Payers, Providers, and Patients – Oh My!: Recent Episodes
Crowell & Moring
Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.
Host Megan Beaver talks to Alex Lucas and Jason Mayer about the No Surprises Act, a 2021 law designed to protect patients from unexpected medical bills, the federal independent dispute resolution process it created, the challenges that have plagued that process, and the new federal rule issued on June 4, 2026. The episode also covers the growing wave of enforcement litigation and what’s on the horizon for IDR.
This podcast episode features the following speakers:
- Alex Lucas is a partner in Crowell & Moring's Chicago office and a member of the firm's Health Care Group. She is regarded as a leading national authority on the No Surprises Act and its implications for managed care organizations. Alex advises clients on a wide range of NSA compliance issues, oversees administration of the NSA's independent dispute resolution process for multiple organizations, and aids in internal and regulatory audits to ensure NSA compliance.
- Jason Mayer is a partner in Crowell & Moring's Chicago office and a member of the firm's Health Care Group. Jason is nationally recognized for his work on complex litigation and regulatory disputes within the healthcare industry, representing managed care organizations and commercial clients in high-stakes matters.
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.
Hosts Megan Beaver and Savanna Williams talk to Rachel Park and Lisa Umans about the regulation of the organ procurement industry, recent congressional interest in the space, and the latest updates from the Centers for Medicare and Medicaid Services (CMS).
This podcast episode features the following speakers:
- Rachel Park is a senior counsel in Crowell & Moring's Washington, D.C. office and a member of the firm’s Health Care Group. She advises clients on a wide array of health care matters, including Medicare and Medicaid reimbursement, managed care litigation, and health care fraud investigations and oversight. Prior to joining Crowell, she served for 24 years at the U.S. Department of Health and Human Services (HHS), most recently as principal deputy general counsel, the highest-level nonpolitical appointee in the HHS Office of the General Counsel.
- Lisa Umans is a partner in Crowell & Moring’s New York office and a member of the firm’s White Collar and Regulatory Enforcement group and Financial Services group. She represents large institutional clients and individuals in federal and state regulatory and criminal investigations conducted by grand juries, congressional committees, and domestic and international law enforcement and regulatory agencies including the Department of Justice’s Criminal and Antitrust Divisions, U.S. Attorney’s Offices, Securities and Exchange Commission (SEC), the Commodity Futures Trading Commission (CFTC), the Financial Industry Regulatory Authority (FINRA), and various State Attorneys General.
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 Megan Beaver speak with Linda Malek and Matthew F. Ferraro about the latest federal and state developments in artificial intelligence (AI) policy affecting health care. The conversation covers the Trump administration’s AI action plan and Executive Orders on AI, new industry-specific and comprehensive state laws, and enforcement trends, with a focus on how these changes impact the health care industry.
This podcast episode features the following speakers:
- Linda Malek is a partner in Crowell & Moring's New York office, and is a member of our Health Care, Privacy & Cybersecurity, and Life Sciences practices. She advises a broad array of health care and life sciences clients on compliance with federal, state, and international law governing clinical research, data privacy, cybersecurity, and fraud and abuse. Linda also counsels digital health and biotech companies developing AI tools. She navigates the complex and evolving federal and state regulatory landscape, balancing the priorities of oversight authorities with issues related to data privacy and security as well as business goals.
- Matthew F. Ferraro is a partner in Crowell & Moring's Washington, D.C. office and is a member of our Privacy and Cybersecurity Group, where he advises leading organizations on high-impact matters involving artificial intelligence (AI), cybersecurity, and emerging technologies. He previously served as Senior Counselor for Cybersecurity and Emerging Technology to the Secretary of Homeland Security, helping shape national AI and cyber policy and helping to establish and run the Artificial Intelligence Safety and Security Board.
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 the second of a two part series on the impact of administrative law in the health care industry, hosts Payal Nanavati and Savanna Williams talk to Dan Wolff about the practicalities of seeking judicial review to challenge agency actions, the impact of Loper Bright, and the major questions doctrine.
This podcast episode features the following speakers:
- Dan Wolff is a partner in Crowell & Moring's Washington, D.C. office and leads the firm’s administrative law litigation practice. Dan's practice encompasses litigation arising under the Administrative Procedure Act or as a result of government enforcement actions or commercial disputes. He regularly appears in federal district and appellate courts around the country and before a host of agency tribunals, and counsels clients on their rights and obligations under a number of federal regulatory programs.
