified

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Strategic Health Law

10 episodes

4 days ago

In this episode of Health Law Simplified, hosts Sandy and Elizabeth unpack a pivotal federal court ruling that vacates a key CMS rule governing RADV audits in Medicare Advantage. Learn why the court struck down CMS’s extrapolation methodology and elimination of the Fee-for-Service Adjuster, and what this means for MA plans, compliance teams, and future rulemaking. We explore the procedural missteps that led to the ruling, its alignment with broader judicial scrutiny of CMS, and the potential ...

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Episodes (10/10)

Health Law Simplified

RADV Ruling: A Legal Earthquake in Medicare Advantage

4 days ago

38 minutes

Health Law Simplified

Breaking Up Is Hard To Do: What MA Organizations Need to Know About Non-Renewal

This episode of Health Law Simplified explores the recent wave of insurer exits from the Medicare Advantage market, examining why major carriers are leaving and the financial, regulatory, and operational challenges involved. Sandy and Elizabeth discuss the strategic consequences of non-renewal, including CMS contracting bars, notification requirements, run-out responsibilities, audits, and legal risks, while offering practical advice for organizations considering an exit and highlighting the ...

1 month ago

37 minutes

Health Law Simplified

Risk, Reform, and Responsibility: Navigating Medicare Compliance with Charles Baker

In this episode of Health Law Simplified, hosts Sandy Durkin and Elizabeth Lippincott welcome Charles Baker, Vice President of Compliance Solutions at ATTAC Consulting, for a deep dive into the evolving landscape of Medicare Advantage compliance. From the operational impact of RADV audits and the philosophical roots of risk adjustment to the implications of the No UPCODE Act and the future of in-home HRA assessments, Charles shares his unique perspective shaped by years in social work, academ...

2 months ago

50 minutes

Health Law Simplified

RADV Audits: Will CMS Crackdown Alter the Medicare Advantage Landscape?

In this episode of Health Law Simplified, we unpack a major shift in Medicare Advantage oversight: CMS’s sweeping expansion of its Risk Adjustment Data Validation (RADV) audit program. Beginning immediately, CMS will significantly expand its oversight by auditing all 550 eligible Medicare Advantage contracts each year – an ambitious leap from the previous annual review of just 60 plans. Hosts Sandy Durkin and Elizabeth Lippincott explore why CMS is cracking down, how it's scaling up with new ...

3 months ago

29 minutes

Health Law Simplified

DOJ Targets Medicare Advantage Marketing

This episode of Health Law Simplified unpacks the U.S. Department of Justice’s False Claims Act lawsuit against major Medicare Advantage insurers and brokerages. The DOJ alleges illegal kickbacks and discriminatory practices targeting disabled beneficiaries. The episode also explores CMS’s 2025 Final Rule on broker compensation, its legal challenges, and the broader implications for compliance, marketing ethics, and regulatory enforcement in the Medicare Advantage space.

4 months ago

34 minutes

Health Law Simplified

Finding Stability in the Medicare Advantage Landscape

In this episode, Elizabeth and Sandy delve into the latest updates in the Medicare Advantage and Part D landscape. Our word of the year, "stability," sets the tone as we explore the implications of the CMS final rule for 2026, which finalizes several Biden-era proposals. We discuss the key changes in the rule, including new guardrails for supplemental benefits and the Medicare Prescription Payment Plan, and highlight what was notably left out of the rule. Additionally, we cover the CMS rate a...

6 months ago

39 minutes

Health Law Simplified

Looking Under the Hood of Medicare Advantage with Molly Turco

We talk with Molly Turco, who served as Senior Policy Advisor on Medicare Advantage (MA) and Medicare Part D at the Center for Medicare at the Centers for Medicare & Medicaid Services until leaving the agency in January. Molly unpacks updates in MA policy and reimbursement, including the v28 risk adjustment model and prior authorization.

8 months ago

56 minutes

Health Law Simplified

How the Inflation Reduction Act Boosts Medicare Advantage

Join us as we walk through the 2022 Inflation Reduction Act’s changes to Medicare Part D and Medicare Advantage. Learn about how those changes are impacting the senior health plan market today.

8 months ago

21 minutes

Health Law Simplified

Making Peace with Uncertainty

We talk about how health care leaders can make peace with uncertainty as we move into 2025 and a new administration. What are the hot button issues for health plans and others in this dynamic time? What can we anticipate in the market for Medicare plans in particular?

8 months ago

24 minutes

Health Law Simplified

Introducing Health Law Simplified

Health Law Simplified℠ breaks down the latest legal developments, challenges, and regulatory impacts in managed care—giving business leaders the insights they need to stay ahead. Join attorneys Elizabeth Lippincott, Sandra Durkin, and Katarina Weessies each month for practical, engaging conversations about the ever-evolving world of health law.

8 months ago

1 minute