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 and Sandra Durkin each month for practical, engaging conversations about the ever-evolving world of health law.
Clover's Ripple Effect: The New Wave of Medicare Advantage Star Ratings Litigation
In this episode of Health Law Simplified, Elizabeth Lippincott and Sandy Durkin revisit the landmark Clover Health decision and explore the growing wave of litigation that is following in its wake. What began as a challenge by a single Medicare Advantage organization has quickly evolved into a broader legal battle with potentially significant implications for Star Ratings, quality bonus payments, and CMS's authority to administer the program. The discussion covers new lawsuits filed by Elevan...
30 Jun 2026
Star Ratings Chaos, Part 2: CMS Responds to the Clover Case
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 only the data sources the court found permissible, and was giving plans four days to decide wheth...
22 Jun 2026
Star Ratings Chaos - The Clover Case
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 Payment (QBP) ratings, which are based on 2026 Star Ratings. We are in the process of recording an upd...
10 Jun 2026
What the New Rules for 2027 Mean for Supplemental Benefits
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 regulatory changes to supplemental benefits, including special supplemental benefits for the chronical...
11 May 2026
Medicare Advantage at a Crossroads: Supplemental Benefits, Risk Adjustment, and What Comes Next
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 providers across Medicare Advantage, Medicaid, and the ACA marketplace. The conversation explores ...
23 Mar 2026
Medicare Supplement (Medigap) 101: What It Covers, Who Regulates It, and Who Chooses It
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 standards, and what that structure means for rate oversight, marketing review, and regulatory enforcemen...
3 Mar 2026
PBM Reform + OIG Guidance + 2026 Medicare Advantage Enrollment = What You Need to Know
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 with a flat, fair market value administrative fee. The discussion explores why this change is so ...
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 medical record submission timelines, and the agency’s approach to balancing accelerated oversigh...
23 Dec 2025
2025 Medicare Advantage Year in Review (It’s been a lot!)
Hosts Elizabeth Lippincott and Sandy Durkin review the most significant compliance, enforcement, and regulatory developments impacting Medicare Advantage plans in 2025.
10 Nov 2025
RADV Ruling: A Legal Earthquake in Medicare Advantage
Hosts Sandy and Elizabeth analyze a federal court ruling that impacts CMS's RADV audit rules for Medicare Advantage, discussing the implications for MA plans and future regulations in this interview episode.
26 Sept 2025
Breaking Up Is Hard To Do: What MA Organizations Need to Know About Non-Renewal
Sandy and Elizabeth analyze the increasing trend of insurer exits from the Medicare Advantage market, addressing the strategic and operational challenges organizations face when considering non-renewal in this interview episode.
28 Aug 2025
Risk, Reform, and Responsibility: Navigating Medicare Compliance with Charles Baker
Sandy Durkin and Elizabeth Lippincott interview Charles Baker, Vice President of Compliance Solutions at ATTAC Consulting, about navigating Medicare compliance challenges and future reforms.
22 Jul 2025
RADV Audits: Will CMS Crackdown Alter the Medicare Advantage Landscape?
Hosts Sandy Durkin and Elizabeth Lippincott examine CMS's intensified RADV audit program for Medicare Advantage plans, revealing the reasons behind the crackdown and its potential impact on the healthcare industry.
23 Jun 2025
DOJ Targets Medicare Advantage Marketing
Industry experts analyze the Department of Justice's False Claims Act lawsuit against Medicare Advantage insurers, revealing implications for compliance, marketing ethics, and regulatory enforcement.
7 May 2025
Finding Stability in the Medicare Advantage Landscape
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 SSBCI and the Medicare Prescription Payment Plan, and highlight what was notably left out. Additionally, we cover the CMS rate announcement and the rebrandi...
19 Mar 2025
Looking Under the Hood of Medicare Advantage with Molly Turco
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.
25 Feb 2025
Making Peace with Uncertainty
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?
25 Feb 2025
How the Inflation Reduction Act Boosts Medicare Advantage
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.
19 Feb 2025
Introducing Health Law Simplified
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.
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Public platform figures. Ratings count people who left a rating, not total listeners.
Apple Podcasts (US)
5.0 / 5
1 ratings
Spotify
5.0 / 5
1 ratings
Podcast Authority Score: 23 / 100
A composite of feed quality, social presence, YouTube performance and engagement. Read the methodology.
Quality
45
Social presence
0
YouTube
0
Engagement
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Based on episode analysis; this does not confirm that the show is currently accepting guests.
Questions about Health Law Simplified
Who hosts Health Law Simplified?
Elizabeth Lippincott and Sandy Durkin and Elizabeth and Sandy host the show. Published by Strategic Health Law.
How often do new episodes come out?
The show publishes monthly, based on its RSS feed.
Does Health Law Simplified take guests?
Yes. Guests have been identified in episode analyses.
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