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 the first of a two part series on the impact of administrative law in the health care industry, hosts Payal Nanavati and Savanna Williams talk to Dan Wolff about how administrative law manifests itself on a day-to-day basis and how to interact with agency officials in a heavily regulated industry.
This podcast episode features the following speakers:
- Dan Wolff is a partner in Crowell & Moring's Washington, D.C. office and leads the firm’s administrative law litigation practice. Dan's practice encompasses litigation arising under the Administrative Procedure Act or as a result of government enforcement actions or commercial disputes. He regularly appears in federal district and appellate courts around the country and before a host of agency tribunals, and counsels clients on their rights and obligations under a number of federal regulatory programs.
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 recognition of World Elder Abuse Awareness Day (June 15), hosts Payal Nanavati and Savanna Williams talk to Jen Mika about best practices that providers should keep in mind to combat elder abuse, neglect, and exploitation.
This podcast episode features the following speakers:
- Jen Mika is a counsel in Crowell’s DC office and is considered a leading authority on Elder Law in the District of Columbia. Jen was the District of Columbia’s first prosecutor solely focused on investigating and prosecuting financial exploitation of elders and vulnerable adults.
In this episode, hosts Payal Nanavati and Megan Beaver talk to Alice Hall-Partyka and Savanna Williams about the impact of Executive Order 14187 on access to gender-affirming care for individuals under the age of 19. Alice and Savanna delve into the implications of this EO, and others, on payors, providers, and potentially conflicting state laws. Executive Order 14187: https://www.federalregister.gov/documents/2025/02/03/2025-02194/protecting-children-from-chemical-and-surgical-mutilation
In this episode, hosts Payal Nanavati and Savanna Williams talk to Aaron Cummings and Stephen Holland about the Trump and Harris campaigns’ approaches to issues affecting the health care industry. This podcast episode features the following speakers:
- Aaron Cummings serves as the co-chair of Crowell’s Government Affairs Group and was Chief of Staff to U.S. Senator Chuck Grassley (R-IA) from 2019-2023. Today, Aaron helps clients make sure their views are represented in policy discussions in Capitol Hill, the White House, and throughout the federal government, including advising clients on health care legislative and policy.
- Stephen Holland is an senior counsel in Crowell’s Government Affairs Group, where he leverages his extensive experience advising members of Congress and their staff as a policy advisor and attorney active in health care legislation. In his most recent role prior to joining Crowell, Stephen spent five years on the Energy and Commerce Committee staff under the leadership of Ranking Member and former Chairman Frank Pallone (D-NJ).
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 Megan Beaver talk to Alice Hall-Partyka and Spencer Bruck about the recently released Mental Health Parity and Addiction Equity Act (MHPAEA) final rule. Alice and Spencer delve into the key new provisions of the rule, including the requirements for Non-Quantitative Treatment Limitations comparative analyses and the focus on data outcomes.
Relevant resources:
- Tri-Agencies Finalize NQTL Comparative Analysis Standards in Final Rule
- Final Mental Health Parity Rule Spurs Loper Bright Legal Threat
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 Savanna Williams talk to Roma Sharma and Wietse Vanpoucke about the European Union’s Artificial Intelligence Act, which establishes a common regulatory and legal framework for AI within the European Union. This podcast episode features the following speakers: * Roma Sharma is a counsel in Crowell’s Health Care Group, where she advises a variety of health care clients on navigating the use of AI in the industry and complying with federal and state laws and regulations. * Wietse Vanpoucke is an associate in Crowell’s Brussels office, where his practice focuses on the life sciences and digital health sectors, relying on his deep experience with European and Belgian regulatory affairs and legal procedures.
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 Megan Beaver talk to Jodi Daniel and Lidia Niecko-Najjum about how HIPAA and existing data privacy protections are shaping health care organizations’ use of artificial intelligence. Jodi and Lidia discuss the various regulations at play and also provide practical takeaways.
This podcast episode features the following speakers:
- Jodi Daniel is a partner in Crowell’s Health Care Group and part of the firms Digital Health Practice where she counsels health technology companies, health care providers, health plans, life science companies and others on regulatory issues, including data access and use, privacy and security, interoperability, health information exchange, information blocking, telehealth, and FDA oversight. Jodi is also the managing director of Crowell Health Solutions.
