Payers, Providers, and Patients – Oh My!
The ACA Risk Corridors Case

The ACA Risk Corridors Case

February 22, 2021

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:

Data Analytics and FCA Investigations

Data Analytics and FCA Investigations

January 21, 2021

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.

Rating in the Time of COVID

Rating in the Time of COVID

December 10, 2020

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 affect health care entities’ in-house counsel, executives, and investors.

ERISA Preemption of State PBM Regulation

ERISA Preemption of State PBM Regulation

August 3, 2020

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, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

 

Materials Discussed in this Episode

Bostock and HHS’s Nondiscrimination Regulations

Bostock and HHS’s Nondiscrimination Regulations

June 29, 2020

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 Affordable Care Act, including HHS's recent revisions to the nondiscrimination regulations.

Materials Discussed in this Episode

Who CARES: The Provider Relief Fund and Other CARES Act Provisions

Who CARES: The Provider Relief Fund and Other CARES Act Provisions

June 4, 2020

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.  

What Providers Should Know about COVID-19 (Part 2 – Federal and State Guidance)

What Providers Should Know about COVID-19 (Part 2 – Federal and State Guidance)

March 26, 2020

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 providers.

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.

What Providers Should Know about COVID-19 (Part 1 – Labor and Employment Issues)

What Providers Should Know about COVID-19 (Part 1 – Labor and Employment Issues)

March 26, 2020

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, 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.

Medical Loss Ratios (Part 2)

Medical Loss Ratios (Part 2)

March 18, 2020

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 can arise under MLR requirements. 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.

Medical Loss Ratios (Part 1)

Medical Loss Ratios (Part 1)

February 25, 2020

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 care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

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