Health Law Simplified

In this bonus episode of Health Law Simplified, Sandy Durkin and Elizabeth Lippincott are joined again by Melissa Newton Smith and Ana Handshuh to discuss CMS’s rapid response to the Clover Health star ratings ruling. Just days after the original episode was recorded, CMS issued an HPMS memo announcing that it recalculated 2026 star ratings for purposes of 2027 quality bonus payments (QBP), using...

In this episode of Health Law Simplified , Sandy Durkin and Elizabeth Lippincott are joined by Melissa Newton Smith and Ana Handshuh for a deep dive into one of the most consequential recent developments in Medicare Advantage: the Clover Health star ratings decision. (*After recording, on June 17, 2026, CMS released an HPMS Memo stating that it was voluntarily recalculating 2027 Quality Bonus Paym...

Supplemental benefits have become a key feature of Medicare Advantage, shaping member experience, plan design, and regulatory oversight. In this episode of Health Law Simplified, we are joined by Regan Pennypacker, Senior Vice President, Compliance Solutions at ATTAC Consulting Group, to explore how these benefits have evolved and what recent CMS guidance means for plans. We walk through key regul...

In this episode of Health Law Simplified, Sandy Durkin and Elizabeth Lippincott are joined by Brandon Solomon, Senior Vice President and General Manager at Pareto Intelligence, for an in depth discussion of where Medicare Advantage is headed and the operational, financial, and compliance pressures shaping its future. Brandon shares insights from two decades advising health plans and risk bearing p...

In this episode of Health Law Simplified , Sandy Durkin and Elizabeth Lippincott shift gears from Medicare Advantage to take a practical look at Medicare Supplement insurance, also known as Medigap, and why it remains an important part of the Medicare coverage landscape. They walk through how Medigap plans became standardized, why the product is state regulated but shaped by federal minimum standa...

In this episode, Sandy Durkin and Elizabeth Lippincott break down several significant developments shaping the Medicare Advantage and Part D landscape. They begin with a close look at newly enacted federal legislation affecting pharmacy benefit managers (PBMs), including major reforms to Part D contracting that eliminate spread pricing and compensation tied to drug prices or rebates, replacing it...

In this episode, Sandy and Elizabeth break down the latest CMS updates shaping the Medicare Advantage landscape, diving into the Advance Notice, RADV audit enforcement, emerging enrollment trends, and sweeping Special Needs Plan (SNP) regulatory changes. We unpack CMS’s recent memo outlining its refined RADV audit strategy, including expanded audit cadence, updated sampling methodologies, extended...

In our Year in Review episode, hosts Elizabeth Lippincott and Sandy Durkin distill a turbulent 2025 into the developments that mattered most for Medicare Plans. You’ll hear a clear breakdown of the year’s biggest compliance and enforcement stories —from DOJ’s kickback allegations against major MA players to CMS’s aggressive expansion of RADV audits , followed by a late‑year court decision that vac...

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 misstep...

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 r...

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-...

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 San...

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, ma...

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 Prescripti...

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. 

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?

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.

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.