- Lidia Niecko-Najjum is a senior counsel in Crowell’s Health Care Group and is part of the firm’s Digital Health Practice. With over 15 years of clinical, policy, and legal experience, Lidia provides strategic advice on health care regulatory and policy matters, with particular focus on artificial intelligence, machine learning, digital therapeutics, telehealth, interoperability, and privacy and security.
In this episode, hosts Megan Beaver and Savanna Williams talk to Jason Johnson and Linda Malek about the evolving regulatory landscape related to artificial intelligence (AI) in health care. In particular, Jason and Linda discuss the use of AI by organizations engaged in clinical research including key issues and emerging themes in this field. This podcast episode features the following speakers:* Jason Johnson is a partner in Crowell’s Health Care and Privacy & Cybersecurity Groups, where he draws on his experience as a former research scientist to advise clients on complex compliance, legal, regulatory, and transactional matters. * Linda Malek is a partner in Crowell’s Health Care and Privacy & Cybersecurity Groups, where she advises a broad array of health care and life sciences clients on compliance with federal, state, and international law governing clinical research, data privacy, cybersecurity, and fraud and abuse.
In this episode, hosts Payal Nanavati and Savanna Williams talk to Paul Pollock and Wayne Pryor about how private equity (PE) got its start in the health care industry, current trends in PE regulation, and where listeners can expect to see PE to continue investing in the industry.
This podcast episode features the following speakers:
- Paul Pollock is a partner in Crowell’s New York office and concentrates his practice on mergers, and acquisitions, and corporate finance, specifically in the health care industry.
- Wayne Pryor is Managing Director in VMG Health’s Financial Due Diligence Division in the Nashville office. He has over 30 years of experience in the health care industry with a focus on transaction surfaces. Wayne has worked on over 450 buy-side and sell-side transactions in every sub sector of the industry, ranging from $1 million to $10 billion deals.
In this episode, hosts Payal Nanavati, Jodi Daniel, and Cara Tenenbaum talk to Ben Moscovitch, Devon Adams, and Noah Goodson about recent policy developments on decentralized clinical trials (DCTs). They also discuss the Crowell Health Solutions’ white paper* on DCTs, which issues to federal agencies a number of policy recommendations to advance DCT adoption and increase clinical trial diversity.
This podcast episode features the following speakers:
- Jodi Daniel is a Managing Director of Crowell Health Solutions and also is a partner in Crowell’s DC office, who leads the firm’s Digital Health Practice. She previously spent 15 years at the Department of Health and Human Services (HHS).
- Cara Tenenbaum is a Consultant with Crowell Health Solutions, leads Strathmore Health, and has extensive experience in health policy and patient advocacy. She worked at the U.S. Food and Drug Administration (FDA) for six years.
- Ben Moscovitch leads Amazon Web Services (AWS) healthcare and life sciences public policy efforts and focuses on policy reforms to improve health data interoperability and clinical research.
- Devon Adams is a Senior Policy Analyst at the American Cancer Society Cancer Action Network, the nonpartisan advocacy affiliate of the American Cancer Society. He works on policy related to cancer research, device and drug development, precision medicine, and clinical trials.
- Noah Goodson, Ph.D. is the Principal of Strategy & Advisory at THREAD Research. He spends his day supporting pharmaceutical, biotech, and medical device companies in the design and execution of clinical trials.
White Paper: https://www.crowell.com/a/web/vFgM2vJzbE4wsuVyJ5o1py/advancing-adoption-of-decentralized-clinical-trials-rationale-current-state-and-policy-recommendations.pdf
In this episode, hosts Payal Nanavati and Megan Beaver talk to Chris Flynn and Alice Hall-Partyka regarding the proposed updates to the regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA). We discuss the current regulatory environment, enforcement, and key takeaways from the proposed rule. For further reading, please see:
New Proposed MHPAEA Rule Builds on NQTL Comparative Analysis Standards
(https://www.crowell.com/en/insights/client-alerts/new-proposed-mhpaea-rule-builds-on-nqtl-comparative-analysis-standards)
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 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.
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.
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.
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 1157 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.
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.
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.
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
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.
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
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.
In this episode, hosts Payal Nanavati and Joe Records talk to Matt Vicinanzo about developments in False Claims Act litigation – including materiality, scienter, and government dismissal authority, among others – and how those developments may have a unique impact on companies in the health care industry.
For more information please see:
- "The Top FCA Developments of 2021," Government Contracts Bullet Points (February 25, 2022). Contacts: Brian Tully McLaughlin, Lyndsay A. Gorton, Nkechi Kanu, Payal Nanavati, Matthew Vicinanzo.
