Payers, Providers, and Patients – Oh My!

Hidden Costs of FCA and AKS Claims

In this episode, hosts Joe Records and Payal Nanavati talk to Rebecca Baskin regarding her recently-published article analyzing the true costs to companies of becoming the subjects of False Claims Act or Anti-Kickback Statue investigations.  We discuss the article’s methodology, findings, and key takeaways. 

 

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.

Industry Views on the Trusted Exchange Framework and Common Agreement

In this episode, hosts Joe Records, Payal Nanavati, and Jodi Daniel talk to three members of the health information industry regarding the Trusted Exchange Framework and Common Agreement (TEFCA) published by the Office of the National Coordinator for Health Information Technology (ONC). This episode features Jay Nakashima (Executive Director of eHealth Exchange), Nichole Sweeney (General Counsel and Chief Privacy Officer of CRISP Shared Services), and Erica Galvez (CEO of Manifest MedEx), who each share their experiences in the health information exchange industry and their expectations of TEFCA.

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.

How to Structure an Affirmative Recovery Program

In this episode, hosts Joe Records and Payal Nanavati talk to Kelly Hibbert and Jed Wulfekotte about how Medicare plan sponsors and Medicaid Managed Care Organizations can structure an affirmative recovery program to prevent and detect fraud, waste, and abuse -- among other things.

 

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.

More Changes to Section 1557 Nondiscrimination Rules

In this episode, hosts Joe Records and Payal Nanavati talk to Michelle Chipetine and Stacie Heller about recent developments regarding the nondiscrimination requirements of Section 1557 of the Affordable Care Act, including new rules proposed by the Biden Administration and litigation around the issue of discrimination on the basis of sex.

 

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.

The Shrinking Medical Loss Ratio Numerator

In this episode, host Payal Nanavati talks to Shelley Rosenberg and Joe Records about changes to the medical loss ratio (MLR) requirements impacting commercial coverage, particularly the limitations on what expenses issuers can include in their MLR numerators.

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.

Massive Federal Investment in Mental Health

In this episode, Joe Records and Payal Nanavati talk to Scott Douglas and Charlotte Freed about the mental health provisions in the federal gun safety legislation. The new law included billions in federal funds to support mental health care—a huge investment likely to have major impacts on the industry.

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.

Crowell Health Solutions Mini-Series Part 2 – A Health System’s Perspective on Prioritizing Health Equity

This episode is the second part in a miniseries with Crowell Health Solutions, which is a strategic consulting firm that Crowell & Moring launched earlier this year to help healthcare organizations and technology companies transform health care by improving patient care and health outcomes, advancing health equity, and lowering health care costs through solutions like digital health innovations and value-based healthcare models.

In this episode, Janet Walker and Roma Sharma interview three leaders working at Ascension, which is one of the nation’s largest not-for-profit health systems with more than 2,600 sites of care, about how Ascension has prioritized health equity and population health initiatives, including its framework “ABIDE,” which is built upon the hallmarks of Appreciation – Belongingness – Inclusivity – Diversity – Equity.  The interviewees are Dr. Stacy Garrett-Ray (Senior Vice-President and Chief Community Impact Officer), Pamela Mitchell Boyd (Senior Director of ABIDE), and Nicole Commodore (Director, Community Impact and Advocacy).

 

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.

 

For more information, please see:

• Crowell & Moring Unveils Crowell Health Solutions

Shared-Risk Arrangements in California

In this episode, host Joe Records talks to Gary Baldwin about the regulation of shared-risk arrangements in the state of California. They discuss the history of shared-risk arrangements in California, how the Department of Managed Health Care (DMHC) approaches these kinds of arrangements, and the kinds of issues entities should consider in approaching shared risk.

 

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.

Crowell Health Solutions Mini-Series Part 1 - The Intersection of Technology and Value-Based Care

This episode is the first part in a miniseries with Crowell Health Solutions, which is a strategic consulting firm that Crowell & Moring launched earlier this year to help healthcare organizations and technology companies transform health care by improving patient care and health outcomes, advancing health equity, and lowering health care costs through solutions like digital health innovations and value-based healthcare models.

In this episode, Troy Barsky interviews Michael Meng (the CEO of Stellar Health) about how technology has impacted, and continues to impact, health care delivery in light of regulatory changes focused on advancing value-based care.  Michael Meng is the CEO and co-founder of Stellar Health, which is a healthcare technology company focused on enabling success across the value-based care continuum by bridging the incentive gap between providers and payors.

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.

For more information, please see:

• Crowell & Moring Unveils Crowell Health Solutions
• Stellar Health

What to Expect in Healthcare Transactions in 2022

In this episode, hosts Payal Nanavati and Joe Records talk to Katy Raffensperger, Todd Rosenberg, and Alexis Gilman about expectations for healthcare transactions in 2022.   The discussion captures how transactions involving health care companies may respond to legal, economic, and market circumstances, including lasting care delivery changes spurred by the COVID pandemic, antitrust scrutiny by federal regulators, inflation, and rising interest rates.

 

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.