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.
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34:19
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34:19
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 announcement and the rebranding of the health equity incentive program to "Excellent Health Outcomes for All (EHO4all)," set to be implemented for the 2027 Star Ratings. Lastly, we examine the recent developments in the risk adjustment litigation against UnitedHealth Group, focusing on the special master's report and its potential impact on MA plans.
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39:17
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39:17
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.
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56:55
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56:55
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.
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21:03
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21:03
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?
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.
Ireland