- "Payers, Providers, and Patients – Oh My!: FCA Dismissals Under the Granston Memo," Podcast: Payers, Providers, and Patients – Oh My! (June 26, 2019). Contacts: John T. Brennan Jr., Joe Records, Payal Nanavati.
- "Payers, Providers, and Patients – Oh My!: Data Analytics and FCA Investigations," Health Care Alert (January 21, 2021). Contacts: Michael Shaheen, Joe Records, Payal Nanavati.
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 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 care.
For more information please see:
- "CMS Issues Sweeping Reform to Modernize the Stark Law: Part I," Health Care Alert (November 30, 2020). Contacts: Troy A. Barsky, John T. Brennan Jr., Lidia Niecko-Najjum, Roma Sharma.
- "OIG Issues Final Rule to Update AKS Safe Harbors: Part II," Administrative Law Alert (February 25, 2021). Contacts: Troy A. Barsky, Jodi G. Daniel, Michael Shaheen, Lidia Niecko-Najjum, Joe Records, Matthew Vicinanzo.
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 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 Information Blocking"
- "Balancing The New Interoperability Rules With Existing Privacy Laws: Challenges for Payers"
- "CMS Expands on Patient Access and Interoperability Requirements for Health Plans"
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 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 has been a leader in Arizona’s health care community for more than 25 years. In this episode, she shares recent examples of Mercy Care’s efforts to address SDOH through collaboration with the Arizona Health Care Cost Containment System (AHCCCS or “ACCESS”), Arizona’s Medicaid agency.
For more information please see:
- Mercy Care
- CDC Notice of Funding Opportunity: Closing the Gap with Social Determinants of Health Accelerator Plans
- CMS Innovation Center Strategy Refresh
- AHCCCS Whole Person Care Initiative
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.
You can follow Lorry Bottrill here.
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 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, 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 regulatory issues that affect health care entities’ in-house counsel, executives, and investors.
Materials discussed in this episode:
- H.R.133 - Consolidated Appropriations Act, 2021
- Department of Labor, Self-Compliance Tool
- "COVID Relief and Appropriations Legislation Includes Mental Health Parity Compliance and Oversight Requirements," Health Care Alert (December 23, 2020). Contacts: Michael W. Lieberman, Lauren R. Nunez, Joe Records.
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 Rules in Favor of Health Plans in Landmark $13 Billion Affordable Care Act Case
- Firm News: Maine Community Health Options Wins U.S. Supreme Court Ruling Enforcing Government Payment Obligation Under Affordable Care Act ‘Risk Corridor’ Cases
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 affect health care entities’ in-house counsel, executives, and investors.
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
- "Payers, Providers, and Patients – Oh My!: Pharmacy Benefit Managers," Podcast, November 13, 2019
- "Payers, Providers, and Patients – Oh My!: Removal under ERISA," Podcast, September 11, 2019
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
- "Supreme Court Adopts Expansive Interpretation of Sex Discrimination Under Title VII," Client Alert, June 15, 2020
- "Trump Administration Scales Back Obama-era Healthcare Nondiscrimination Regulations," Client Alert, June 16, 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.
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.
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.
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.
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.
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 regulatory issues that affect health care entities’ in-house counsel, executives, and investors.
Materials Discussed in this Episode
- "The Future of Health is Digital: A Policy Roadmap," PDF, C&M International
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 affect health care entities’ in-house counsel, executives, and investors.
Materials Discussed in this Episode
- "For Policy Makers Looking To Expand Coverage, Lessons From The Demise Of The ACA’s Multi-State Plan Program," Health Affairs Blog, September 30, 2019
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 Comment on Clinical Decision Support Software Guidance and Issues Policy Updates on its Oversight Authority Regarding Medical Software and Apps," C&M Health Law, October 23, 2019
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 federal court.
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 Care Act may impact providers and payers. The discussion focuses on the authority for innovative health care models and important fraud and abuse provisions that were enacted in the ACA.
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: * ERISA at Crowell & Moring * $28 Trillion and Personal Liability: ERISA Roars Back * Court Unravels New Association Health Plan Rules * ERISA Health Plan Compliance [PDF] * ERISA Mental Health Parity Compliance [PDF] * Fiduciary Protection - Employee Benefit Plans [PDF]
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 John Brennan about what health care companies need to know about FCA dismissals under the Granston memo.