Payers, Providers, and Patients – Oh My!

In this episode, hosts Payal Nanavati and Joe Records talk to Troy Barsky and Roma Sharma about their reflections on the first year of implementation of new regulations implementing the major fraud and abuse statutes — the Stark Law and Anti-Kickback Statute (AKS) — including discussing challenges, opportunities, and outstanding questions about the new exceptions and safe harbors for value-based c...

In this episode, hosts Payal Nanavati and Joe Records talk to Jodi Daniel and Savanna Williams about the latest developments in interoperability, including challenges of implementing recent CMS and ONC regulations and expectations about potential enforcement of these rules.  For more information please see: "HHS Finalizes Sweeping Regulations on Interoperability of Health Information and Informati...

In this episode, hosts Payal Nanavati and Joe Records talk to Janet Walker and Mercy Care’s CEO, Lorry Bottrill about the ways in which the government and health plans are addressing the social determinants of health (SDOH), which are the conditions in which people are born, live, learn, work, play and age and they affect a wide range of health, functioning, and quality-of-life outcomes.    Lorry...

In this episode, hosts Payal Nanavati and Joe Records talk to Lidia Niecko-Najjum and John Brennan about the legal issues that investors, providers, and innovators should be prepared to navigate when considering offering Ketamine-assisted treatment, including the federal and state laws and regulations related to the practice of medicine, licensure, and many other issues.  Payers, Providers, and Pa...

In this episode, host Payal Nanavati talks to Joe Records about recent enforcement activities under the Mental Health Parity and Addiction Equity Act (MHPAEA), including federal agencies’ requests for insurers to submit comparative analyses of their non-quantitative treatment limitations.  Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regu...

In this episode, hosts  Payal Nanavati  and  Joe Records  talk to partner  Steve McBrady , who led the Crowell & Moring team that represented Maine Community Health Options in the long running Affordable Care Act §1342 “risk corridors” litigation that ended with U.S. Supreme Court decision in favor of Maine and companion insurers.  Materials discussed in this episode: Client Alert:  Supreme Court...

In this episode, hosts  Payal Nanavati  and  Joe Records  talk to partner  Michael Shaheen , who recently served as a Trial Attorney with the Fraud Section of the DOJ.  Michael sheds some light on what potential FCA targets can do to understand and rebut DOJ’s use of data analytics to pursue FCA investigations.

In this episode, hosts  Payal Nanavati  and  Joe Records  are joined by  Xavier Baker  and special guest  Tim Murray , Director & Senior Consulting Actuary in Wakely Consulting Group’s New York office, to discuss the actuarial perspective on the cost of COVID-19. Payers, Providers, and Patients – Oh My! is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that...

In this episode, hosts  Payal Nanavati  and  Joe Records  are joined by  Todd Rosenberg  and  Sam Krause  to discuss ERISA preemption of state regulation of pharmacy benefit managers (PBMs) in light of the upcoming U.S. Supreme Court hearing in Rutledge v. Pharmaceutical Care Management Association. Payers, Providers, and Patients – Oh My! is Crowell & Moring’s biweekly health care podcast, discus...

In this episode, host  Payal Nanavati  talks to  Amanda DiSanto  and  Joe Records  about the potential implications of the Supreme Court’s recent decision in Bostock v. Clayton County, Georgia, which addressed the rights of gay and transgender individuals under Title VII of the Civil Rights Act of 1964. Specifically, Amanda and Joe discuss what the ruling may mean for Section 1557 of the Affordabl...

In this episode, hosts Payal Nanavati and Joe Records talk to Jacinta Alves and Matt Vicinanzo about provisions in federal legislation that are aimed at easing the pandemic’s impact on the health care industry, including the processes and requirements for the Provider Relief Fund.  

In part two of our two part series on what providers should know about COVID-19, hosts  Payal Nanavati  and  Joe Records  discuss federal and state guidance with  Brian McGovern . The  first episode  included a discussion of challenges that providers’ may face as employers. This episode touches on the various federal and state guidance issued in response to COVID-19 that may impact health care pro...

In part one of this two-part series on what providers should know about COVID-19, hosts  Payal Nanavati  and  Joe Records  discuss labor and employment issues with  Eric Su . This episode touches on health care providers’ obligations as employers and some best practices for handling this pandemic. Stay tuned for tomorrow’s release of Part 2 with Brian McGovern on Federal and State Guidance. Payers...

In part two of this deep dive, hosts  Payal Nanavati  and  Joe Records  continue their discussion with  Xavier Baker  and  Kevin Kroeker  about medical loss ratio requirements. The  first episode  provided background on what an MLR is and some of the history of MLR requirements, among other things. This episode touches on how the MLR is determined for plans and some of the compliance risks that ca...

In part one of this deep dive, hosts  Payal Nanavati  and  Joe Records  begin a discussion with  Xavier Baker  and  Kevin Kroeker  about medical loss ratio requirements. This episode touches on what an MLR is, some of the history of MLR requirements in health coverage, and some of the similarities and differences across markets. Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s health...

In this episode, hosts  Payal Nanavati  and  Joe Records  sit down with  Jodi Daniel  and  Ambassador Robert Holleyman  to discuss how regulators—across the U.S. and the rest of the world—can overcome the challenges of regulating emerging digital health technologies without stifling innovation. Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s health care podcast, discussing legal and...

In this episode, hosts  Payal Nanavati  and  Joe Records  sit down with former regulators  Jon Foley ,  Rob Shriver , and  Kristi Martin  to discuss the goals and design of the Affordable Care Act’s MSP Program—and what can be learned from its ultimate failure. Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that a...

Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors. In this episode, hosts Payal Nanavati and Joe Records discuss PBMs with Todd Rosenberg .

Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors. In this episode, hosts  Payal Nanavati  and  Joe Records  discuss recent FDA guidance related to digital health with  Jodi Daniel  and  Shaina Vinayek . Related Materials " FDA Seeks Commen...

Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors. In this "deep dive" episode, hosts  Payal Nanavati  and  Joe Records  talk to  Barbara Ryland  about benefits under Medicare Part C.

Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors. In this "deep dive" episode, hosts  Payal Nanavati  and  Joe Records  talk to Shelley Rosenberg about how health care defendants can use ERISA preemption as a way to remove litigation to fe...

Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors. In this episode, hosts  Payal Nanavati  and  Joe Records  talk with  Troy Barsky  and  Alice Hall-Partyka  about how recent litigation challenging the constitutionality of the Affordable Ca...

Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors. In this episode, hosts Joe Records and Payal Nanavati talk with Jacinta Alves about compliance programs and how the government looks at them.

Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors. In this episode, hosts Joe Records and Payal Nanavati talk with Lex Eley and Stephanie Willis about what private equity firms need to consider when investing in health care.

Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors. In this episode, hosts Joe Records and Payal Nanavati talk with David McFarlane and Sam Krause about fiduciary duties related to health care under ERISA. Materials Discussed in this Episode...